- An article in Autoimmunity Reviews suggests that patients with rheumatoid arthritis (RA) may be at higher risk for COVID-19.
- Factors associated with increased risk may include immunocompromise and therapies (e.g., corticosteroids and possibly NSAIDs) with potential iatrogenic effects.
Why this matters
- The article advocates a possible shift in, but no cessation of, RA treatment in areas with high risk for SARS-CoV-2 infection.
- Several RA drugs may have antiviral applications against COVID-19.
- Review article of COVID-19 infection and RA.
- Funding: None disclosed.
- Although there are no direct studies of COVID-19 risk among RA patients, they are at higher risk for viral infection (up to 4-fold increase).
- The increased risk is likely because of 2 factors:
- (1) underlying immunocompromise by RA disease itself; and
- (2) iatrogenic effect of some RA therapies (e.g., corticosteroids and possibly NSAIDs, the latter of which may facilitate viral penetration by overexpression of angiotensin-converting enzyme 2 [ACE 2]).
- Certain antirheumatic drugs may be useful for treating COVID-19:
- Chloroquine and hydroxychloroquine are hypothesized to have antiviral effect by inhibition of Toll-like receptor activity and interference with terminal glycosylation of the cellular receptor ACE 2, among other factors.
- IL-6 inhibitors may diminish the cytokine storm in acute respiratory distress syndrome.
- Baricitinib and TNF-inhibitors may inhibit viral penetration.