Abstract
In December 2019, a cluster of severe pneumonia was observed in China, with the subsequent discovery of a new beta-coronavirus (SARS-CoV-2) as the causative agent. The elicited disease COVID-19 is characterized by fever, dry cough, myalgia, or fatigue and has a favorable outcome in the majority of cases. However, in some patients COVID-19 leads to severe pneumonia and sepsis with subsequent respiratory failure and gastrointestinal, hematological, neurological, and cardiovascular complications. A higher risk of infection is intrinsic to active rheumatic and musculoskeletal diseases (RMD) and the use of biological disease modifying anti-rheumatic drugs (DMARDs). With an increasing number of reports on COVID-19 in RMD patients, we are beginning to appraise their risks. In this review, we summarize the published cases of COVID-19 infections in RMD patients, including patients with inflammatory arthritis and connective tissue diseases as well as anti-phospholipid syndrome and Kawasaki syndrome. Overall, patients with inflammatory arthritis do not seem to be at a higher risk for infection or a severe course of COVID-19. Risk for critical COVID-19 in patients with systemic inflammatory diseases such as SLE or vasculitis might be increased, but this needs further confirmation. Furthermore, we summarize the data on DMARDs used to fight SARS-CoV-2 infection and hyperinflammation.
Highlights
Since the discovery of the novel coronavirus severe acute respiratory syndrome (SARS)-CoV-2 causing COVID-19 in December 2019 until June 2020, more than 30,000 reports on the disease or the virus itself have been published
(5) treatment with biological DMARDs (bDMARDs)/Januskinase inhibitors (JAKi) monotherapy just prior to COVID-19 diagnosis reduced the risk of hospitalization compared with no disease modifying anti-rheumatic drugs (DMARDs) therapy (OR = 0.46, 95% CI 0.22–0.93; p = 0.03)
This argues against a protective role of HCQ in SARS-CoV-2 infection, which is supported by pharmacological in vitro data describing a much higher level needed for effective viral inhibition [61]
Summary
Since the discovery of the novel coronavirus SARS-CoV-2 causing COVID-19 in December 2019 until June 2020, more than 30,000 reports on the disease or the virus itself have been published. Sixty-four percent of the SLE-patients were taking antimalarials prior to the infection with SARS-CoV-2 and admission frequency to the hospital did not differ between HCQ users and non-users [55% (16/29) vs 57% (29/51), p = ns; χ2-test] [60] This argues against a protective role of HCQ (in the usually administered dose for RMD patients) in SARS-CoV-2 infection, which is supported by pharmacological in vitro data describing a much higher level needed for effective viral inhibition [61]. Whether this indicates any possible protective effect of these biologics to prevent the occurrence of a CRS in RMD patients remains a matter of speculation Another possibility to learn about the course of COVID19 on patients with RMD is to follow prospectively a cohort of patients with a defined disease and to note symptoms and outcomes of any SARS-CoV-2 infection.
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