The outbreak of coronavirus left the world by surprise and unprepared.
The new SARS-COVID 19 has generated a lot of concerns above the population, bringing uncertainty especially in immunosuppressed patients, patients with immune system diseases.
However, their concerns are justified and understandable since Covid-19 affects lung tissue causing extensive lesions at the alveolar level.
Although there is no currently evidence to carefully demonstrate that patients with autoimmune diseases or taking immunosuppressive drugs are at increased risk of contracting COVID infection, there remains a theoretical risk of increased complications in those who do contract COVID. infection.
Analyzing data from the global registry of the COVID-19 Global Rheumatology Alliance, which provides real-time information on rheumatic diseases and COVID-19, they showed that as of August 17, 2020, the most common rheumatic disease in which COVID-19 has been documented is RA (694 of 1783 patients) .
Both SARS-CoV-2 acute respiratory disease and RA are characterized by inflammatory states.
Among the numerous cytokines produced by our body during an inflammatory process, IL-6 is one of the interleukins that are the protagonists, adopting a central role in the pathogenesis of rheumatic diseases (in particular RA rheumatoid arthritis).
Elevated levels of IL-6 has been observed in COVID-19 patients
[1, 2, 3].
Considering the strong inflammatory correlation due to the excessive production and release of IL-6, some experimentals data emerged according to which, very familiar drugs in rheumatology such as chloroquine (no longer produced for some months) and hydroxychloroquine used in the therapy of many autoimmune diseases, would be able to inhibit the replication of the virus and some of these are used in different protocols on patients with COVID-19. The same is true for patients being treated with Tocilizumab.
This drug could help COVID-19 patients because it turns off inflammation in the lungs but has no antiviral effect, so rheumatic patients with this drug are not protected from infections.
The use of anti-inflammatory and immunomodulatory therapy in the context of rheumatoid arthritis and COVID-19 could prove to be a double-edged sword:
The “timely” and appropriate use of these drugs has proven to be useful in dealing with the cytokine storm (particularly IL-6), but their use at an advanced stage is controversial today.
On the other hand, if used too early, these drugs can also promote viral replication through their immunosuppressive effects, in particular this would happen with corticosteroids.
In conclusion, from the available data, it does not appear that patients with rheumatological diseases are more exposed to the risk of falling ill with COVID-19; it is good that patients take the suggested preventive measures and continue to follow the therapies regularly.
Pending more evidence, preventative measures such as practicing hand hygiene, wearing a face mask and maintaining social distancing cannot be underestimated.
- Overview |COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders| Guidance | NICE
- Huang H, Zhang M, Chen C, Zhang H, Wei Y, Tian J et al (2020) Clinical characteristics of COVID-19 in patients with preexisting ILD: A retrospective study in a single center in Wuhan, China. J Med Virol:jmv.26174
- Cheng C, Li C, Zhao T, Yue J, Yang F, Yan Y et al (2020) COVID-19 with rheumatic diseases: a report of 5 cases. Clin Rheumatol 14:1
- The COVID-19 Global Rheumatology Alliance Global Registry. Available from: https://rheum-covid.org/updates/combined-data.html. Accessed 17 Aug 2020