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Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets

The ongoing pandemic coronavirus disease 19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a matter of global concern. Environmental factors such as air pollution and smoking and comorbid conditions (hypertension, diabetes mellitus and underlying cardio-resp...

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Autores principales: Misra, Durga Prasanna, Agarwal, Vikas, Gasparyan, Armen Yuri, Zimba, Olena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer London 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145936/
https://www.ncbi.nlm.nih.gov/pubmed/32277367
http://dx.doi.org/10.1007/s10067-020-05073-9
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author Misra, Durga Prasanna
Agarwal, Vikas
Gasparyan, Armen Yuri
Zimba, Olena
author_facet Misra, Durga Prasanna
Agarwal, Vikas
Gasparyan, Armen Yuri
Zimba, Olena
author_sort Misra, Durga Prasanna
collection PubMed
description The ongoing pandemic coronavirus disease 19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a matter of global concern. Environmental factors such as air pollution and smoking and comorbid conditions (hypertension, diabetes mellitus and underlying cardio-respiratory illness) likely increase the severity of COVID-19. Rheumatic manifestations such as arthralgias and arthritis may be prevalent in about a seventh of individuals. COVID-19 can result in acute interstitial pneumonia, myocarditis, leucopenia (with lymphopenia) and thrombocytopenia, also seen in rheumatic diseases like lupus and Sjogren’s syndrome. Severe disease in a subset of patients may be driven by cytokine storm, possibly due to secondary hemophagocytic lymphohistiocytosis (HLH), akin to that in systemic onset juvenile idiopathic arthritis or adult-onset Still’s disease. In the absence of high-quality evidence in this emerging disease, understanding of pathogenesis may help postulate potential therapies. Angiotensin converting enzyme 2 (ACE2) appears important for viral entry into pneumocytes; dysbalance in ACE2 as caused by ACE inhibitors or ibuprofen may predispose to severe disease. Preliminary evidence suggests potential benefit with chloroquine or hydroxychloroquine. Antiviral drugs like lopinavir/ritonavir, favipiravir and remdesivir are also being explored. Cytokine storm and secondary HLH might require heightened immunosuppressive regimens. Current international society recommendations suggest that patients with rheumatic diseases on immunosuppressive therapy should not stop glucocorticoids during COVID-19 infection, although minimum possible doses may be used. Disease-modifying drugs should be continued; cessation may be considered during infection episodes as per standard practices. Development of a vaccine may be the only effective long-term protection against this disease.
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spelling pubmed-71459362020-04-10 Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets Misra, Durga Prasanna Agarwal, Vikas Gasparyan, Armen Yuri Zimba, Olena Clin Rheumatol Perspectives in Rheumatology The ongoing pandemic coronavirus disease 19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a matter of global concern. Environmental factors such as air pollution and smoking and comorbid conditions (hypertension, diabetes mellitus and underlying cardio-respiratory illness) likely increase the severity of COVID-19. Rheumatic manifestations such as arthralgias and arthritis may be prevalent in about a seventh of individuals. COVID-19 can result in acute interstitial pneumonia, myocarditis, leucopenia (with lymphopenia) and thrombocytopenia, also seen in rheumatic diseases like lupus and Sjogren’s syndrome. Severe disease in a subset of patients may be driven by cytokine storm, possibly due to secondary hemophagocytic lymphohistiocytosis (HLH), akin to that in systemic onset juvenile idiopathic arthritis or adult-onset Still’s disease. In the absence of high-quality evidence in this emerging disease, understanding of pathogenesis may help postulate potential therapies. Angiotensin converting enzyme 2 (ACE2) appears important for viral entry into pneumocytes; dysbalance in ACE2 as caused by ACE inhibitors or ibuprofen may predispose to severe disease. Preliminary evidence suggests potential benefit with chloroquine or hydroxychloroquine. Antiviral drugs like lopinavir/ritonavir, favipiravir and remdesivir are also being explored. Cytokine storm and secondary HLH might require heightened immunosuppressive regimens. Current international society recommendations suggest that patients with rheumatic diseases on immunosuppressive therapy should not stop glucocorticoids during COVID-19 infection, although minimum possible doses may be used. Disease-modifying drugs should be continued; cessation may be considered during infection episodes as per standard practices. Development of a vaccine may be the only effective long-term protection against this disease. Springer London 2020-04-10 2020 /pmc/articles/PMC7145936/ /pubmed/32277367 http://dx.doi.org/10.1007/s10067-020-05073-9 Text en © International League of Associations for Rheumatology (ILAR) 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Perspectives in Rheumatology
Misra, Durga Prasanna
Agarwal, Vikas
Gasparyan, Armen Yuri
Zimba, Olena
Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets
title Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets
title_full Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets
title_fullStr Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets
title_full_unstemmed Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets
title_short Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets
title_sort rheumatologists’ perspective on coronavirus disease 19 (covid-19) and potential therapeutic targets
topic Perspectives in Rheumatology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145936/
https://www.ncbi.nlm.nih.gov/pubmed/32277367
http://dx.doi.org/10.1007/s10067-020-05073-9
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