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Infliximab Use Near Surgery is Safe
Risk factors for perioperative infections include age, comorbidity, rheumatoid arthritis and steroids to name a few; whether concurrent use of TNF inhibitor (TNFI) therapy adds to this risk has been debated. In a study of elderly patients receiving infliximab infusions, infliximab use prior to surgery did not change the risk of post-operative infections.
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DMARD Use Does Not Increase COVID Hospitalization
An observational study of patients with systemic autoimmune inflammatory rheumatic diseases (AIRD) who also had COVID-19 disease shows that AIRD increased the risk of hospitalization, but that the use of disease-modifying antirheumatic drugs (DMARDs) were not associated with hospitalization.
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Fighting Hydroxychloroquine Misinformation
JAMA Internal Medicine has posted an Editor's note on the use of hydroxychloroquine for COVID-19; noting the sequence of dysfunction since the president promoted its use on March 21, 2020, when he said “What do you have to lose? I’ll say it again: What do you have to lose? Take it.”.
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RheumNow Podcast - Top 13 Rheumatology Centers (7-31-20)
Dr. Jack Cush reviews the news and TOP 13 list of Best Rheumatology Hospitals.
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Colchicine Benefits COVID-19 Patients
A proof-of-concept study published in Annals of Rheumatic Disease suggests that colchicine significantly improves COVID-19 outcomes.
Efficacy and safety must be determined in controlled clinical trials.he outbreak of COVID-19 posed the issue of urgently identifying treatment strategies. Colchicine was considered for this purpose based on well-recognised anti-inflammatory effects and potential antiviral properties.
Low Risk of COVID in Biologic Treated Rheum Patients
In an Annals of Rheumatic Disease report, Italian investigators performed consecutive testing for SARS-CoV-2 (IgM and IgG) between 25 March to 25 May 2020 and compared test results between rheumatic disease (RMD) patients and the general population.
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Rapid Loss of SARS-CoV-2 Antibodies in Mild Disease
According to a small, observational study out of UCLA published as correspondence in the NEJM on July 21, 2020, those with mild COVID-19 symptoms showed an approximate antibody half-life of 73 days.
COVID-19 infection was confirmed by PCR in 30 out of 34 study participants. The remaining four patients developed consistent symptoms and cohabitated with a person who had a known positive test but could not get testing due to availability or mild symptoms.
Higher Rates of SARS-CoV-2 Seropositivity in the USA
The number of reporting cases of COVID-19 infection tends to underestimate the true prevalence of infection as only the more severe cases (e.g.,acute respiratory syndrome) get tested or go to the hospital. JAMA Internal Medicine reports that a cross-sectional seroprevalence study from the U.S. shows that COVID-19 is underreported and that actual infection rates can be 6 to 24 times more prevalent than currently reported infections due to SARS-CoV-2.
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Steroids and Tocilizumab in Cytokine Storm Syndrome
A recent study from the Netherlands has shown that patients with severe COVID-19-associated cytokine storm syndrome (CSS) with high dose steroids and tocilizumab had a faster recovery, less need for invasive mechanical ventilation and fewer deaths when compared to CSS patients receiving supportive care only.
They studed COVID-19 patients with CSS, defined as rapid respiratory deterioration plus at least two of the following biomarkers: a) C-reactive protein >100mg/L; b) ferritin >900 µg/L; or c) D-dimer >1500 µg/L.
RECOVERY Trial: Dexamethasone in COVID-19
Inflammatory events following infection with SARS-CoV-2 can often worsen the morbid or mortal outcomes with COVID, yet it has been unclear if glucocorticoids may modulate inflammation-mediated damage and lung injury. The RECOVERY trial reports that dexamethasone (DEX) use lowered 28-day mortality among COVID-19 patients requiring respiratory support.
The RECOVERY trial was performed in the UK and enrolled hospitalized COVID-19 patients who were randomly assigned patients to usual care alone or the addition of oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days. The primary outcome was 28-day mortality.
Characteristics Underlying Mortal COVID-19 Outcomes
From January 1, 2020–May 18, 2020, approximately 1.3 million cases of coronavirus disease 2019 (COVID-19) and 83,000 COVID-19–associated deaths were reported in the United States.
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RheumNow Podcast – LTF – Listen to Fauci (7.17.20)
Dr. Jack Cush reviews the news, tweets and journal articles from the past week on RheumNow. Let's dig into this week's 14 highlights.
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Anti-Rheumatic Therapies for COVID-19 Infection
Since the onset of the COVID-19 pandemic numerous anti-rheumatic therapies have been proposed as being potentially beneficial. The mechanistic effects of these agents, either presumed antiviral, anti-inflammatory and anti-thrombotic effects, may benefit mitigate the damage seen with COVID-19 infection.
This review will examine the potential benefits and existing evidence for treating suspected or proven COVID-19 infection with antimalarials, inhibitors of interleukin-6 (IL-6) or interleukin-1 (IL-1) Janus kinase (JAK) inhibitors, TNF inhibitors or colchicine. There are many other antirheumatic and immunosuppressive therapies that are in clinical trials that will not be reviewed here including IVIG, rituximab, calcineurin inhibitors (sirolimus, etc.), apremilast, emapalumab (anti-IFN gamma), etc.
Growing Risk of COVID Among Adolescents
The risk COVID-19 infection and mortality in the U.S. has been closely correlated with increasing age. However, recent data suggests that young adults (aged 18–25 years) have shown an increasing risk of COVID-19 infection since the pandemic began in March 2020.
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Extrapulmonary Manifestations of COVID-19
A new article in Nature Medicine delineates how our understanding of COVID-19 infection has evolved over time, such that the infection outomes may be worsened by extrapulmonary manifestations; notably thrombotic, cardiac, renal, gastrointestinal hepatic, neurologic, and other complications.
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ICYMI: Protective Benefit of Colchicine in COVID-19 Infection
Colchicine has been advocated as a potential anti-inflammatory intervention in patients with the coronavirus 2 infection and clinical trials have been developed to assess its effect in early COVID-2 infection. JAMA has published a randomized clinical trial showing that low dose colchicine had less clinical deterioration without significant changes in biomarkers, such as high-sensitivity cardiac troponin and C-reactive protein.
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ICYMI: Preventing COVID - Masks, Meters and Eyewear
A Lancet systematic review and meta-analysis provides the basis for physical distancing and the value of making as measures to prevent infection with coronavirus 2 (SARS-CoV-2) or COVID-19.
The analysis included 172 observational studies, no randomised controlled trials and 44 relevant comparative studies involving 25 697 patients.