Clinical rheumatology
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Clinical rheumatology · Sep 2020
Observational StudyDeterminants of COVID-19 disease severity in patients with underlying rheumatic disease.
Over the month of April, Spain has become the European country with more confirmed cases of COVID-19 infection, after surpassing Italy on April 2nd. The community of Castile and León in Spain is one of the most affected by COVID-19 infection and the province of León has a total of 3711 cases and 425 deaths so far. Rheumatic patients should be given special attention regarding COVID-19 infection due to their immunocompromised state resulting from their underlying immune conditions and use of targeted immune-modulating therapies. Studying epidemiological and clinical characteristics of patients with rheumatic diseases infected with SARS-CoV2 is pivotal to clarify determinants of COVID-19 disease severity in patients with underlying rheumatic disease. ⋯ Our results suggest that comorbidities, rheumatic disease activity and laboratorial abnormalities such as C-reactive protein (CRP), D-Dimer, lactate dehydrogenase (LDH), serum ferritin elevation significantly associated with mortality whereas previous use of rheumatic medication did not. Inflammation is closely related to severity of COVID-19. Key Points • Most patients recover from COVID-19. • The use of DMARDs, corticosteroids and biologic agents did not increase the odds of mortality in our study. • Rheumatic disease activity might be associated with mortality.
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Clinical rheumatology · Sep 2020
Review Case ReportsConcomitant new diagnosis of systemic lupus erythematosus and COVID-19 with possible antiphospholipid syndrome. Just a coincidence? A case report and review of intertwining pathophysiology.
In the midst of the COVID-19 pandemic, further understanding of its complications points towards dysregulated immune response as a major component. Systemic lupus erythematosus (SLE) is also a disease of immune dysregulation leading to multisystem compromise. We present a case of new-onset SLE concomitantly with COVID-19 and development of antiphospholipid antibodies. ⋯ In terms of pathophysiology, COVID-19 is believed to cause a dysregulated cytokine response which could potentially be exacerbated by the shift in Th1 to Th2 response seen in SLE. Also, it is well documented that viral infections are an environmental factor that contributes to the development of autoimmunity; however, COVID-19 is a new entity, and it is not known if it could trigger autoimmune conditions. Additionally, it is possible that SARS-CoV-2, as it happens with other viruses, might lead to the formation of antiphospholipid antibodies, potentially contributing to the increased rates of thrombosis seen in COVID-19.
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Clinical rheumatology · Sep 2020
ReviewThrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow's triad.
The pathogenesis of Coronavirus disease 2019 (COVID-19) is gradually being comprehended. A high number of thrombotic episodes are reported, along with the mortality benefits of heparin. COVID-19 can be viewed as a prothrombotic disease. ⋯ There is an urgent need to explore newer avenues like activated protein C, PAI-1 antagonists, and tissue plasminogen activators (tPA). These should be augmented with therapies targeting RAAS, antiplatelet drugs, repurposed antiinflammatory, and antirheumatic drugs. Key Points • Venous and arterial thromboses in COVID-19 can be viewed through the prism of Virchow's triad. • Endothelial dysfunction, platelet activation, hyperviscosity, and blood flow abnormalities due to hypoxia, immune reactions, and hypercoagulability lead to thrombogenesis in COVID-19. • There is an urgent need to stratify COVID-19 patients at risk for thrombosis using age, comorbidities, D-dimer, and CT scoring. • Patients with COVID-19 at high risk for thrombosis should be put on high dose heparin therapy.
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Clinical rheumatology · Sep 2020
Challenges in delivering rheumatology care during COVID-19 pandemic.
COVID-19 has significantly affected healthcare systems around the world. To prepare for this unprecedented emergency, elective patient care was put on hold across the National Health Service (NHS). ⋯ We describe our experience of delivering rheumatology service as recommended by the National Institute for Health and Care Excellence (NICE NG167) guidelines at a district general hospital during the current pandemic. Key Points • Prepare to deliver a rapid mass communication; ensure email and mobile phones registered in patients' records; enable access to text and video messaging. • To ensure wider access to innovative digital technology in clinical practice; implement telephone and video consultations where appropriate. • To consider setting up community OP clinics, for example, mobile and satellite clinics.
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Clinical rheumatology · Sep 2020
Switching to teleconsultation for rheumatology in the wake of the COVID-19 pandemic: feasibility and patient response in India.
The emergent COVID-19 pandemic dictates an urgent switch to teleconsultation. India has high patient to rheumatologist ratio, and patients have limited concepts about telemedicine. Thus, we attempted to find the feasibility and acceptance of patients in switching to teleconsultation. ⋯ It enabled quick reduction in the number of persons travelling to the centre. Not making the switch could have deprived approximately three-quarters of these patients of proper medical care. Key Points • Patient to rheumatologist ratios in India is heavily skewed and awareness about telemedicine is limited. • Switch to telemedicine was feasible and allowed a decrease in the number of people attending the clinic. • Not switching could have lead to disruption of care or self-medication in a majority of patients.