By Mary Hearty
COVID-19 is not milder or more severe in patients with rheumatic diseases than the general population, expert says.
Dr Charles Omondi, Rheumatologist at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) and Lecturer at Uzima University stated during a media briefing with Africa Science Media Centre (AfriSMC) on Rheumatic Diseases (RD) and COVID-19.
“Poor outcome from COVID-19 seems to be associated with older age and the presence of other comorbidities such as previous stroke, diabetes, hypertension or cardiac failure rather than the type of rheumatic disease or the degree of pharmacological immunosuppression,” he said.
Dr. Omondi noted that these were findings from studies that had been carried out on the effects of COVID-19 on rheumatic diseases from various parts of the world. The studies were observing the severity of COVID-19 in RD patients, risk of COVID-19 infections among RD patients and effect of COVID-19 on treatments.
Dr. Omondi noted that two large studies carried out in China and Italy conclusively confirmed that the risk of infection of COVID-19 in RD patients is not higher than in the general population.
Rheumatic diseases are autoimmune and inflammatory diseases that cause the immune system to attack the joints, muscles, bones and organs. They include gout, rheumatoid arthritis, and systemic lupus erythematosus (SLE) among others.
With regards to RD treatment, the rheumatologist said that drugs such as Hydroxychloroquine, JAK inhibitors, and IL-6 inhibitors are major immunosuppressive drugs used for managing rheumatic diseases like rheumatoid arthritis, gout and SLE.
Dr. Omondi noted that when the pandemic began, initial studies suggested use of Hydroxychloroquine in COVID-19 treatment. As a result, it went out of stock thus causing a challenge to patients with rheumatoid arthritis. However, the claims were withdrawn on the basis of technical error.
“What we feared in COVID-19 was the immunosuppression, that anybody who is in an immunosuppressed state could have worst outcomes,” he stated.
RD has immunosuppression in three ways, he explained, the rheumatic disease causing direct immunosuppression for example in systemic lumpous (SLE).It causes direct immunosuppression through various mechanisms.
“Another way in which immunosuppression occurs is if you have another immunosuppressive disease which does not cause immunosuppression like gout, for example,” Dr. Omondi said, “but if you have diabetes on top of gout, then you will have a disease causing immunosuppression in a non-immunosuppressive rheumatic disease; or if you have malignancy in gout you’ll have immunosuppression.
Moreover, he stated that the biggest chunk of immunosuppression is through the drugs. Most of the drugs used in RD like glucocorticoids, also known as steroids, IL-6 inhibitor, JAK inhibitor cause immunosuppression. The worst fear was that the use of steroids with COVID-19 would have a bad outcome in the patients, the rheumatologist said.
He noted that such fears resulted responses such as use of tele-health for patients with stable disease, to reduce risk of RD patients acquiring COVID-19.
Dr. Omondi advised that patients need to follow timing of anti-rheumatic medications before taking COVID-19 vaccine, adding that the American College of Rheumatology (ACR) had set guidelines on this.
He said that the Rheumatic Disease patients on Methotrexate and JAK inhibitors need to skip the drugs for one week after each COVID-19 vaccine dose.
For the patients on immunosuppressants such as leflunomide, mycophenolate and azathioprine, he said that if the disease is stable, there is no need to stop or modify the drugs, and the vaccine can be taken as planned. But, if the disease is unstable, the vaccine should be postponed and the Rheumatic Disease patient should continue with his or her dugs.
Dr. Omondi noted that the vaccination of patients on Hydroxychloroquine, or glucocorticoids/ steroids that are less than 20mg per day should not be interrupted.
With regards to Abatacept, he explained that where the drugs are being given subcutaneously (under the skin), the first COVID-19 dose should be given after one week but the second dose can be given without interruption. However, where Abatacept is administered intravenously (through the vein), the first vaccination should occur four weeks after the entire dosing interval of Abatacept infusion, and the subsequent Abatacept infusion by one week.
Dr. Omondi reiterated the need for people to observe the basic protocols of hand washing, sanitizing, masking and keeping social distance in order to curb the spread of COVID-19.