According to a story from Medpage Today, rheumatologists could play an important role in treating patients with the most severe cases of COVID-19/coronavirus. This is because some of the drugs that are currently showing potential for treating patients are commonly used for rheumatic diseases. Some examples include tocilizumab and hydroxychloroquine.
The Immune System and COVID-19
As it turns out, many of the most serious cases of COVID-19 seem to involve extreme responses from the immune system. The signs and symptoms displayed by these patients bear similarly to certain rare diseases, such as macrophage activation syndrome and hemophagocytic lymphohistiocytosis. These are conditions which are characterized by the over-activation of the immune system. The body produces huge amounts of macrophages and T-cells, in turn triggering an event called a cytokine storm in which proinflammatory cytokines are unleashed in massive concentrations. This situation can sometimes be lethal.
“There is a role for us in educating our colleagues on recognizing impending secondary HLH or MAS and helping to select patients who may benefit from immunologic treatments,” Dr. Theresa Wampler Muskardin says.
Rheumatic Diseases and Coronavirus
Unfortunately, patients with autoimmune or rheumatic diseases are at a greater risk of severe symptoms if they are infected with the coronavirus. While there isn’t a ton of data out there regarding this group of patients, the characteristics of these diseases combined with the common use of immunosuppressing drugs could make them more vulnerable. Studies focusing on rheumatic patients with COVID-19 are currently underway.
Nevertheless, patients should not stop taking their medications without talking to their rheumatologist, even if they show signs of infection. Ultimately, the particular circumstances of the case, such as the exact disease involved, will determine if halting treatment is a good idea. Unfortunately, the lack of data means that rheumatologists are often going to have to rely on their own expertise and experiences when making these decisions.
Another unfortunate circumstance is that the potential for drugs such as hydroxychloroquine or IL-6 inhibitors to treat COVID-19 means that there are now shortages of these medications, leaving patients with rheumatic diseases in an even more precarious situation.
All patients with autoimmune or rheumatic diseases should make sure to follow CDC protocols on social distancing, staying at home, and hand washing.