23rd Jul 2020

COVID-19 FAQ: Why are rheuthmatic diseases a risk factor for infection and severe illness?

23rd Jul 2020

Curated by Endre Szvetnik

Researchers have found that the combination of some rheumatic diseases (such as rheumatoid arthritis, psoriatic arthritis, axial spondylarthritis and systemic lupus erythematosus) and being over 65 can significantly increase the risk of severe or critical COVID-19 illness.

People with rheumatic diseases are in the at-risk group

German scientists reported that according to statistical data, people in the over 65 group suffering from rheumatic diseases were five times more likely to be taken to hospital after a SARS-CoV-2 infection than younger individuals. Diseases like rheumatoid arthritis are autoimmune diseases and are characterised by the irregular functioning of the immune system and inflammation caused by it. Patients need to take immunosuppressive disease-modifying anti-rheumatic drugs (DMARDs) and have weaker immune systems making them vulnerable to infections. A recent Chinese study has confirmed that patients with autoimmune rheumatic diseases (the majority of whom are likely to be women) were more susceptible to COVID-19 infection than the general population. Not only these patients were more likely to be infected, but they were at risk of more severe progression of the COVID-19 disease. According to a Spanish study, the risk increased by 92 per cent if COVID-19 patients had an underlying condition of systemic autoimmune or immune-mediated illness. An American research paper offered a stark warning: COVID-19 patients with rheumatic diseases were more likely to require mechanical ventilation in intensive care units. This is because patients with rheumatic diseases might be at an increased risk of developing respiratory failure if they develop COVID-19.
 
What can be done to help people with such conditions?Not all is bad news for people with rheumatic diseases at risk from COVID-19. Researchers have highlighted that inflammatory arthritis and systemic lupus erythematosus patients’ risk depends on the type of DMARD drugs they are taking for their condition. Patients on conventional synthetic DMARDs were found not to be at an increased risk as opposed to people on biologic or targeted synthetic DMARDs. Other research revealed that if patients were already taking the antimalarial drug hydroxychloroquine (now widely used to treat rheumatic disease because of its mild immunosuppressive effect) they had a lower risk of COVID-19 infection than those on other disease-modifying anti-rheumatic drugs. Interestingly, the focus on rheumatoid arthritis patients during the pandemic has revealed that a drug prescribed for their condition could be repurposed to treat COVID-19. Baricitnib (a treatment interfering with the inflammatory processes that cause RA symptoms) was found to limit immune-overreactions. This may help prevent the so-called ‘cytokine-storm’ that leads to lung tissue damage and potentially death in COVID-19 patients. Results of an Italian study showed that none of the participating patients treated with the drug died as opposed to some in the control group. The medication is currently undergoing clinical trials to establish its safety and effectiveness.
 

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Curated by

Endre Szvetnik

Endre Szvetnik is Senior Editor at Sparrho. Endre works with Sparrho Heroes to curate, translate and disseminate scientific research to the wider public.

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