Lege Artis Medicinae

[Coronavirus disease-2019 among rheumatic musculoskeletal patients – possible outcomes of infection, severe disease development and effectiveness of vaccination]

HODINKA László1

SEPTEMBER 16, 2021

Lege Artis Medicinae - 2021;31(08-09)

DOI: https://doi.org/10.33616/lam.31.024

Review

[The prevalence of coronavirus infection of patients with inflammatory and rheumatic diseases does not differ significantly from the rate of the disease in the local general population. Patients treated with higher doses of corticosteroids, especially those with more severe systemic autoimmune disease, contract coronavirus infection at a higher rate. The risks of hospitalisation and the mortality rate do not differ significantly from those of the general COVID infected population. Patients treated with high-dose corticosteroids and cytostatic drugs are exceptions of this. Associated diseases that are generally threatening the COVID-19 patients (according to pre-COVID rheumatology surveys) are the same in inflammatory and non-inflammatory rheumatology conditions. Hence, the risk of severe COVID-19 outcome does not essentially depend on rheumatological conditions since the aging itself with typical cardiopulmonary and metabolic diseases are also responsible for. From the treatment armamentarium of inflammatory rheumatology/autoimmune diseases only arbitrarily dosed dexamethasone treatment seems efficacious. In specific patient groups, interleukin 6 antagonists and JAK inhibitors may also have a beneficial effect. The rheumatological and autoimmune drugs as antimetabolites, anti-cytokine immunotherapies and JAK inhibitors, do not increase the risk of COVID-19 infection since it is not necessary to stop them in infected pa­tients. The B-cell antagonist rituximab is the exception since by attenuating humoral immunity and the presence of active disease increase the risk of severe outcome in COVID-19 infected cases. COVID vaccination does not mean specific acute risk for rheumatological and autoimmune patients. The long term effect of COVID vaccination regarding the robustness and sustained immunity specifically in autoimmune and inflammatory diseases needs further studies.]

AFFILIATIONS

  1. Országos Mozgásszervi Intézet, Országos Reumatológiai és Fizioterápiás Intézet, 2. Reumatológiai Osztály

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