Pediatric Rheumatologists’ Perspective on Corona Virus Disease 2019

COVID-19 and pediatric rheumatology

Abstract

Corona Virus Disease 2019 (COVID-19) has become a pandemic affecting the entire the world. Rheumatologists may play an important role in the management of COVID-19 cases owing to their experiences on inflammation and macrophage activating syndrome (MAS), one of the most important complications of COVID-19. Here, we present the applicability of pediatric rheumatology treatment methods on COVID-19 therapy, and management of children with rheumatic diseases using immune suppressive treatments, in this pandemic season. COVID-19 causes severe acute respiratory distress syndrome (SARS) in about 20% of infected patients. The virus specifically recognizes the angiotensin converting enzyme 2 (ACE2) receptor by its spike protein. In patients whose immunomodulatory capacities are not strong enough, the virus can trigger a severe cytokine storm. The rheumatologist may play an important role to avoid this complication with a timely treatment. In COVID-19 patients, by detecting elevated serum ferritin levels, cytokine storm syndrome can be recognized early, and the necessary treatments can be initiated on time. Anti-rheumatic drugs, such as hydroxychloroquine, colchicine, interleukin-1 and interleukin-6 blockers, JAK inhibitors, TNF inhibitors are used in the treatment of COVID-19 at different stages of the disease. Another very important issue is the management of patients with rheumatic diseases in this pandemic season. The increased risk of infection is an important concern in patients with rheumatic disease who are receiving immunosuppressive drugs. Various rheumatism associations have recommended the continuation of anti-rheumatism treatments to control of chronic inflammatory status, based on the experience so far.