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Among long term conditions that could be negatively affected by the Covid-19 pandemic it is important to acknowledge chronic rheumatic conditions.
Rheumatic diseases are among the most disabling diseases around the world (1), and affected patients typically need to be strictly followed to ensure a good quality of life as well as to maintain a good control of the disease activity. Moreover, patients with autoimmune chronic arthritis (namely rheumatoid arthritis and seronegative spondyloarthritis) are usually treated with immunosuppressant drugs, that may impair their immune response and be associated with an increased infectious risk.
Notwithstanding this, recommendations on how to manage patients with autoimmune diseases, how to deal with anti-cytokine drugs used by about 20% of these patients, how to keep the disease activity under strict control in the COVID-19 era are all still lacking.
The mainstay for optimal chronic arthritis management is represented by the so-called treat-to-target strategy, requesting frequent controls of disease activity by using well standardized clinimetric evaluations (2): how this could be performed in the future is really a problem that should need a rapid evaluation and response. The other important point is related to early diagnosis: it is now clear that early diagnosis and treatment is the main prognostic factor for achieving clinical remission as well as halting radiographic progression (3). Around the world, many clinical services devoted to early diagnosis have been organized to shorten the delay between symptoms onset and diagnosis (and treatment) (so called early arthritis clinics). In this moment, of course, all our efforts are devoted to patients affected by COVID-19, so these services are not working properly.
We think that rheumatologists should start thinking about the future of their patients and start organizing new modalities to follow their patients to avoid a leap backwards in time, losing all of the fantastic clinical results obtained in the last 15 years.
References
1. Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open. 2016 Jun 20;6(6):e010364. doi: 10.1136/bmjopen-2015-010364. Review. PubMed PMID: 27324708; PubMed Central PMCID: PMC4932255.
2. Smolen JS. Treat to Target in Rheumatology: A Historical Account on Occasion of the 10th Anniversary. Rheum Dis Clin North Am. 2019 Nov;45(4):477-485. doi: 10.1016/j.rdc.2019.07.001. Epub 2019 Aug 16. Review. PubMed PMID: 31564291.
3. Burgers LE, Raza K, van der Helm-van Mil AH. Window of opportunity in rheumatoid arthritis - definitions and supporting evidence: from old to new perspectives. RMD Open. 2019 Apr 3;5(1):e000870. doi: 10.1136/rmdopen-2018-000870. eCollection 2019. Review. PubMed PMID: 31168406; PubMed Central PMCID: PMC6525606.
Competing interests:
No competing interests
30 March 2020
Roberto Caporali
medical doctor, rheumatologist
Ennio Giulio Favalli
dept of clinical sciences and community health, University of Milan, and G. Pini Hospital, Milan, Italy
Re: Covid-19 and long term conditions: what if you have cancer, diabetes, or chronic kidney disease?
Dear Editor
Among long term conditions that could be negatively affected by the Covid-19 pandemic it is important to acknowledge chronic rheumatic conditions.
Rheumatic diseases are among the most disabling diseases around the world (1), and affected patients typically need to be strictly followed to ensure a good quality of life as well as to maintain a good control of the disease activity. Moreover, patients with autoimmune chronic arthritis (namely rheumatoid arthritis and seronegative spondyloarthritis) are usually treated with immunosuppressant drugs, that may impair their immune response and be associated with an increased infectious risk.
Notwithstanding this, recommendations on how to manage patients with autoimmune diseases, how to deal with anti-cytokine drugs used by about 20% of these patients, how to keep the disease activity under strict control in the COVID-19 era are all still lacking.
The mainstay for optimal chronic arthritis management is represented by the so-called treat-to-target strategy, requesting frequent controls of disease activity by using well standardized clinimetric evaluations (2): how this could be performed in the future is really a problem that should need a rapid evaluation and response. The other important point is related to early diagnosis: it is now clear that early diagnosis and treatment is the main prognostic factor for achieving clinical remission as well as halting radiographic progression (3). Around the world, many clinical services devoted to early diagnosis have been organized to shorten the delay between symptoms onset and diagnosis (and treatment) (so called early arthritis clinics). In this moment, of course, all our efforts are devoted to patients affected by COVID-19, so these services are not working properly.
We think that rheumatologists should start thinking about the future of their patients and start organizing new modalities to follow their patients to avoid a leap backwards in time, losing all of the fantastic clinical results obtained in the last 15 years.
References
1. Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open. 2016 Jun 20;6(6):e010364. doi: 10.1136/bmjopen-2015-010364. Review. PubMed PMID: 27324708; PubMed Central PMCID: PMC4932255.
2. Smolen JS. Treat to Target in Rheumatology: A Historical Account on Occasion of the 10th Anniversary. Rheum Dis Clin North Am. 2019 Nov;45(4):477-485. doi: 10.1016/j.rdc.2019.07.001. Epub 2019 Aug 16. Review. PubMed PMID: 31564291.
3. Burgers LE, Raza K, van der Helm-van Mil AH. Window of opportunity in rheumatoid arthritis - definitions and supporting evidence: from old to new perspectives. RMD Open. 2019 Apr 3;5(1):e000870. doi: 10.1136/rmdopen-2018-000870. eCollection 2019. Review. PubMed PMID: 31168406; PubMed Central PMCID: PMC6525606.
Competing interests: No competing interests