The new COVID-19 generates a lot of concern and brings with it an high number of doubts. These can particularly affect the most fragile part of the population, such as patients with chronic conditions. To clarify the most common doubts, the Italian Society of Rheumatology has tried to answer some common questions among rheumatic patients.

We discussed this with Professor Carlo Selmi, Head of Rheumatology and Clinical Immunology at Humanitas, and lecturer at Humanitas University.

There are over 150 rheumatological diseases and they differ one from the other, in terms of how the occur, of their symptoms, and in terms of their causes. We will distinguish between degenerative diseases (such as arthrosis), inflammatory diseases (such as arthritis) and diseases related to metabolism (such as gout). These are serious, painful, and often disabling disorders that are rapidly growing in Italy (more than 5 million Italians suffer from them), and are further accelerated by the increase in the average age of the population. Nevertheless, they are often underestimated diseases, because symptoms such as pain, rigidity, and difficulty of movement are erroneously attributed to advancing age or climate. Even if they are not only related to old age, older people are particularly exposed to them.

Rheumatic diseases and new Coronavirus

“At the moment, from the available data, it does not seem that patients with rheumatological diseases are more at risk of infection; it is advisable that patients follow the suggested preventive measures, that they continue to regularly follow the treatment,and, in case of doubts or special needs, that they contact their doctor or the rheumatologist. It is desirable that, precisely because of their knowledge of their disease and the effects of their treatments, rheumatological patients follow the recommendations in order to lower risk of becoming ill.

Patients taking immunosuppressive drugs (such as biological drugs, oral Janus kinase inhibitors, Methotrexate or other immunosuppressive drugs such as corticosteroids) should not discontinue therapy. Suspending or reducing these treatments may help reactivate the disease, exposing patients to the need for more aggressive treatments.

In general, therefore, these patients should not suspend or reduce therapies without medical indication, but they should follow the ministerial recommendations for individual protection. In the presence of symptoms such as cough or fever, a doctor should be consulted, because regardless of the Coronavirus infection, therapy in these cases can be suspended until the symptoms are resolved, as would also be case of infections other than Coronavirus.

Patients taking corticosteroids should also continue therapy and consult their doctor or rheumatologist if they have any doubts or special needs. In Humanitas we have set up a special telephone number (02 8224 8296) for clinical questions, active from Monday to Friday from 10 a.m. to 6 p.m.”, explained Professor Selmi.

Does chloroquine and Tocilizumab protect against COVID-19 infection?

“Some experimental data showed that very familiar drugs in rheumatology such as chloroquine (which has not been produced for months) and hydroxychloroquine used in the therapy of many autoimmune diseases, would be able to inhibit virus replication and some of these are used in different protocols on patients with COVID-19. The same applies to patients treated with Tocilizumab. This drug may help in treating patients with COVID-19 because it reduces  inflammation in the lungs, but it has no antiviral effect meaning that rheumatic patients treated with this drug are not protected from the infection.

Those who are already taking these drugs should continue with therapy, but should not consider themselves protected from infection and must still respect preventive measures”, reminded Prof. Selmi.

Prevention recommendations valid for everyone, including rheumatological patients:

  • Wash your hands and wrists frequently for at least 20 seconds using soap and water.
  • Do not touch your mouth, nose, or eyes.
  • Sneeze into the elbow or into a disposable wipe, which should be discarded immediately after use.
  • Stay at least one meter away from other people.
  • Avoid handshakes.
  • Avoid group gatherings or any occasion involving close proximity to other people, when possible.
  • Avoid unnecessary travels, stay at home as much as possible; only go out for necessities (for work, grocery shopping or pharmacy).
  • Strictly follow orders that the Ministry of Health has issued.