PMC:7102591 / 1247-4151
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7102591","sourcedb":"PMC","sourceid":"7102591","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7102591","text":"1 Introduction\nIn December 2019 a new type of pneumonia supported by a novel member of the coronoviridae family named SARS-CoV-2 (severe acute respiratory coronavirus 2 syndrome) developed from Wuhan Province in China [1]. Phylogenetic analysis demonstrated that this is a different virus with ~80% nucleotide identity with SARS-CoV-1 [2]. The disease caused by SARS-CoV-2 is characterized by dry cough, fever, dyspnea and fatigue, accompanied by lymphopenia [[3], [4], [5], [6]]. In more severe cases (apparently up to 15–20% of infected patients) the picture may become more complicated by the onset of interstitial pneumonia with alveolar damage, which clinically can lead to severe Acute Respiratory Distress Syndrome (ARDS) and even death [7]. Since the initial outbreak, the epidemic has had a rapid global spread worldwide which led the World Health Organization (WHO) to declare the disease now called COVID-19 a Public Health Emergency of International Concern on 30th January 2020 and a pandemic on 11th March 2020. The epidemiological picture is constantly evolving, and data updated as of March 17th count 159 countries involved with more than 185,000 cases and 7500 confirmed deaths [8].\nIn this context of growing health emergency, clarifying the relationship between COVID-19 and the population of fragile patients suffering from immune-rheumatological diseases is absolutely crucial. On the one hand, the rapid and uncontrolled spread of the epidemic can clearly generate even more concerns in rheumatic patients, which are intrinsically characterized by an increased infectious risk due to the disease itself and to the iatrogenic effect of immunosuppressive agents such as corticosteroids and synthetic or biological disease-modifying drugs [9]. On the other hand, the growing knowledge about the pathogenesis of SARS-CoV-2 infection is leading to the introduction of drugs commonly used for the treatment of rheumatoid arthritis (RA) even for the management of more complex cases of COVID-19. Chloroquine and hydroxychloroquine have now been permanently included, alongside antiviral drugs, in protocols for the treatment of COVID-19 pneumonia [10]. In addition, the use of interleukin 6 (IL-6) blockers seems to be very promising for the management of the massive cytokine storm associated to the development of the typical lung damage and the consequent ARDS occurring in the most aggressive patterns of SARS-CoV infection [11].\nTherefore, waiting for observational data on the incidence of COVID-19 in rheumatological patients, the best strategy to manage immune-rheumatological diseases during this emergency period is still far to be clear. The purpose of this review is to provide an overview on viral infectious risk in RA patients, with a particular focus on the knowledge about the current new pandemic and the use of anti-rheumatic drugs in this context of health 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