Login Register Cart 0
Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Review Article

Rheumatologic Aspects of the COVID-19 Pandemic: A Practical Resource for Physicians in Kuwait and the Gulf region as Recommended by the Kuwait Association of Rheumatology

Author(s): Fatemah Baron*, Heba Alhajeri, Fatemah Abutiban, Mona Almutairi, Adel Alawadhi, Ali Aldei, Adeeba Alherz, Yaser Ali, Saud Alsayegh, Ahmed Dehrab, Aqeel Ghanem, Eman Hajji, Saswan Hayat, Khulood Saleh, Ramia Shaikh-Alsooq, Hoda Tarakmah, Anwar Albasri, Ahmed Alenezi, Naser Alhadhood, Waleed Alkanderi, Ammar Almathkoori, Nora Almutairi, Ali Alturki, Amjad Alkadi and Hussain Behbahani

Volume 18, Issue 2, 2022

Published on: 06 October, 2021

Page: [108 - 116] Pages: 9

DOI: 10.2174/1573397117666211007091256

Price: $65

Abstract

The Kuwait Association of Rheumatology members met thrice in April 2020 to quickly address and support local practitioners treating rheumatic disease in Kuwait and the Gulf region during the coronavirus disease 2019 (COVID-19) pandemic. Because patients with rheumatic and musculoskeletal disease (RMD) may need treatment modifications during the COVID-19 pandemic, we voted online for the general guidance needed by local practitioners. In this review, we have addressed patients' vulnerability with rheumatic disease and issues associated with their optimum management. Our recommendations were based on the formulation of national/international guidelines and expert consensus among KAR members in the context of the Kuwaiti healthcare system for patients with RMD. The most recent reports from the World Health Organization, the Center for Disease Control, the National Institutes of Health-National Medical Library, and the COVID-19 educational website of the United Kingdom National Health Service have been incorporated. We discuss the management of RMD in various clinical scenarios: screening protocols in an infusion clinic, medication protocols for stable patients, and care for patients with suspected or confirmed COVID infection and whether they are stable, in a disease flare or newly diagnosed. Further, we outline the conditions for the hospital admission. This guidance is for the specialist and non-specialist readership and should be considered interim as the virus is relatively new, and we rely on the experience and necessity more than evidence collection. The guidance presented should be supplemented with recent scientific evidence wherever applicable.

Keywords: Infections, treatment, COVID-19, acute respiratory syndrome coronavirus 2, rheumatic disease, guideline, kuwait medical association, recommendation, disease-modifying antirheumatic drugs.

« Previous Next »
Graphical Abstract

[1]
Ceribelli A, Motta F, De Santis M, et al. Recommendations for coronavirus infection in rheumatic diseases treated with biologic therapy. J Autoimmun 2020; 109: 102442-2.
[http://dx.doi.org/10.1016/j.jaut.2020.102442] [PMID: 32253068]
[2]
Au K, Reed G, Curtis JR, et al. High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis. Ann Rheum Dis 2011; 70(5): 785-91.
[http://dx.doi.org/10.1136/ard.2010.128637] [PMID: 21288960]
[3]
Accortt NA, Lesperance T, Liu M, et al. Impact of sustained remission on the risk of serious infection in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken) 2018; 70(5): 679-84.
[http://dx.doi.org/10.1002/acr.23426] [PMID: 28960869]
[4]
Dougados M, Soubrier M, Antunez A, et al. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: Results of an international, cross-sectional study (COMORA). Ann Rheum Dis 2014; 73(1): 62-8.
[http://dx.doi.org/10.1136/annrheumdis-2013-204223] [PMID: 24095940]
[5]
Rasch EK, Hirsch R, Paulose-Ram R, Hochberg MC. Prevalence of rheumatoid arthritis in persons 60 years of age and older in the United States: Effect of different methods of case classification. Arthritis Rheum 2003; 48(4): 917-26.
[http://dx.doi.org/10.1002/art.10897] [PMID: 12687533]
[6]
Wotton CJ, Goldacre MJ. Risk of invasive pneumococcal disease in people admitted to hospital with selected immune-mediated diseases: Record linkage cohort analyses. J Epidemiol Community Health 2012; 66(12): 1177-81.
[http://dx.doi.org/10.1136/jech-2011-200168] [PMID: 22493476]
[7]
Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE. Frequency of infection in patients with rheumatoid arthritis compared with controls: A population-based study. Arthritis Rheum 2002; 46(9): 2287-93.
[http://dx.doi.org/10.1002/art.10524] [PMID: 12355475]
[8]
Franklin J, Lunt M, Bunn D, Symmons D, Silman A. Risk and predictors of infection leading to hospitalisation in a large primary- care-derived cohort of patients with inflammatory polyarthritis. Ann Rheum Dis 2007; 66(3): 308-12.
[http://dx.doi.org/10.1136/ard.2006.057265] [PMID: 16984941]
[9]
Landewé RBM, Machado PM, Kroon F, et al. EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Ann Rheum Dis 2020; 79(7): 851-8.
[http://dx.doi.org/10.1136/annrheumdis-2020-217877] [PMID: 32503854]
[10]
Mathew AJ, Ravindran V. Infections and arthritis. Best Pract Res Clin Rheumatol 2014; 28(6): 935-59.
[http://dx.doi.org/10.1016/j.berh.2015.04.009] [PMID: 26096095]
[11]
Joo YB, Lim Y-H, Kim K-J, Park K-S, Park Y-J. Respiratory viral infections and the risk of rheumatoid arthritis. Arthritis Res Ther 2019; 21(1): 199-9.
[http://dx.doi.org/10.1186/s13075-019-1977-9] [PMID: 31470887]
[12]
Listing J, Gerhold K, Zink A. The risk of infections associated with rheumatoid arthritis, with its comorbidity and treatment. Rheumatology (Oxford) 2013; 52(1): 53-61.
[http://dx.doi.org/10.1093/rheumatology/kes305] [PMID: 23192911]
[13]
Galloway JB, Hyrich KL, Mercer LK, et al. Anti-TNF therapy is associated with an increased risk of serious infections in patients with rheumatoid arthritis especially in the first 6 months of treatment: Updated results from the British Society for Rheumatology Biologics Register with special emphasis on risks in the elderly. Rheumatology (Oxford) 2011; 50(1): 124-31.
[http://dx.doi.org/10.1093/rheumatology/keq242] [PMID: 20675706]
[14]
Widdifield J, Bernatsky S, Paterson JM, et al. Serious infections in a population-based cohort of 86,039 seniors with rheumatoid arthritis. Arthritis Care Res (Hoboken) 2013; 65(3): 353-61.
[http://dx.doi.org/10.1002/acr.21812] [PMID: 22833532]
[15]
NHS. University Hospitals Coventry and Warwickshire NHS trust. Important: Personal 2020; 4(1) Available from:www.uhcw.nhs.uk Accessed 15th August 2020.
[16]
Askanase AD, Khalili L, Buyon JP. Thoughts on COVID-19 and autoimmune diseases. Lupus Sci Med 2020; 7(1): e000396-6.
[http://dx.doi.org/10.1136/lupus-2020-000396] [PMID: 32341791]
[17]
Favalli EG, Ingegnoli F, De Lucia O, Cincinelli G, Cimaz R, Caporali R. COVID-19 infection and rheumatoid arthritis: Faraway, so close! Autoimmun Rev 2020; 19(5): 102523.
[http://dx.doi.org/10.1016/j.autrev.2020.102523] [PMID: 32205186]
[18]
Smitten AL, Choi HK, Hochberg MC, et al. The risk of hospitalized infection in patients with rheumatoid arthritis. J Rheumatol 2008; 35(3): 387-93.
[PMID: 18260176]
[19]
Tudesq JJ, Cartron G, Rivière S, et al. Clinical and microbiological characteristics of the infections in patients treated with rituximab for autoimmune and/or malignant hematological disorders. Autoimmun Rev 2018; 17(2): 115-24.
[http://dx.doi.org/10.1016/j.autrev.2017.11.015] [PMID: 29180125]
[20]
Favalli EG. Tofacitinib’s infectious profile: Concerns for clinical practice. Lancet Rheumatol 2020; 2: e65-7.
[http://dx.doi.org/10.1016/S2665-9913(20)30001-1]
[21]
Bello SL, Serafino L, Bonali C, et al. Incidence of influenza-like illness into a cohort of patients affected by chronic inflammatory rheumatism and treated with biological agents. Reumatismo 2012; 64(5): 299-306.
[http://dx.doi.org/10.4081/reumatismo.2012.299] [PMID: 23256105]
[22]
Mikuls TR, Johnson SR, Fraenkel L, et al. American college of rheumatology guidance for the management of rheumatic disease in adult patients during the COVID-19 pandemic: Version 1. Arthritis Rheumatol 2020; 72(8): 1241-51.
[http://dx.doi.org/10.1002/art.41301] [PMID: 32349183]
[23]
Marotto D, Sarzi-Puttini P. What is the role of rheumatologists in the era of COVID-19? Autoimmun Rev 2020; 19(6): 102539-9.
[http://dx.doi.org/10.1016/j.autrev.2020.102539] [PMID: 32251716]
[24]
Tufan A, Avanoğlu Güler A, Matucci-Cerinic M. COVID-19, immune system response, hyperinflammation and repurposing antirheumatic drugs. Turk J Med Sci 2020; 50(SI-1): 620-32.
[http://dx.doi.org/10.3906/sag-2004-168] [PMID: 32299202]
[25]
Kavanagh O, Marie Healy A, Dayton F, et al. Inhaled hydroxychloroquine to improve efficacy and reduce harm in the treatment of COVID-19. Med Hypotheses 2020; 143: 110110-0.
[http://dx.doi.org/10.1016/j.mehy.2020.110110] [PMID: 33017904]
[26]
Tisoncik JR, Korth MJ, Simmons CP, Farrar J, Martin TR, Katze MG. Into the eye of the cytokine storm. Microbiol Mol Biol Rev 2012; 76(1): 16-32.
[http://dx.doi.org/10.1128/MMBR.05015-11] [PMID: 22390970]
[27]
Stebbing J, Phelan A, Griffin I, et al. COVID-19: Combining antiviral and anti-inflammatory treatments. Lancet Infect Dis 2020; 20(4): 400-2.
[http://dx.doi.org/10.1016/S1473-3099(20)30132-8] [PMID: 32113509]
[28]
Perricone C, Triggianese P, Bartoloni E, et al. The anti-viral facet of anti-rheumatic drugs: Lessons from COVID-19. J Autoimmun 2020; 111: 102468-8.
[http://dx.doi.org/10.1016/j.jaut.2020.102468] [PMID: 32317220]
[29]
Boers M, Verhoeven AC, Markusse HM, et al. Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet 1997; 350(9074): 309-18.
[http://dx.doi.org/10.1016/S0140-6736(97)01300-7] [PMID: 9251634]
[30]
Dixon WG, Suissa S, Hudson M. The association between systemic glucocorticoid therapy and the risk of infection in patients with rheumatoid arthritis: Systematic review and meta-analyses. Arthritis Res Ther 2011; 13(4): R139.
[http://dx.doi.org/10.1186/ar3453] [PMID: 21884589]
[31]
Organization WH. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: Interim guidance. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: Interim guidance 2020; 21-1.
[32]
University of Oxford.. Dexamethasone reduces death in hospitalised patients with severe respiratory complications of COVID-19. 2020. Available from: https://www.ox.ac.uk/news/ 2020-06-16-dexamethasone-reduces-death-hospitalised-patients- severe-respiratory-complications Accessed 15th August 2020.
[33]
Lacaille D, Guh DP, Abrahamowicz M, Anis AH, Esdaile JM. Use of nonbiologic disease-modifying antirheumatic drugs and risk of infection in patients with rheumatoid arthritis. Arthritis Rheum 2008; 59(8): 1074-81.
[http://dx.doi.org/10.1002/art.23913] [PMID: 18668604]
[34]
NLM PubChem CID Index. Vitamin D Handbook. 239-44.
[35]
Shah S, Das S, Jain A, Misra DP, Negi VS. A systematic review of the prophylactic role of chloroquine and hydroxychloroquine in coronavirus disease-19 (COVID-19). Int J Rheum Dis 2020; 23(5): 613-9.
[http://dx.doi.org/10.1111/1756-185X.13842] [PMID: 32281213]
[36]
Duru N, van der Goes MC, Jacobs JWG, et al. EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 2013; 72(12): 1905-13.
[http://dx.doi.org/10.1136/annrheumdis-2013-203249] [PMID: 23873876]
[37]
Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis 2020; 79(6): 685-99.
[http://dx.doi.org/10.1136/annrheumdis-2019-216655] [PMID: 31969328]
[38]
Strehl C, Ehlers L, Gaber T, Buttgereit F. Glucocorticoids-all-rounders tackling the versatile players of the immune system. Front Immunol 2019; 10: 1744.
[http://dx.doi.org/10.3389/fimmu.2019.01744] [PMID: 31396235]
[39]
Huscher D, Thiele K, Gromnica-Ihle E, et al. Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis 2009; 68(7): 1119-24.
[http://dx.doi.org/10.1136/ard.2008.092163] [PMID: 18684744]
[40]
Saag KG, Koehnke R, Caldwell JR, et al. Low dose long-term corticosteroid therapy in rheumatoid arthritis: An analysis of serious adverse events. Am J Med 1994; 96(2): 115-23.
[http://dx.doi.org/10.1016/0002-9343(94)90131-7] [PMID: 8109596]
[41]
Wolfe F, Caplan L, Michaud K. Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia: Associations with prednisone, disease-modifying antirheumatic drugs, and anti-tumor necrosis factor therapy. Arthritis Rheum 2006; 54(2): 628-34.
[http://dx.doi.org/10.1002/art.21568] [PMID: 16447241]
[42]
Schulze-Koops H, Krueger K, Specker C. Actions required to assure continuous supply of anti-rheumatic medication during the SARS-CoV-2/COVID-19 pandemic. Response to: ‘Treatment adherence behaviours in rheumatic diseases during pandemic COVID-19: A Latin American experience’ by Pineda-Sic et al 2020; 218223.
[43]
van Mulligen E, de Jong PHP, Kuijper TM, et al. Gradual tapering TNF inhibitors versus conventional synthetic DMARDs after achieving controlled disease in patients with rheumatoid arthritis: First-year results of the randomised controlled TARA study. Ann Rheum Dis 2019; 78(6): 746-53.
[http://dx.doi.org/10.1136/annrheumdis-2018-214970] [PMID: 30954969]
[44]
Wei WE, Li Z, Chiew CJ, Yong SE, Toh MP, Lee VJ. Presymptomatic Transmission of SARS-CoV-2 - Singapore, January 23-March 16, 2020. MMWR Morb Mortal Wkly Rep 2020; 69(14): 411-5.
[http://dx.doi.org/10.15585/mmwr.mm6914e1] [PMID: 32271722]

Rights & Permissions Print Cite
Article Metrics
24
1
© 2024 Bentham Science Publishers | Privacy Policy