Antirheumatic drugs and COVID-19: What is important?

In the times of COVID-19, many rheumatism patients, omit essential drugs for pain control or skip picking up new prescriptions from physicians due to media reports or out of fear. Often, such reactions are completely unfounded.

There is no evidence of an increased risk of infection

In the times of COVID-19, many rheumatism patients are more inclined, due to numerous media reports and out of fear of the disease, to simply omit important drugs for pain control. They also may no longer dare to go to their physicians to pick up new prescriptions; reactions that are in most cases completely unfounded.

In times of fake news and medical half-truths, the uncertainty is particularly great for many patients with rheumatoid diseases. First of all, it is important that patients do not stop their medication on their own for fear of a virus infection or any unforeseen impact on their health.

Rheumatics are not more at risk per se

On the one hand, there are as yet no scientific observations suggesting that certain forms of therapy in rheumatology could lead to an increased incidence of infection. On the other hand, the discontinuation of the drugs themselves represents an increased risk. This is because it leads to a more frequent flare-up of the rheumatic disease, which is immunologically unfavorable for those affected due to the chronic inflammatory conditions. Inflammations may require a higher dose of cortisone, which further weakens the immune response.

However, the coast is not clear either in the opposite case: rheumatics are not better protected against SARS-CoV-2 and thus against COVID-19 due to their respective medication, e.g. with biologicals. However, it is a fact that in the course of an already existing SARS-CoV-2 infection, certain biologicals (e.g. IL-6 and IL-1 inhibitors) are used in studies to prevent the dangerous "cytokine storm" in some COVID-19 patients. However, initial data on this are still pending.

NSAIDs do not promote the risk of infection

A myth that has long persisted in the COVID-19 debate is that non-steroidal anti-inflammatory drugs, such as ibuprofen, are dangerous if patients have become infected with SARS-CoV-2. However, this statement was based only on supposed clinical observations and theoretical considerations and could not be confirmed in further clinical observations. This means that this group of drugs, which is important in rheumatology, can still be used.

The omission of ACE inhibitors is the real danger

It is known from clinical studies and observations that more than one-third of all patients with rheumatoid arthritis suffer from hypertension at the same time. Therefore, unfounded statements such as "ACE inhibitors to lower high blood pressure are dangerous for COVID-19 patients" are, put simply, pure poison. On the basis of these assumptions, many rheumatism patients with hypertension began to stop taking their antihypertensive medication. The result: an increasing number of rheumatism patients with dangerous blood pressure disorders. This finding is also critical because hypertension is a major risk factor for severe COVID-19 courses.

What’s the big idea?

The observations and study results available to date indicate that patients with inflammatory rheumatic diseases do not have an increased risk of infection and do not need to fear a worse course of COVID-19 infection in every case.

However, the general risk factors are important for the prognosis, such as advanced age, significant overweight, cardiovascular diseases, chronic lung diseases, hypertension, and diabetes mellitus. Many of these comorbidities can be well treated both by a change in lifestyle (sport, diet, nicotine withdrawal) and by an optimized medication plan.

Source: EULAR 2020 online press conference of 27.05.2020

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