Contemporary rheumatology is a field dealing with the phenomena of autoimmune states and
inflammation.
Rheumatic diseases cover a wide spectrum of diseases of the musculoskeletal system, connective tissue and vessels. The occurrence of an immune, autoimmune and autoinflammatory response is often linked to different kinds of
infections. Which aspects of the
coronavirus infection relate to rheumatological
therapy and practice? In order to answer this question one needs to look at the pathogenesis of the
SARS-CoV-2 infection.
Antimalarial drugs may block antigen presentation of the viral
peptides from antigen presenting cells, as they may alter the lysosomal
proteases that mediate the viral entry in the cells and have demonstrated efficacy in improving the
infection. Anti-IL-6 may interfere with
cytokine storm in severe cases and use of
tocilizumab has had good results in a small cohort.
Baricitinib not only plays a role in inhibiting the synthesis of
cytokines but it also has a function in suppressing receptor-mediated endocytosis. The constantly new and tested concepts in the treatment of COVID testify to the growing knowledge about the virus, but also to the need for more targeted
therapy. Treatment regimens have been developed for both patients with
COVID-19 and those with symptomatic SARS-CoV
infection and
rheumatic disease. This article is an attempt to discuss the management of
COVID-19 and coexisting
rheumatic disease.