Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets

Abstract

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.

Rheumotologitsts’ view on the use of hydroxychloroquine to treat COVID-19

“…When the disease progression is from mild to severe, hospitalization and stronger immunosuppressive treatment are required. Our opinions on HCQ/CQ for the treatment of COVID-19 here appear somewhat different from the more conservative ones expressed recently by other rheumatology colleagues [15]. The role of HCQ in against COVID-19 needs to be thoroughly evaluated in both observational studies and high quality randomized controlled studies.…”

SARS-CoV-2 Infection-Associated Hemophagocytic Lymphohistiocytosis: An autopsy series with clinical and laboratory correlation

“…39 In addition, a variety of targeted approaches against inflammatory cytokines traditionally used in the setting of autoimmune disease-associated MAS have been proposed. 7,8 Of note, patient 1 who had definitive SARS-CoV-2 associated HLH in our cohort received anakinra (IL-1R antagonist) with persistence of hemophagocytosis at autopsy. Hemophagocytosis but not HLH was seen in one of two patients who received sarilumab (anti-IL-6R mAb).…”

“…5 The latter has raised clinical concerns for hemophagocytic lymphohistiocytosis (HLH) and the overlapping disorder, macrophage activation syndrome (MAS), highlighting the potential for therapeutic cytokine blockade. [6][7][8] Despite these clinical observations, there has been relatively little clinicopathologic correlation with the post-mortem findings in COVID-19 which to date have generally focused on the pulmonary histology of diffuse alveolar damage. [9][10][11][12] Herein we report the first cases of SARS-CoV-2 associated HLH diagnosed post-mortem using histologic, clinical and laboratory criteria.…”

Prevalence of Coronavirus Disease 2019 in Rheumatic Patients and Evaluation of The Effect of Disease-Modifying Anti-Rheumatic Drugs

“…Many rheumatologists state that patient's drugs should not be discontinued or reduced because of increasing the risk of disease are-up and leading to uncontrolled rheumatic disease (RD) [7]. Nevertheless, some may consider reducing the doses of some drugs, such as prednisolone, cautiously, or even discontinue the therapy in the case of SARS-CoV-2 infection [8]. As mentioned earlier, some drugs which are commonly used in the treatment of RD has also been considered as potential candidates for COVID-19 treatment, based on recent studies, including chloroquine, hydroxychloroquine, le unomide, tumor necrosis factor (TNF) inhibitors, Janus kinase (JAK) inhibitors, interleukin antagonists, and even corticosteroids [6,7].…”