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Six Things Rheumatologists Need to Know About COVID-19

Rachel Tate, DO

From flu shots and face masks to vaccines and searching for the immunological endotype, here are six things rheumatologists need to know about COVID-19.

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Infection and Rheumatic Diseases: A New Dawn

Mrinalini Dey, MD

Infection in the setting of autoimmune rheumatic disease (ARD) has been the subject of increasing research and clinical interest for decades. Despite the huge burden of infection in patients with ARDs, this area of research has really been catapulted to the centre-stage of research agendas and coverage at congresses, including ACR 2020, with the arrival of the coronavirus disease 2019 (COVID-19) pandemic.

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Immune Necrotizing Myopathy

Jack Cush, MD

A full read review of immune-mediated necrotizing myopathy is portrayed as a distinct subtype of inflammatory myopathies first described in 2004.

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Dr. Siri will see you now...🤖 Machine learning identified 9 signatures including nail pso, CRP and 7 biomarkers to distinguish PsA from PsO pts without arthritis and will help diagnose PsA early. ➡️will need to test independent data @RheumNow #ACR20 Abs#0502

Robert B Chao, MD doctorRBC ( View Tweet)

@LCalabreseDO @cappelliMD @MarieKostine @EladSharonMD @rheum_covid For those who missed it, my attempt to capture some of it in a Twitter thread: https://t.co/Z55sV7ZyBt

Links:

David Liew drdavidliew ( View Tweet)

@RheumNow #acr20 abs0063 in silico, in vitro &clinical study: Amitriptyline, naloxone& thalidomide prevent NOS2, IL6, IL1B, MMP9 release, inhibits NLRP3 inflammasome pathway> decreased colchicine consumption in gout pts using above meds for other indications #acrbest #different https://t.co/cz3htmtBU0
Olga Petryna DrPetryna ( View Tweet)
#ACR20 keynote Infectious disease Dr Eric Rubin @NEJM EIC answers questions about medications, immunity and vaccines in #COVID19. Many post covid inflammatory symptoms but not sure if its because of background autoimmunity. Need more data. More to come in a few months @RheumNow

Bella Mehta bella_mehta ( View Tweet)

Eric Rubin, MD, editor-in-chief @NEJM: "All of the vaccines are based on the same hypothesis". Scary thought in relying in one solution #ACR20. @RheumNow

Eric Dein ejdein1 ( View Tweet)

Lots of JAK safety studies in #ACR20. Abst#0237 pooled 5 RCTs on UPA. Good safety numbers and low VTE rates, but watch out for herpes zoster trend, elevated in UPA (30>15mg) compared to MTX and ADA. @RheumNow

Eric Dein ejdein1 ( View Tweet)

Determining safety of a vaccine requires NUMBERS (more subjects to detect rare, serious side effects) and TIME (longer trials to be able to detect more delayed side effects) per Dr. Eric Rubin’s (ID physician’s) keynote address at #ACR20 @RheumNow

Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)

“When we will have a vaccine. The answer is not so simple. Safety [of vaccines] is an important component of making a decision to move forward.”- Dr. Eric Rubin at #ACR20. We want a vaccine that is both SAFE and EFFECTIVE! @RheumNow

Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)

Dr. L Calabrese excellent review of irAEs and a proposed personalized algorithm for mgmt of irAE #ACR20 @LCalabreseDO @rheumnow He believes there should be more studies combining TNFi or IL-6 with CPI https://t.co/GbvgXtNJnI
k dao KDAO2011 ( View Tweet)
Dr. Noha Abdel-wahab on timing for grade 3/4 irAE fastest with the skin after exposure to CPI #ACR20 @rheumnow https://t.co/sc5c6Zn3Uq
k dao KDAO2011 ( View Tweet)
“Immunology is the cornerstone of medicine and we are the experts.” #ACR20 president, Dr. Ellen Gravallese @RheumNow

Dr. Rachel Tate uptoTate ( View Tweet)

JAKs are no longer new, Winthrop et al presents 8.4 year BARI data in Abst#0202 at #ACR20. VTE risk stable over time, again shows reason to vaccinate patients for zoster before starting. @RheumNow https://t.co/OSIvHl2f7Y
Eric Dein ejdein1 ( View Tweet)

How would you change csDMARDS and bDMARDS a few days before vaccination - if/when #COVID19 KILLED vaccine comes in (Assuming live vaccine would need strict medication management.) #ACR20 @RheumNow

Bella Mehta bella_mehta ( View Tweet)

Vaccinate your pts against pneumococcal- it works! 595 vaccinated pts with RA & SpA vs 2379 nonvaccinated followed to 10 yrs showed 50% less pneumonia if vaccinated even though those pts had more infections prior. Limitation not RCT & not vaccine I use @RheumNow @CRASCRRheum https://t.co/SySEL19Gcn
Janet Pope Janetbirdope ( View Tweet)
Delighted to be reporting for @RheumNow at #ACR20! Here, I review the last year in #infection in #rheumaticdiseases (it’s been a busy one!) and highlight just a few of the abstracts on infections (incl #COVID19), #vaccination and #immunogenicity. Enjoy! https://t.co/x1pzyOICAF

Links:

Mrinalini Dey DrMiniDey ( View Tweet)

What is your top concern about the SARS-Co-V2 vaccine for rheum patients? @RheumNow #ACR20

k dao KDAO2011 ( View Tweet)

Working on an Endocarditis for the Rheumatologist podcast. fast facts!!! 1️⃣ 20% no fever 2️⃣ 20% joint pain at presentation 3️⃣ >40% splenomegly 4️⃣ 90% anemia 5️⃣ most common rash = petechiae (Osler node/janeway/Roth spots 10% combined!) #rheumatology #cleclinicrheum #immunology

Adam J Brown AdamJBrownMD ( View Tweet)

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