COVID-19 and Rheumatic Diseases

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an infectious agent affecting respiratory system the most and spreads rapidly due to large number of ACE2 receptors in the lung. Arthralgia and myalgia are the most common rheumatologic findings, but arthritis is rare. Hyperinflammatory condition called cytokine storm causes acute respiratory distress syndrome (ARDS) leading to death. Although coronavirus disease 2019 (COVID-19) is mild or asymptomatic in most cases, it may progress to pneumonia and ARDS, especially in elderly patients who have comorbidities. Drugs such as tocilizumab which suppress inflammatory response and reduce cytokine storm may be effective on treating COVID-19 pneumonia. Cytokine storm, the cause of which is not fully understood and in which many structures of immune system interact with each other, is quite complex and has different mechanisms contributing to it. Although antimalarial drugs such as hydroxychloroquine are used in the treatment, there is no definite evidence that they are effective. It has been shown that the prevalence and course of COVID-19 in rheumatic diseases is similar to the general population, and that increasing age and additional comorbid conditions increase the risk of mortality. It is recommended that anti-rheumatic drugs used in the treatment of rheumatic diseases should not be stopped unless the patient is infected with COVID-19.

Keywords

• COVID-19
• rheumatic diseases
• cytokine strom
• anti-rheumatic drugs

COVID-19 ve Romatizmal Hastalıklar

Abstract

Şiddetli akut solunum yolu sendromu koronavirüsü 2 (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) solunum sistemini en çok etkileyen ve akciğerdeki çok sayıda ACE2 reseptörü nedeniyle hızla yayılan bulaşıcı bir ajandır. Artralji ve miyalji en sık görülen romatolojik bulgulardır, ancak artrit nadirdir. Sitokin fırtınası adı verilen hiperinflamatuar durum, akut solunum sıkıntısı sendromu (acute respiratory distress syndrome, ARDS)’na neden olarak ölüme neden olur. Koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) çoğu durumda hafif veya asemptomatik olmasına rağmen, özellikle ileri yaş ve komorbiditeleri olan hastalarda pnömoni ve ARDS'ye ilerleyebilir. Enflamatuar yanıtı baskılayan ve sitokin fırtınasını azaltan tosiluzumab gibi ilaçlar, COVID-19 pnömonisinin tedavisinde etkili olabilir. Nedeni tam olarak anlaşılamayan ve bağışıklık sistemindeki birçok yapının birbiriyle etkileşime girdiği sitokin fırtınası oldukça karmaşıktır ve buna katkıda bulunan farklı mekanizmalara sahiptir. Tedavide hidroksiklorokin gibi antimalaryal ilaçlar kullanılsa da etkili olduklarına dair kesin bir kanıt yoktur. Romatizmal hastalıklarda COVID-19 sıklığının ve seyrinin genel popülasyona benzer olduğu, artan yaş ve ek komorbid durumların mortalite riskini artırdığı gösterilmiştir. Romatizmal hastalıkların tedavisinde kullanılan anti-romatizmal ilaçların, hasta COVID-19 ile enfekte olmadıkça kesilmemesi önerilmektedir.

Keywords

• COVID-19
• romatizmal hastalıklar
• sitokin fırtınası
• anti-romatizmal ilaçlar

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