Editorial: Rheumatology at the center of coronavirus disease 2019: pathogenesis, treatment, and clinical care

Abstract

DOI:10.1097/BOR.0000000000000813 The first case of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus 2019 (COVID-19), was reported in Wuhan, China in December 2019 [1]. Cases increased exponentially and quickly spread across the globe, reaching pandemic levels and becoming an international health crisis [2]. As of 22 May 2021, there have been 165 772 430 cases of COVID-19 reported to the WHO, including 3 437 454 deaths [3]. The entirety of the healthcare community, including rheumatologists, adapted seemingly overnight to this new medical reality – including reassignment of practitioners to the care of patients with COVID-19 from their normal duties and the heavy reliance on telemedicine to continue routine, maintenance care [4,5]. Rheumatology, perhaps unexpectedly, quickly emerged as a key medical discipline in the fight against COVID-19. In addition to direct redeployment to hospitals for the care of patients with COVID-19, the field took part in a massive undertaking to characterize infection and its impact on our patients. Rapidly, epidemiologic and cohort studies from across the globe emerged, showing that, in general, patients with immune-mediated inflammatory diseases (IMIDs) who developed COVID-19 did not have worse outcomes (i.e. hospitalization and death) compared with non-IMID patients [6–9]. Additionally, while most immunomodulatory therapy had no effect on outcomes, glucocorticoids appeared to increase the risk of hospitalization, while alternatively, tumor necrosis factor inhibitors were found to possibly decrease the risk of poor outcomes [9,10]. These findings allowed practitioners to confidently keep patients with IMID on their medications through the pandemic, likely preventing a heavy burden of disease flares. Importantly, as evidence emerged that many of the poor outcomes from COVID-19 may actually be because of a hyperinflammatory response [11,12] and that immunomodulatory medications may play a role in the treatment of acute infection [13–15], the expertise of rheumatologists became even more essential. Our understanding of COVID-19 pathogenesis, therapeutics, and prevention has evolved significantly