Perfect storm: a rheumatologist's point of view on COVID-19 infection
CitationKobak S. (2020). Perfect storm: a rheumatologist's point of view on COVID-19 infection. Current rheumatology reviews, 10.2174/1573397116666201029155105. Advance online publication. https://doi.org/10.2174/1573397116666201029155105
New corona virus infection (Covid-19) is a pandemic that affects the whole world and progresses with high morbidity and mortality. It has a high contagion rate and a course capable of rapidly lung involvement with severe acute respiratory distress syndrome (ARDS) and pulmonary insuficiency. Severe clinical picture develops as a result of a "perfect cytokin storm" as a result of possible immunological mechanisms triggered by viral infection. Immun system disregulation and possible autoinflammatory and autoimmune mechanisms are responsible for higher amount cytokines release from immune cells. Although there is no clear treatment of Covid-19 infection yet, it is argued that some disease modifying anti-rheumatic drugs (DMARDs) may be effective in addition to anti-viral treatments. These drugs (antimalarial drugs, colchicum dispert, biologics) have been well known to rheumatologists for years, because they have been used in the treatment of many inflammatory rheumatologic diseases, so now all eyes are on rheumatologists. Another important issue is whether DMARDs, which can cause severe immunosuppression, pose a risk for Covid-19 infection and whether they are discontinued beforehand. Although there are insufficient data on this subject, considering the risk of disease reactivation, patients may continue their DMARDs treatment under the supervision of the rheumatologist. In this article, the possible immunological mechanisms in the pathogenesis of Covid-19 infection and the efficacy and safety of various DMARDs used in the treatment have been discussed with a rheumatologist perspective in the light of recent literature data.