En quoi la Covid-19 concerne la prise en charge des rhumatismes inflammatoires ? Place de la vaccination selon les cas

The Covid-19 pandemic has clearly impacted the management of inflammatory rheumatisms in terms of discontinuation of follow-up and discontinuation of treatment due to the risk of severe infection linked to the disease and to immunomodulatory treatments. Treatments are now available to prevent severe forms of the disease, including vaccines and specific monoclonal antibodies directed against the S protein of the SARS-CoV2 virus. Among the treatments used to treat inflammatory rheumatisms, corticosteroids and rituximab are clearly associated with a severe form of Covid. The humoral vaccine response after vaccination with messenger RNA (mRNA) vaccines appears to be reduced with methotrexate, abatacept and especially rituximab. Specific vaccine regimens have already been proposed for patients undergoing rituximab and should be refined as more knowledge becomes available, as these vaccines should now be part of our patients’ vaccination schedule. For those who do not develop antibodies after a complete vaccination regimen, the combination of casirivimab and imdevimab antibodies can be given monthly as a preventive measure or just after exposure.