Broad clinical spectrum of SARS-CoV-2-associated inflammatory joint disease in adults: a report of 35 cases from the COVID-19 & Autoimmune Systemic Disease Italian study group

Abstract

rollout of COVID19 vaccines around the world, masks remain the standard of care. We strongly advocate the use of masks for all, including patients with ILD, who may be at higher risk if they develop COVID19. Although only CTD may not confer additional risk for COVID19, the presence of ILD increases the risk of severe disease. Functional MRI studies have shown carbon dioxide retention while wearing face mask alters brain oxygenation patterns without affecting task activation in healthy subjects. Other studies which have shown no effect of masks have been on elderly participants without any active exertion or on young adults during exercise. However, these studies had smaller numbers and did not evaluate patients with lung disease during exertion. Conversely, it should also be kept in mind that dyspnoea is a subjective feeling and patients with respiratory diseases may be subconsciously biased against masks. This study should not be misinterpreted as implying face masks should not be used in patients with CTDILD. Our limitations include the use of surgical mask only. However, this was to standardise the experiment. We expect other types of masks and idiopathic ILD to behave similarly. We reiterate that it is quintessential for these patients to continue wearing masks. However, patients with ILD, their caregivers and physicians should know that functional capacity may be reduced with masks. Patients should limit physical exertion while wearing masks. This study should not be misinterpreted as implying face masks should not be used by patients with CTDILD because this would risk COVID19 infection, which would be very much detrimental to such patients. Continuous use of masks as well as other COVID19 protocols is secondary to none.