Rheumatoid arthritis therapies raise concerns about vulnerability to COVID-19

  • Favalli EG & al.
  • Autoimmun Rev
  • 20 Mar 2020

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • 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.

Study design

  • Review article of COVID-19 infection and RA.
  • Funding: None disclosed.

Highlights

  • 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.