Scientific articles on COVID-19 and rheumatic diseases
Rheumatologists' perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets
Abstract: The ongoing pandemic coronavirus disease 19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a matter of global concern. Environmental factors such as air pollution and smoking and comorbid conditions (hypertension, diabetes mellitus and underlying cardio-respiratory illness) likely to increase the severity of COVID-19. Rheumatic manifestations such as arthralgias and arthritis may be prevalent in about a seventh of individuals. COVID-19 can result in acute interstitial pneumonia, myocarditis, leucopenia (with lymphopenia) and thrombocytopenia, also seen in rheumatic diseases like lupus and Sjogren's syndrome. Download article.
Are my patients with rheumatic diseases at higher risk of COVID-19?
Abstract: According to the last WHO situation report (10 March 2020), the novel Coronavirus disease 2019 (COVID-19) has been confirmed in 113 702 patients, most of them in China (71.1%) and the rest in other 109 countries, with a global case-fatality rate (CFR) of 3.5% (4012 deaths among 113702 confirmed cases) .1 Most patients have presented with fever, dry cough and fatigue, about 81% of cases reported in China have been classified as mild, 14% severe and 5% critical, the higher CFR has been observed among older patients and with comorbid conditions (cardiovascular disease, diabetes, chronic respiratory disease, hypertension, cancer, etc) .2 To our knowledge none of the fatal cases reported has been associated with rheumatic diseases. Download article.
Therapies used in rheumatology with relevance to coronavirus disease 2019
Abstract: With the ongoing coronavirus disease 2019 (COVID-19) pandemic and growing evidence suggesting a role for some drugs commonly used in the context of rheumatic diseases, both colleagues and patients are coming to us with questions about these claims. Despite the fact that evidence is still scarce, it is pertinent to be able to address these queries in light of our previous experience in handling these prescriptions and take part in the multidisciplinary care of COVID-19 patients. Download article.
COVID-19: the new challenge for rheumatologists
Abstract: On Saturday, March 21, 2020 two articles on coronavirus disease 2019 (COVID-19) were submitted to Clinical and Experimental Rheumatology: a review by the colleagues from Milan, summarizing the current knowledge on this new disease, and a letter on the same topic from Portugal (1, 2). We have given these articles top priority not only because of their topic, but also because the review was submitted by the principal hotspot in Italy (and probably in the world in this moment) where the epidemic is more serious. This article testifes that our colleagues, although on the forefront at the bedside of their patients, also wanted to share their expertise with scientists all over the world to help identify potential solutions. Download article.
COVID-19 infection and rheumatoid arthritis: Faraway, so close!
Abstract: The outbreak of the new coronavirus infections COVID-19 in December 2019 in China has quickly become a global health emergency. Given the lack of specific anti-viral therapies, the current management of severe acute respiratory syndrome coronaviruses (SARS-CoV-2) is mainly supportive, even though several compounds are now under investigation for the treatment of this life-threatening disease. COVID-19 pandemic is certainly conditioning the treatment strategy of a complex disorder as rheumatoid arthritis (RA), whose infectious risk is increased compared to the general population because of an overall impairment of immune system typical of autoimmune diseases combined with the iatrogenic effect generated by corticosteroids and immunosuppressive drugs .. Download article.
Associations between immune-suppressive and stimulating drugs and novel COVID-19 — a systematic review of current evidence
Abstract: The COVID-19 pandemic has led to challenging decision-making about treatment of critically unwell patients. Low-dose prednisolone and tacrolimus may have beneficial impacts on COVID-19. The mycophenolate mofetil picture is less clear, with conflicting data from pre-clinical studies. There is no definitive evidence that specific cytotoxic drugs, low-dose methotrexate for auto-immune disease, NSAIDs, JAK kinase inhibitors or anti-TNFα agents are contraindicated. There is clear evidence that IL-6 peak levels are associated with severity of pulmonary complications. Download article.
Recommendations for coronavirus infection in rheumatic diseases treated with biologic therapy
Abstract: The Coronavirus-associated disease, that was first identified in 2019 in China (CoViD-19), is a pandemic caused by a bat-derived beta-coronavirus, named SARS-CoV2. It shares homology with SARS and MERS-CoV, responsible for past outbreaks in China and in Middle East. SARS-CoV2 spread from China where the first infections were described in December 2019 and is responsible for the respiratory symptoms that can lead to acute respiratory distress syndrome Download article.
Epigenetic dysregulation of ACE2 and interferon-regulated genes might suggest increased COVID-19 susceptibility and severity in lupus patients
Abstract: Infection caused by SARS-CoV-2 can result in severe respiratory complications and death. Patients with a compromised immune system are expected to be more susceptible to a severe disease course. In this report we suggest that patients with systemic lupus erythematous might be especially prone to severe COVID-19 independent of their immunosuppressed state from lupus treatment. Specially, we provide evidence in lupus to suggest hypomethylation and overexpression of ACE2, which is located on the X chromosome and encodes a functional receptor for the SARS-CoV-2 spike glycoprotein. Oxidative stress induced by viral infections exacerbates the DNA methylation defect in lupus, possibly resulting in further ACE2 hypomethylation and enhanced viremia. Download article.
Potential of chloroquine and hydroxychloroquine to treat COVID-19 causes fears of shortages among people with systemic lupus erythematosus
Abstract: In March 2020, in the midst of the COVID-19 pandemic1, reports that chloroquine (CQ) can inhibit the growth of severe acute respiratory syndrome coronavirus (SARS-CoV-2) 2,3 have brought this molecule into the spotlight. Hydroxychloroquine (HCQS), which is typically used in dermatology clinics for the management of systemic lupus erythematosus (SLE) and has a better clinical safety profile and fewer drug – drug interactions than CQ, has also been demonstrated to have anti-SARSCoV activity in vitro2 ,4 . Now, amid the speculation regarding the beneficial roles of these molecules in COVID-19 treatment, shortages of CQ and HCQS are feared Download article.
Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies
Abstract: Different viral agents are associated with an increased risk of more severe disease course and respiratory complications in immunocompromised patients.1–3 The recent outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) responsible for a severe acute respiratory syndrome (SARS) represents a source of concern for the management of patients with inflammatory rheumatic diseases .. Download article.
The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The experience of clinical immunologists from China
Abstract: The pandemic outbreak of coronavirus disease 2019 (COVID-19) is rapidly spreading all over the world. Reports from China showed that about 20% of patients developed severe disease, resulting in a fatality of 4%. In the past two months, we clinical immunologists participated in multi-rounds of MDT (multidiscipline team) discussion on the anti-inflammation management of critical ill COVID-19 patients, with our colleagues dispatched from Chinese leading PUMC Hospital to Wuhan to admit and treat the most severe patients. Here, from the perspective of clinical immunologists, we will discuss the clinical and immunological characteristics of severe patients, and summarize the current evidence and share our experience in anti-inflammation treatment, including glucocorticoids, IL-6 antagonist, JAK inhibitors and choloroquine / hydrocholoroquine , of patients with severe COVID-19 that may have an impaired immune system. Download article.
American College of Rheumatology Guidance for the Management of Adult Patients with Rheumatic Disease During the COVID-19 Pandemic
Abstract: The task force approved 77 initial guidance statements, 36 with moderate and 41 with high consensus. These were combined, resulting in 25 final guidance statements. These guidance statements are provided to promote optimal care during the current pandemic. However, given the low level of available evidence and the rapidly evolving literature, this guidance is presented as a “living document” and future updates are anticipated. Download article.
• International database on Covid-19 and rheumatic diseases: www.rheum-covid.org/langages
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Links of interest
• PANLAR: www.panlar.org
• ACR: www.rheumatology.org
• EULAR: www.eular.org
• BE: www.ser.es
• Argentine Society of Rheumatology: www.reumatologia.org.ar
• Hospital Italiano de Buenos Aires: www.hospitalitaliano.org.ar
• Brazilian Society of Rheumatology: www.reumatologia.com.br
• Chilean Society of Rheumatology: www.sochire.cl
• MSP: www.msp.gub.uy
• ASSE: www.asse.com.uy
• National Resource Fund: www.fnr.gub.uy
• UDELAR: www.fmed.edu.uy
• Medical College of Uruguay: www.colegiomedico.org.uy
• SMU: www.sermedico.com.uy
• FEMI: www.femi.com.uy
• Uruguayan Society of Physiatrists: www.surmefi.org.uy
• Society of Orthopedics and Traumatology of Uruguay: www.sotu.org.uy
• Society of Internal Medicine of Uruguay: www.medicinainterna.org.uy