Managing rheumatoid arthritis during COVID-19

The outbreak of coronavirus in the world has led to an uncertainty about treatment of patients with autoimmune disorders because of their weakened immune system coupled with immunosuppressive agents they take which predisposes them to a host of infections. Data on COVID-19 patients with underlying rheumatological diseases has been emerging mostly in the form of small case series and one global registry. From these data, it seems like our patients, although immunosuppressed, are not particularly susceptible to the coronavirus infection and if infected, do not have significantly worse outcomes than other patients. In fact, drugs like hydroxychloroquine, dexamethasone, and tocilizumab have been studied for treatment of COVID-19. However, this is only preliminary data, and since a few parts of the world are still grappling with the pandemic at its peak, we need to be equipped on how to protect and manage our immunosuppressed patients. Published evidence to guide treatment decisions are lacking and doubts regarding continuation and initiation of immunosuppressants remain. Rheumatoid arthritis (RA) is the most common immune-mediated disorder in COVID-19 patients, and in this review, we discuss how the commonly used drugs in RA alter the patients' susceptibility to this infection. The review also summarizes the recommendations from the major bodies on how to manage this disease in these times. Key Points • Patients on immunosuppressive medications are not found to be at a greatly increased risk of acquiring COVID-19 infection. • Patients doing well on a stable dose of steroid and/or Disease-Modifying Antirheumatic Drugs (DMARDs) should be allowed to continue the same unless they get infected in which case, temporary stoppage of methotrexate and leflunomide may be considered. • Initiation of high-dose steroids, DMARDs, and biologics, if the clinical situation demands so, can be done. • Maintenance biologic therapy for stable patients should be individualized by the treating physician.

Media Type:

Electronic Article

Year of Publication:

2020

Contained In:

Clinical rheumatology - Vol. 39, No. 11 (2020), p. 3237-3244

Language:

English

Contributors:

Roongta, Rashmi
Ghosh, Alakendu

Links:

Volltext

Keywords:

*Coronavirus Infections
*Pandemics
*Pneumonia, Viral
Anti-Inflammatory Agents, Non-Steroidal
Antirheumatic Agents
Arthritis, Rheumatoid
Betacoronavirus
Biological Products
COVID-19
Deprescriptions
Disease Management
Glucocorticoids
Humans
Journal Article
Management
Review
Rheumatoid arthritis
Treatment
Tumor Necrosis Factor Inhibitors

Notes:

Date Completed 23.10.2020

Date Revised 23.10.2020

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1007/s10067-020-05358-z

PMID:

32892311

PPN (Catalogue-ID):

NLM315597941