Korean Journal of Internal Medicine最新文献

{"title":"The 2020 disease burden and economic implications of digestive diseases in Korea: a nation-wide comprehensive study.","authors":"Eui Sun Jeong, Hye-Kyung Jung, Younhee Kim, Hyung Seok Lim","doi":"10.3904/kjim.2025.376","DOIUrl":"10.3904/kjim.2025.376","url":null,"abstract":"<p><strong>Background/aims: </strong>Digestive diseases are highly prevalent and contribute substantially to healthcare utilization and costs. However, national-level data on digestive diseases burden in Korea are limited. This study aimed to estimate the healthcare burden of digestive diseases in Korea via a national database analysis.</p><p><strong>Methods: </strong>We analyzed the 2020 National Patient Sample data from the Health Insurance Review and Assessment Service, covering the entire Korean population. Digestive diseases were grouped into seven categories. Medical utilization and expenditures were assessed using two criteria: the principal estimate (primary diagnosis only) and the extended estimate (primary plus first-listed secondary diagnosis).</p><p><strong>Results: </strong>Approximately 18.5 million individuals (39.2% of all patients) received care for digestive diseases, according to the principal estimate, and 30.1 million (63.8%) received care, according to the extended estimate. Corresponding medical exdigespenditures were $8.5 billion (11.6% of total national healthcare costs) based on the principal estimate and $14.4 billion (19.6%) based on the extended estimate. Although only 7.4% of patients were hospitalized, they accounted for 51.4% of the total expenditure for digestive diseases. Colorectal cancer incurred the highest inpatient costs. Gastroesophageal reflux disease was the most common and expensive diagnosis in outpatients. Intestinal infectious diseases were the leading causes of hospitalization and emergency department visits; foreign body ingestion was a key driver in pediatric emergency cases.</p><p><strong>Conclusion: </strong>Digestive diseases impose significant clinical and economic burdens in Korea. Their frequent occurrence as primary and comorbid diseases highlights the need for comprehensive healthcare strategies and informed policy planning.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 4","pages":"649-662"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Sjögren syndrome to Sjögren disease: rethinking classification and diagnostic complexity.","authors":"Jennifer Jooha Lee, Howook Jeon, Hyun-Sook Kim, Hae-Rim Kim, Seung-Ki Kwok, Yoon-Kyoung Sung, Jisoo Lee, Shin-Seok Lee, Sung-Hwan Park, Yun Jong Lee","doi":"10.3904/kjim.2025.340","DOIUrl":"10.3904/kjim.2025.340","url":null,"abstract":"<p><p>Sjögren syndrome (SS), traditionally regarded as a sicca-predominant condition, is now recognized as a systemic autoimmune disease characterized by type I interferon activation, B-cell hyperactivity, and periepithelial lymphocytic infiltration. This conceptual shift has prompted changes in terminology, with \"SS\" increasingly replaced by \"Sjögren disease (SjD)\" and \"secondary SS\" by \"associated SjD,\" reflecting the concept of polyautoimmunity and ensuring equal clinical standing. In this review, we trace the historical evolution of SS classification criteria and examine their limitations in real-world clinical practice. Current classification criteria employ a weighted scoring system incorporating objective measures, including anti-Ro antibodies, salivary gland histopathology, and exocrine function tests. However, their diagnostic application in routine care is constrained by spectrum bias, clinical heterogeneity, the presence of mimickers, and shared clinical features with other autoimmune diseases. Over-reliance on serological markers, driven by their accessibility, may further contribute to misdiagnosis. We highlight that accurate diagnosis requires flexible clinical reasoning and contextual interpretation beyond rigid adherence to classification criteria. Individualized diagnostic strategies should integrate demographics, laboratory findings, salivary ultrasonography, and histopathology. Practical challenges in diagnosing and evaluating disease activity in associated SjD are also discussed.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 4","pages":"620-635"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor necrosis factor inhibitor prescribing and persistence by specialty in radiographic axial spondyloarthritis: a Korean claims study.","authors":"Bon San Koo, Ye-Jee Kim, Yeo-Jin Lee, Yong-Gil Kim, Tae-Hwan Kim","doi":"10.3904/kjim.2026.015","DOIUrl":"10.3904/kjim.2026.015","url":null,"abstract":"<p><strong>Background/aims: </strong>Although several studies have shown that specialist care may be associated with better outcomes, methodological limitations have made it difficult to draw definitive conclusions. Therefore, we examined real-world patterns of tumor necrosis factor inhibitor (TNFi) use for radiographic axial spondyloarthritis (r-axSpA) across prescribing specialties and compared TNFi retention between internal medicine and other departments using a nationwide claims database.</p><p><strong>Methods: </strong>Using Health Insurance Review and Assessment Service claims data (January 1, 2011 to June 30, 2022), we identified patients diagnosed with r-axSpA who initiated their first TNFi treatment. Baseline characteristics, TNFi retention by specialty and agent, and discontinuation risk were assessed. HRs for TNFi discontinuation were estimated using Cox proportional hazards models.</p><p><strong>Results: </strong>Among 5,944 TNFi initiators, 2,543 received adalimumab, 1,026 etanercept, 876 infliximab, and 1,499 golimumab. Most patients were treated in internal medicine (n = 5,102, 85.8%), followed by orthopedics (n = 622, 10.5%), neurosurgery (n = 185, 3.1%), and other departments (n = 35, 0.6%). TNFi retention was the highest in internal medicine. In multivariable analyses, the risk of discontinuation was higher in orthopedics (HR 1.24, 95% CI 1.11-1.37, p < 0.001), neurosurgery (HR 1.82, 95% CI 1.53-2.16, p < 0.001), and other departments than in internal medicine (HR 2.41, 95% CI 1.72-3.36, p < 0.001).</p><p><strong>Conclusion: </strong>TNFi retention was the highest in internal medicine, suggesting that care in this department may be associated with better treatment continuity in r-axSpA. Standardized management protocols and education may help optimize care across specialties.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 4","pages":"766-778"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of corticosteroids in sepsis and infectious diseases: a narrative review.","authors":"Jong Hun Kim","doi":"10.3904/kjim.2025.283","DOIUrl":"10.3904/kjim.2025.283","url":null,"abstract":"<p><p>Critically ill patients with septic shock exhibit dysregulated host inflammatory responses. Critical illness-related corticosteroid insufficiency (CIRCI) has been recognized as a potential contributor to poor outcomes in critically ill patients. CIRCI is characterized by dysregulation of the hypothalamic-pituitary-adrenal axis, which results in a state of systemic inflammation through altered cortisol metabolism and tissue resistance to corticosteroids, all of which may lead to systemic inflammation. Based on these pathophysiological mechanisms, the beneficial anti-inflammatory effects of corticosteroids have been proposed and evaluated in several clinical trials. However, evidence of the beneficial effects of corticosteroids has been evolving for years. While some studies have demonstrated beneficial outcomes, such as accelerated shock reversal, reduced duration of mechanical ventilation, and reduced mortality, other studies have failed to demonstrate significant mortality benefits. Such disparity in studies suggests the heterogeneity of critical illnesses and the difficulty in identifying optimal indications for corticosteroids. Recent studies demonstrated the beneficial role of corticosteroids in patients with severe COVID-19 and community-acquired pneumonia. Given the evolving body of evidence, this review discusses the utility of corticosteroids in critically ill patients, including those with sepsis, septic shock, COVID-19, and severe community-acquired pneumonia.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 4","pages":"585-596"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal radial access in acute coronary syndrome patients with good arterial pulsation: a subgroup analysis from the KODRA registry.","authors":"Jun-Won Lee, Su Yong Kim, Jung Ho Heo, Han-Young Jin, Sung Woo Cho, Yongcheol Kim, Bong-Ki Lee, Sang-Yong Yoo, Sang Yeub Lee, Chan Joon Kim, Jin Sup Park, Do Hoi Kim, Jin Bae Lee, Dong-Kie Kim, Jun Ho Bae, Sung-Yun Lee, Seung-Hwan Lee","doi":"10.3904/kjim.2025.349","DOIUrl":"10.3904/kjim.2025.349","url":null,"abstract":"<p><strong>Background/aims: </strong>Distal radial access (DRA) has been associated with fewer access-site complications, but evidence in acute coronary syndrome (ACS) remains limited. This study evaluated the feasibility and safety of DRA in ACS patients with good arterial pulsation.</p><p><strong>Methods: </strong>Patients with good arterial pulsation from the prospective, multicenter KODRA registry were analyzed, comparing those with ACS (n = 1,618) and non-ACS (n = 2,588). The primary efficacy endpoint was successful coronary angiography (CAG) without access-site crossover. The primary safety endpoint was DRA-related bleeding, and the secondary safety endpoint was radial artery occlusion (RAO). Multivariable logistic regression was performed to assess the association between ACS and study endpoints.</p><p><strong>Results: </strong>The mean age was 66.3 ± 11.9 years, and 69.6% were male. The rate of successful CAG without access-site crossover was comparable between ACS and non-ACS patients (94.2% vs. 94.9%, p = 0.094). DRA-related bleeding occurred more frequently in ACS (4.3% vs. 2.6%, p = 0.002). RAO rates were similar before discharge (0.1% vs. 0.2%, p = 0.396), but lower at one-month in ACS patients (0.3% vs. 1.0%, p = 0.010). ACS was not independently associated with either primary efficacy (OR 0.871, 95% CI 0.664-1.144) or primary safety endpoint (OR 0.817, 95% CI 0.538-1.240).</p><p><strong>Conclusion: </strong>In patients with good arterial pulsation, DRA was feasible in ACS, with higher bleeding but lower RAO compared with non-ACS. ACS was not independently associated with procedural failure or DRA-related bleeding. DRA may be considered a reasonable access strategy in selected ACS patients.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 4","pages":"663-675"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic analysis according to adjuvant chemotherapy and anti-HER2 therapy following surgery in T1a/b HER2-positive breast cancer.","authors":"Woochan Park, Koung Jin Suh, Jeongmin Seo, Se Hyun Kim, Yu Jung Kim, Hee-Chul Shin, Eun-Kyu Kim, In Ah Kim, So Yeon Park, Jee Hyun Kim","doi":"10.3904/kjim.2025.375","DOIUrl":"10.3904/kjim.2025.375","url":null,"abstract":"<p><strong>Background/aims: </strong>The optimal adjuvant chemotherapy and anti-human epidermal growth factor receptor 2 (HER2) therapy regimen following surgery for T1a/b HER2-positive breast cancer remains debatable.</p><p><strong>Methods: </strong>In this single-center retrospective analysis, we examined the postoperative treatment strategies for patients diagnosed with T1a/b node-negative HER2-positive breast cancer. Invasive breast cancer-free survival (IBCFS), invasive disease-free survival, and overall survival (OS) were compared between patients who received chemotherapy only, chemotherapy plus anti-HER2 therapy, and neither adjuvant treatment.</p><p><strong>Results: </strong>The analysis included 165 patients, with a median follow-up duration of 98.4 (25.8-238.5) months. Patients who did not receive any adjuvant therapy had a 15-year IBCFS rate of 86.9%, and those who received only chemotherapy exhibited a rate of 77.6%. Conversely, those who received both trastuzumab and chemotherapy had the highest 15-year IBCFS rate of 97.4%, although the difference between the treatment groups was not statistically significant (p = 0.492). Among patients with T1a tumors, chemotherapy plus anti-HER2 therapy showed the most favorable long-term IBCFS, with a 15-year rate of 100%, compared with 57.5% in the chemotherapy-only group and 79.8% in the no-treatment group (p = 0.363). The 15-year OS rate was 100% in both chemotherapy-containing treatment groups, compared with 90.4% in the no-treatment group (p = 0.068).</p><p><strong>Conclusion: </strong>In this retrospective cohort of patients with HER2-positive T1a/bN0 breast cancer, anti-HER2-containing adjuvant treatment was associated with numerically favorable long-term outcomes, particularly among those with T1a tumors. Given the retrospective study design and limited number of events, these findings should be interpreted cautiously.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 4","pages":"734-747"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic significance of 1-year versus baseline high-sensitivity C-reactive protein after acute myocardial infarction: nationwide landmark results.","authors":"Seok-Woo Seong, Hyun Woong Park, Jae-Hwan Lee, Jin-Ok Jeong, Mi Joo Kim, Pil Sang Song, Seon-Ah Jin, Kye Taek Ahn, Myung Ho Jeong, Sang Hyun Park, Jin-Yong Hwang","doi":"10.3904/kjim.2025.382","DOIUrl":"10.3904/kjim.2025.382","url":null,"abstract":"<p><strong>Background/aims: </strong>Residual inflammatory risk after acute myocardial infarction (AMI) remains an important determinant of long-term outcomes despite optimal lipid-lowering therapy. The prognostic significance of serial high-sensitivity C-reactive protein (hs-CRP) measurements beyond the acute phase remains unclear. This study compared baseline and 1-year hs-CRP for predicting 3-year major adverse cardiovascular events in patients with AMI undergoing percutaneous coronary intervention.</p><p><strong>Methods: </strong>We analyzed a large prospective AMI registry in which hs-CRP was measured at baseline and 1 year, classifying patients at each time point using a ≥ 2 mg/L threshold. The primary endpoint was 3-year MACE, including cardiovascular death, recurrent myocardial infarction, stroke, repeat revascularization, and stent thrombosis.</p><p><strong>Results: </strong>Among 16,371 patients, 9,618 (58.8%) had elevated hs-CRP at baseline. Of the 5,389 patients with 1-year data, 28.9% had elevated hs-CRP. Baseline hs-CRP predicted MACE within the first year (hazard ratio [HR] 1.38, 95% CI 1.21-1.57); however, this association was no longer significant beyond 1 year. One year hs-CRP independently predicted subsequent 2-year MACE (HR 1.33, 95% CI 1.01-1.77). Patients with persistently high hs-CRP (≥ 2 mg/L at both time points) had the highest 3-year MACE risk (HR 1.49, 95% CI 1.08-2.06, p = 0.015 vs. persistently low group) than patients with recovered, worsening, and persistently low hs-CRP.</p><p><strong>Conclusion: </strong>In patients with AMI, hs-CRP measured at 1-year provides stronger long-term prognostic information than that at baseline beyond 1 year. Routine assessment of hs-CRP may improve risk stratification and guide targeted anti-inflammatory strategies in secondary prevention.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 4","pages":"690-705"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The medical impact of emergent banning of N-nitrosodimethylamine: contaminated antihypertensive drug.","authors":"Juhee Ahn, Sungho Won, Jong-Heon Park, Hae-Young Lee","doi":"10.3904/kjim.2026.023","DOIUrl":"10.3904/kjim.2026.023","url":null,"abstract":"<p><strong>Background/aims: </strong>Concerns exist regarding the potential carcinogenic effect of N-nitrosodimethylamine (NDMA) as a contaminant of the antihypertensive medication, valsartan. This study evaluated the association of NDMA-contaminated valsartan with cancer incidence.</p><p><strong>Methods: </strong>Nationwide longitudinal observational cohort of 3,231,212 participants from the National Health Insurance Service of South Korea consisted and was followed up more than 7 years. We performed 1:1:1 pairwise propensity score matching (PSM) of NDMA-uncontaminated, NDMA-contaminated, and initially-suspended-but-finally confirmed as NDMA-uncontaminated valsartan user-groups. The primary outcome was any primary cancer incidence. The secondary outcome was the incidences of 12 organ-specific cancers. The risks of all-cause and cardiovascular deaths were estimated before and after the withdrawal of valsartan.</p><p><strong>Results: </strong>Among participants (59.5 ± 13.1 yr; male, 53.5%), valsartan new users had adjusted hazard ratios and 95% confidence intervals of 1.069 (1.054-1.085) and 1.172 (1.128-1.216) for any cancer in the NDMA-exposed period (versus NDMA-unexposed) before and after PSM, respectively. Regardless of PSM, prostate cancer risk increased significantly. All-cause and cardiovascular mortality did not differ significantly with NDMA exposure before and after emergent banning.</p><p><strong>Conclusion: </strong>Use of valsartan products contaminated with NDMA was associated with a modestly increased risk of overall cancer compared with uncontaminated products, a finding that requires confirmation in further studies.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 4","pages":"676-689"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of hyperuricemia with valvular heart disease and the modifying effect of obesity.","authors":"Seung Min Jung, Sang-Hyuk Jung, Su-Nam Lee, Jin A Choi, Dokyoon Kim, Hong-Hee Won, Jae-Seung Yun","doi":"10.3904/kjim.2025.269","DOIUrl":"10.3904/kjim.2025.269","url":null,"abstract":"<p><strong>Background/aims: </strong>Hyperuricemia has been widely associated with cardiovascular health, but its relationship with incident valvular heart disease (VHD) remains uncertain. This study investigated the association between hyperuricemia and VHD, and further explored the role of weight management within this context.</p><p><strong>Methods: </strong>Participants from the UK Biobank cohort were categorized into three groups based on serum uric acid (SUA) level: normal (< 6.0 mg/dL), high (6.0-8.9 mg/dL), and very high (≥ 9.0 mg/dL). The risk of VHD associated with SUA level was assessed in the overall population and across subgroups with differing metabolic profiles. To examine the impact of obesity on VHD development, the relative risk of VHD was analyzed based on body mass index and waist circumference.</p><p><strong>Results: </strong>Among 462,705 participants, 340,793 (73.7%) had normal SUA levels, 118,861 (25.7%) had high levels, and 3,051 (0.7%) had very high levels. Over an average follow-up period of 12.3 years, the adjusted risk of VHD was significantly higher in individuals with very high SUA, followed by those with high and normal SUA (2.31 vs. 1.25 vs. reference, respectively). Stratifying VHD risk by metabolic disorders revealed a dose-response relationship between SUA level and VHD risk. The impact of obesity on VHD development was notable among individuals with SUA below 9.0 mg/dL, but less pronounced in those with SUA exceeding 9.0 mg/dL.</p><p><strong>Conclusion: </strong>This finding suggests a significant association between hyperuricemia and VHD, highlighting the potential relevance of elevated SUA levels in VHD risk stratification.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 4","pages":"748-762"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmune diseases in the era of COVID-19: emerging mechanisms, clinical implications, vaccine considerations, and future directions.","authors":"Jaehyun Kong, Seohyun Hong, Jiyeon Oh, Sooji Lee, Lee Smith, Francesco Branda, Hanseul Cho, Jiyoung Hwang, Dong Keon Yon","doi":"10.3904/kjim.2025.301","DOIUrl":"10.3904/kjim.2025.301","url":null,"abstract":"<p><p>The coronavirus disease 2019 (COVID-19) pandemic has highlighted a complex, bidirectional relationship between SARSCoV-2 infection and autoimmune diseases. This review examines how SARS-CoV-2 infection influences the incidence, progression, and outcomes of five major autoimmune conditions: systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, and Guillain-Barré syndrome. Patients with autoimmune diseases are at increased risk of severe COVID-19 due to intrinsic immune dysregulation and the use of immunosuppressive therapies, both of which impair antiviral host defenses. Conversely, COVID-19 has been implicated in the initiation and exacerbation of autoimmune responses through mechanisms such as molecular mimicry and bystander activation. Concerns have also arisen regarding the safety and efficacy of COVID-19 vaccines in immunocompromised populations. Although vaccines are generally tolerated in these individuals, certain immunosuppressive therapies may attenuate humoral and cellular immune responses. Strategies such as adjusting immunosuppressive regimens and optimizing the timing of vaccination have been proposed to improve vaccine efficacy. Disease-specific considerations are essential to balance infection risk with adequate control of autoimmune activity. Overall, this review underscores the importance of individualized treatment strategies, close clinical monitoring, and interdisciplinary care in managing patients with autoimmune diseases during the COVID-19 pandemic. A deeper understanding of these interactions will be critical for improving patient outcomes and preparing for future pandemics involving immune-mediated diseases.</p>","PeriodicalId":48785,"journal":{"name":"Korean Journal of Internal Medicine","volume":"41 4","pages":"597-619"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}