COVID-19 in patients with chronic inflammatory rheumatic diseases: Do these patients have a higher risk of COVID-19 due to their underlying medication?

Abstract

Since the first case was reported to the World Health Organization (in late December 2019 in Wuhan, Hubei Province, China), by mid-June 2021, there have been 175,541,600 confirmed cases of COVID-19 globally, including 3,798,361 reported deaths. Many of those infected with SARS-CoV-2 have an asymptomatic form of the disease or mild flu-like symptoms. In another category of patients, the disease may be more aggressive, with a severe form that can lead to acute respiratory distress syndrome (ARDS), respiratory failure, and even death with a negative impact on patients. The COVID-19 pandemic has arisen serious concerns in the rheumatology community regarding the management of immunosuppressed patients diagnosed with inflammatory rheumatic diseases. It has been stated that severe forms of COVID-19 occur as a result of exacerbated inflammation status and cytokine production. Nevertheless, it remains unclear whether the use of biological agents subjects the patient to a higher risk, or rather protects them against severe forms of the disease. According to the American College of Rheumatology, rheumatic diseases were not identified as a risk factor that predicted poor outcome in patients with COVID-19. However, various studies have certified that corticosteroid treatment in patients with chronic rheumatic diseases at a dose >10 mg/day is associated with an increased risk of infection as well as the possibility of developing more severe COVID-19 symptoms.