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ACR Advice on Reopening Strategies
The American College of Rheumatology (ACR) has issued a guidance document for rheumatologists and rheumatology health professionals to consider as practices, business and patient care begins to reopen in this next phase of the COVID-19 pandemic.
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RheumNow Podcast – COVID-19 Responds to Steroids (7.24.20)
Dr. Jack Cush reviews the News and Journal Reports from the past week on RheumNow.com.
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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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For TNF Response in RA, Weight Matters
Patients with rheumatoid arthritis (RA) who were obese were significantly less likely to remain on treatment with tumor necrosis factor (TNF) inhibitors -- but so were those who were underweight, a large, long-term study determined.
Compared with patients with normal weight, patients in obesity class II, whose body mass index (BMI) was 35 to 39.9, had a hazard ratio for shorter drug survival (i.e., the drug's effectiveness, safety, and tolerability) of 1.28 (95% CI 1.06-1.54), while those in obesity class III, whose BMI exceeded 40, had a hazard ratio of 1.67 (95% CI 1.29-2.18), according to Sytske Anne Bergstra, PhD, of Leiden University Medical Center in the Netherlands, and colleagues.
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.
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Retrospective cohort of 147 Adult-Onset Stills Dz pts finds 18 (12.3%) with lung dz (LD) at the diagnosis of AOSD. AOSD-LD were older, w/ more myalgia, LN, pleuritis, ab,dominal pain, more systemic Dz, higher ferritin and more mortality (%39 vs 10%). https://t.co/2phEFwi6n2
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