Clinical rheumatology
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Clinical rheumatology · Jul 2020
ReviewCytokine storm in COVID-19: pathogenesis and overview of anti-inflammatory agents used in treatment.
COVID-19 infection has a heterogenous disease course; it may be asymptomatic or causes only mild symptoms in the majority of the cases, while immunologic complications such as macrophage activation syndrome also known as secondary hemophagocytic lymphohistiocytosis, resulting in cytokine storm syndrome and acute respiratory distress syndrome, may also occur in some patients. According to current literature, impairment of SARS-CoV-2 clearance due to genetic and viral features, lower levels of interferons, increased neutrophil extracellular traps, and increased pyroptosis and probable other unknown mechanisms create a background for severe disease course complicated by macrophage activation syndrome and cytokine storm. ⋯ Anti-rheumatic drugs, which are tried for managing immunologic complications of COVID-19 infection, will also be discussed including chloroquine, hydroxychloroquine, JAK inhibitors, IL-6 inhibitors, IL-1 inhibitors, anti-TNF-α agents, corticosteroids, intravenous immunoglobulin (IVIG), and colchicine. Early recognition and appropriate treatment of immunologic complications will decrease the morbidity and mortality in COVID-19 infection, which requires the collaboration of infectious disease, lung, and intensive care unit specialists with other experts such as immunologists, rheumatologists, and hematologists.
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Clinical rheumatology · Jul 2020
ReviewRheumatologists' perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets.
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 increase the severity of COVID-19. Rheumatic manifestations such as arthralgias and arthritis may be prevalent in about a seventh of individuals. ⋯ Disease-modifying drugs should be continued; cessation may be considered during infection episodes as per standard practices. Development of a vaccine may be the only effective long-term protection against this disease. Key Points• Patients with coronavirus disease 19 (COVID-19) may have features mimicking rheumatic diseases, such as arthralgias, acute interstitial pneumonia, myocarditis, leucopenia, lymphopenia, thrombocytopenia and cytokine storm with features akin to secondary hemophagocytic lymphohistiocytosis.• Although preliminary results may be encouraging, high-quality clinical trials are needed to better understand the role of drugs commonly used in rheumatology like hydroxychloroquine and tocilizumab in COVID-19.• Until further evidence emerges, it may be cautiously recommended to continue glucocorticoids and other disease-modifying antirheumatic drugs (DMARDs) in patients receiving these therapies, with discontinuation of DMARDs during infections as per standard practice.
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Clinical rheumatology · Jul 2020
EditorialThe systemic sclerosis patient in the COVID-19 era: the challenging crossroad between immunosuppression, differential diagnosis and long-term psychological distress.
COVID-19 is a world health emergency which may inevitably affect the management of a complex autoimmune disease such as systemic sclerosis (SSc). Several SSc patients are frail and, in this pandemic, need a careful protection. The COVID-19 infection might complicate the clinical scenario of interstitial lung disease (ILD) in SSc because it determines a severe pneumonia characterized by radiological features similar to SSc-ILD. ⋯ For these reasons, the rheumatologist in daily clinical practice should carefully differentiate the possible COVID-19 infection in order to optimize the patient management. Therefore, the challenge in everyday life will be to achieve in due time the differential diagnosis as well as the long-term psychological impact. Key Points• SSc patients should be encouraged to continue their chronic therapy; in case of immunosuppressive therapy it must be discontinued for safety in case of COVID-19 infection.• Psychological support must be guaranteed to every SSc patients.• COVID-19 pneuminia is hard to distinguish from an interstitial lung disease due to SSc lung involvment.• Data sharing is fundamental for an optimal managment of SSc patients during COVID-19 pandemia.
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Clinical rheumatology · Jul 2020
YouTube as a source of information on COVID-19 and rheumatic disease link.
The current 2019 novel coronavirus outbreak is continuing to spread rapidly despite all efforts. Patients with rheumatic disease may have higher levels of anxiety due to their disease characteristics and medications. The web-based platforms are widely used sources for gaining medical information. YouTube presents a wide range of medical information, but there are concerns on its quality. Therefore, we aimed to evaluate the quality of the YouTube videos about COVID-19 and rheumatic diseases link. ⋯ Besides high-quality videos, there were substantially low-quality videos that could cause misleading information to spread rapidly during the pandemic. Videos from trustworthy sources such as universities, academics, and physicians should be kept in the foreground.Key Points•Web-based platforms have become an important source of health-related information. One of the most important online sources is YouTube because it is easy accessible and free.•Of the videos evaluating the link between COVID-19 and rheumatic diseases, 41.4% (n = 19) were of high quality.•The main sources of high-quality videos were academics/universities and physicians.•The most frequently discussed topics in videos were the place of hydroxychloroquine in the treatment of COVID-19 and whether to continue the use of existing rheumatological drugs.