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Managing rheumatoid arthritis during COVID-19
Rashmi Roongta1, Alakendu Ghosh2
1Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India.
Clinical Rheumatology
|September 6, 2020
Summary
Patients with autoimmune disorders on immunosuppressants are not at higher risk for COVID-19 infection. Continue stable treatments unless infected, then consider temporary drug stoppage. Management requires individualized physician decisions.
Area of Science:
- Rheumatology
- Infectious Diseases
- Immunology
Background:
- Patients with autoimmune disorders often take immunosuppressive agents, raising concerns about COVID-19 susceptibility and outcomes.
- Emerging data on COVID-19 in patients with rheumatological diseases is primarily from small case series and registries.
- Uncertainty exists regarding the management of immunosuppressive therapies during the pandemic.
Purpose of the Study:
- To review the susceptibility of immunosuppressed patients to COVID-19.
- To discuss the impact of commonly used rheumatoid arthritis (RA) drugs on COVID-19 infection risk.
- To summarize current recommendations for managing patients with autoimmune disorders during the COVID-19 pandemic.
Main Methods:
- Literature review of emerging data on COVID-19 in patients with rheumatological diseases.
- Analysis of preliminary data regarding patient susceptibility and outcomes.
- Synthesis of recommendations from major medical bodies.
Main Results:
- Patients on immunosuppressive medications do not appear to be at a significantly increased risk of acquiring COVID-19.
- If infected, immunosuppressed patients do not necessarily have worse outcomes than the general population.
- Drugs like hydroxychloroquine, dexamethasone, and tocilizumab have been investigated for COVID-19 treatment.
Conclusions:
- Stable patients on Disease-Modifying Antirheumatic Drugs (DMARDs) and/or steroids should generally continue their medication.
- Temporary cessation of methotrexate and leflunomide may be considered if a patient becomes infected.
- Initiation or continuation of immunosuppressive therapy, including biologics, should be individualized based on clinical status and physician judgment.
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