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Lobato JCM, Arouche TDS, Nero JD, Filho T, Borges RDS, Neto AMDJC. Interactions between carbon nanotubes and external structures of SARS-CoV-2 using molecular docking and molecular dynamics. J Mol Struct 2023; 1286:135604. [PMID: 37089815 PMCID: PMC10111146 DOI: 10.1016/j.molstruc.2023.135604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/01/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
Molecular modeling techniques are used to describe the process of interaction between nanotubes and the main structures of the Covid-19 virus: the envelope protein, the main protease, and the Spike glycoprotein. Molecular docking studies show that the ligands have interaction characteristics capable of adsorbing the structures. Molecular dynamics simulations provide information on the mean squared deviation of atomic positions between 0.5 and 3.0 Å. The Gibbs free energy model and solvent accessible surface area approaches are used. Through the results obtained through molecular dynamics simulations, it is noted that the zig-zag nanotube prefers to interact with E-pro, M-pro, and S-gly, respectively. Molecular couplings and free energy showed that the S-gly active site residues strongly interact with zigzag, chiral, and armchair nanotubes, in this order. The interactions demonstrated in this manuscript may predict some promising candidates for virus antagonists, which may be confirmed through experimental approaches.
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Affiliation(s)
- Júlio Cesar Mendes Lobato
- Laboratory of Preparation and Computation of Nanomaterials (LPCN), Federal University of Pará, C. P. 479, 66075-110, Belém, PA, Brazil
- Proderna, Federal University of Pará, C. P. 479, 66075-110, Belém, PA, Brazil
| | - Tiago da Silva Arouche
- Laboratory of Preparation and Computation of Nanomaterials (LPCN), Federal University of Pará, C. P. 479, 66075-110, Belém, PA, Brazil
| | - Jordan Del Nero
- Physics Faculty, Science Institute of Sciences (ICEN), Federal University of Pará, 66075-110, Belém, PA, Brazil
| | - TarcisoAndrade Filho
- Federal University of the South and Southeast of Pará. 68507-590, Marabá - PA, Brazil
| | - Rosivaldo Dos Santos Borges
- Pharmacy Faculty, Science Institute of Sciences (ICEN), Federal University of Pará, C. P. 479, 66075-110, Belém, PA, Brazil
| | - Antonio Maia de Jesus Chaves Neto
- Laboratory of Preparation and Computation of Nanomaterials (LPCN), Federal University of Pará, C. P. 479, 66075-110, Belém, PA, Brazil
- Physics Faculty, Science Institute of Sciences (ICEN), Federal University of Pará, 66075-110, Belém, PA, Brazil
- Chemistry and Biochemistry, The University of Texas at Arlington, Box 19065, 700 Planetarium Place, Room 130, Arlington, TX 76019-0065
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Abdin AY, De Pretis F, Landes J. Fast Methods for Drug Approval: Research Perspectives for Pandemic Preparedness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2404. [PMID: 36767769 PMCID: PMC9915940 DOI: 10.3390/ijerph20032404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
Public heath emergencies such as the outbreak of novel infectious diseases represent a major challenge for drug regulatory bodies, practitioners, and scientific communities. In such critical situations drug regulators and public health practitioners base their decisions on evidence generated and synthesised by scientists. The urgency and novelty of the situation create high levels of uncertainty concerning the safety and effectiveness of drugs. One key tool to mitigate such emergencies is pandemic preparedness. There seems to be, however, a lack of scholarly work on methodology for assessments of new or existing drugs during a pandemic. Issues related to risk attitudes, evidence production and evidence synthesis for drug approval require closer attention. This manuscript, therefore, engages in a conceptual analysis of relevant issues of drug assessment during a pandemic. To this end, we rely in our analysis on recent discussions in the philosophy of science and the philosophy of medicine. Important unanswered foundational questions are identified and possible ways to answer them are considered. Similar problems often have similar solutions, hence studying similar situations can provide important clues. We consider drug assessments of orphan drugs and drug assessments during endemics as similar to drug assessment during a pandemic. Furthermore, other scientific fields which cannot carry out controlled experiments may guide the methodology to draw defeasible causal inferences from imperfect data. Future contributions on methodologies for addressing the issues raised here will indeed have great potential to improve pandemic preparedness.
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Affiliation(s)
- Ahmad Yaman Abdin
- Division of Bioorganic Chemistry, School of Pharmacy, Saarland University, D-66123 Saarbrucken, Germany
| | - Francesco De Pretis
- Department of Communication and Economics, University of Modena and Reggio Emilia, 42121 Reggio Emilia, Italy
- VTT Technical Research Centre of Finland Ltd., 70210 Kuopio, Finland
| | - Jürgen Landes
- Department of Philosophy “Piero Martinetti”, University of Milan, 20122 Milan, Italy
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Duarte-García A, Graef ER, Liew JW, Konig MF, Kim AH, Sparks JA. Response to: 'Correspondence on ' Festina lente: hydroxychloroquine, COVID-19and the role of the rheumatologist' by Graef et al' by Lo et al. Ann Rheum Dis 2022; 81:e164. [PMID: 32769149 PMCID: PMC8075104 DOI: 10.1136/annrheumdis-2020-218680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 01/20/2023]
Affiliation(s)
| | | | - Jean W Liew
- Divison of Rheumatology, Boston University, Boston, Massachusetts, USA
| | - Maximilian F Konig
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alfred Hyoungju Kim
- Medicine/Rheumatology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Jeffrey A Sparks
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
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4
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Ugarte-Gil MF, Konig MF, Korsten P, Berenbaum F, Kim AH, Sparks JA. Response to: 'Hydroxychloroquine ineffective for COVID-19 prophylaxis in lupus and rheumatoid arthritis' by Singer et al. Ann Rheum Dis 2022; 81:e162. [PMID: 32759257 PMCID: PMC8075121 DOI: 10.1136/annrheumdis-2020-218683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | - Maximilian F Konig
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Gottingen, Germany
| | | | - Alfred Hyoungju Kim
- Medicine/Rheumatology, Washington University in Saint Louis School of Medicine, St. Louis, Missouri, USA
| | - Jeffrey A Sparks
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Lo CH, Wang YH, Tsai CF, Chan KC, Li LC, Lo TH, Su CH, Wei JCC. Correspondence on ' Festina lente: hydroxychloroquine, COVID-19 and the role of the rheumatologist' by Graef et al. Ann Rheum Dis 2022; 81:e163. [PMID: 32769154 DOI: 10.1136/annrheumdis-2020-218589] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Chien Hsien Lo
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chin Feng Tsai
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Kuei Chuan Chan
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Li Ching Li
- Department of Internal Medicine, DaChien General Hospital, Miaoli, Taiwan
| | - Tse Hsien Lo
- Department of Internal Medicine, DaChien General Hospital, Miaoli, Taiwan
| | - Chun Hung Su
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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Singer ME, Kaelber DC, Antonelli MJ. Hydroxychloroquine ineffective for COVID-19 prophylaxis in lupus and rheumatoid arthritis. Ann Rheum Dis 2022; 81:e161. [PMID: 32759263 DOI: 10.1136/annrheumdis-2020-218500] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Mendel E Singer
- Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - David C Kaelber
- Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Internal Medicine and Pediatrics, The MetroHealth System, Cleveland, Ohio, USA
| | - Maria J Antonelli
- Internal Medicine and Rheumatology, Case Western Reserve University at The MetroHealth System, Cleveland, Ohio, USA
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Assar S, Mohamadzadeh D, Pournazari M, Soufivand P. Frequency, characteristics and outcome of corona virus disease 2019 (COVID-19) infection in Iranian patients with rheumatic diseases. THE EGYPTIAN RHEUMATOLOGIST 2022; 44:209-213. [PMID: 38620998 PMCID: PMC8660257 DOI: 10.1016/j.ejr.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 12/19/2022]
Abstract
Aim of the work To investigate the frequency, clinical characteristics and outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in rheumatic diseases patients. Patients and methods One thousand patients with rheumatic diseases including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (SpA), systemic sclerosis (SSc), Sjögren's syndrome (SS), Behçets disease (BD), vasculitis, idiopathic inflammatory myositis (IIM), relapsing polychondritis, sarcoidosis and antiphospholipid syndrome (APS) were studied. The following data were collected: age, sex, disease diagnosis, rheumatic disease medication. Rheumatic diseases patients were divided into two groups of infected and non-infected patients with COVID-19 and collected data were compared. Results The 1000 patients mean age was 43.4 ± 13 years and 84.1% were females. The main diagnosis was RA (37.1%), followed by SLE (23.8%), SpA (13.4%), SSc (12.4%), vasculitis, BD and rhupus in 2.4%, 2.3% and 2.2% respectively, SS and SSc in 0.7% each. Most patients were taking glucocorticoids (78.4%). A large majority of patients were taking at least one of the cDMARDs. 16.1% were taking biologic therapy. 221 rheumatic diseases patients with COVID-19 were identified. Of these, 38 patients (17.2%) were hospitalized and 9 patients (4.1%) died. No significant difference was observed for compared variables in patients with and without COVID-19 except for prednisolone >20 mg/d (0.64% vs 2.26%; p = 0.048). Conclusion Most rheumatic diseases do not seem to be a risk factor for developing COVID-19 infection and despite immunosuppressive therapies, there is no poorer outcome. Only, patients using prednisolone >20 mg/d are at higher risk of developing COVID-19 infection.
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Affiliation(s)
- Shirin Assar
- Rheumatology Department, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Dena Mohamadzadeh
- Rheumatology Department, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehran Pournazari
- Rheumatology Department, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parviz Soufivand
- Rheumatology Department, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Voit K, Timmermann C, Steger F. Medication of Hydroxychloroquine, Remdesivir and Convalescent Plasma during the COVID-19 Pandemic in Germany-An Ethical Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115685. [PMID: 34073254 PMCID: PMC8197849 DOI: 10.3390/ijerph18115685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/20/2022]
Abstract
This paper aims to analyze the ethical challenges in experimental drug use during the early stage of the COVID-19 pandemic, using Germany as a case study. In Germany uniform ethical guidelines were available early on nationwide, which was considered as desirable by other states to reduce uncertainties and convey a message of unity. The purpose of this ethical analysis is to assist the preparation of future guidelines on the use of medicines during public health emergencies. The use of hydroxychloroquine, remdesivir and COVID-19 convalescent plasma in clinical settings was analyzed from the perspective of the ethical principles of beneficence, non-maleficence, justice and autonomy. We observed that drug safety and drug distribution during the pandemic affects all four ethical principles. We therefore recommend to establish ethical guidelines (i) to discuss experimental treatment options with patients from all population groups who are in urgent need, (ii) to facilitate the recording of patient reactions to drugs in off-label use, (iii) to expand inclusion criteria for clinical studies to avoid missing potentially negative effects on excluded groups, and (iv) to maintain sufficient access to repurposed drugs for patients with prior conditions.
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D'Silva KM, Serling-Boyd N, Wallwork R, Hsu T, Sparks JA, Wallace ZS. Response to: 'COVID-19 in patients with rheumatological diseases treated with Anti-TNF' by Brito et al and 'Clinical characteristics and outcomes of patients with COVID-19 and rheumatic disease in China 'hot spot' versus in US 'hot spot': similarities and differences' by Zhao et al. Ann Rheum Dis 2021; 80:e64. [PMID: 32546600 DOI: 10.1136/annrheumdis-2020-218196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Kristin M D'Silva
- Division of Rheumatology, Allergy, and Immunology, Harvard Medical School, Boston, Massachusetts, USA
| | - Naomi Serling-Boyd
- Division of Rheumatology, Allergy, and Immunology, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel Wallwork
- Division of Rheumatology, Allergy, and Immunology, Harvard Medical School, Boston, Massachusetts, USA
| | - Tiffany Hsu
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Zachary Scott Wallace
- Division of Rheumatology, Allergy, and Immunology, Harvard Medical School, Boston, Massachusetts, USA
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Robinson PC, Yazdany J, Machado PM. Global research collaboration in a pandemic-challenges and opportunities: the COVID-19 Global Rheumatology Alliance. Curr Opin Rheumatol 2021; 33:111-116. [PMID: 33394601 PMCID: PMC7924930 DOI: 10.1097/bor.0000000000000783] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review discusses the coronavirus disease-2019 (COVID-19) Global Rheumatology Alliance (GRA), the reason for its formation, the challenges with running the registry, and future opportunities for global collaborative research in rheumatology. RECENT FINDINGS The GRA has been successful in collecting and publishing a large volume of case data on patients with rheumatic disease with COVID-19. In addition, the GRA has published reviews, opinion pieces, and patient-directed summaries of research to further assist in disseminating timely and accurate information about COVID-19 in rheumatic diseases. There have been numerous challenges in the journey but they have been addressed through a collaborative problem-solving approach. SUMMARY The initial objectives of the GRA to describe the outcomes in patients with rheumatic disease who developed COVID-19 have been achieved. There has been extensive use of the data in the clinic and also to try and understand the mechanisms of disease and opportunities for drug repurposing. There remain numerous important areas for research which the GRA will continue to pursue as the pandemic evolves.
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Affiliation(s)
| | - Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco, California, USA
| | - Pedro M. Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London
- National Institute for Health Research (NIHR), Biomedical Research Centre (BRC), University College London Hospitals (UCLH), NHS Foundation Trust
- Department of Rheumatology, Northwick Park Hospital, London North West University, Healthcare NHS Trust, London, UK
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11
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Liu A, Chen Z, Cheng Y, Wang X, Gao M, Huang C. Tocilizumab for Severe COVID-19 Pneumonia: Experience from 5 Geriatric Chinese Patients with 6 Months Follow-up. RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2021; 2:35-42. [PMID: 36467896 PMCID: PMC9524772 DOI: 10.2478/rir-2021-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/08/2021] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To enable physicians to understand the efficacy and safety of Tocilizumab (TCZ) in patients with severe coronavirus disease-2019 (COVID-19). METHODS We respectively reviewed the clinical records, laboratory results, and chest computed tomography (CT) scans of 5 geriatric patients with severe COVID-19 treated with TCZ during their inpatient hospitalization period in Wuhan from February 08, 2020 to April 04, 2020. The survival status of the patients in the third and the sixth month after being discharged was followed up and recorded. RESULTS On the fourteenth day after TCZ administration, periphery oxygen saturation rate (SpO2) returned to normal in 4 patients. The serum Interleukin-6 (IL-6) levels altered in five patients after TCZ infusion. One patient rapidly progressed to acute respiratory distress syndrome (ARDS) and died of multiple organ failures eventually. The other 4 patients were cured and discharged from the hospital. During the inpatient hospitalization period, two patients suffered from virus shedding periods (VSPs) delay, and one patient had mild upper respiratory tract infection. One patient died of esophageal carcinoma one month after being discharged. The other 3 patients survived despite mild cough and insomnia. Serum-specific IgG type antibody titer was decreased in one patient. Six months after being discharged, the other three patients were in good condition. CONCLUSION TCZ may be an efficient therapeutic option for patients with COVID-19. However, the possibility of VSPs delay, secondary infection, serum protective antibody tilter attenuation, and long-term survival status should be addressed before TCZ therapy initiation.
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Affiliation(s)
- Aihua Liu
- Department of Rheumatology and Immunology, Beijing Hospital, National Centre of Gerontology, Beijing, China
| | - Zhe Chen
- Department of Rheumatology and Immunology, Beijing Hospital, National Centre of Gerontology, Beijing, China
| | - Yongjing Cheng
- Department of Rheumatology and Immunology, Beijing Hospital, National Centre of Gerontology, Beijing, China
| | - Xutao Wang
- Department of Emergency, Beijing Hospital, National Centre of Gerontology, Beijing, China
| | - Ming Gao
- Department of Rheumatology and Immunology, Beijing Hospital, National Centre of Gerontology, Beijing, China
| | - Cibo Huang
- Department of Rheumatology and Immunology, Beijing Hospital, National Centre of Gerontology, Beijing, China
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Sattui SE, Graef ER, Liew JW, Sparks JA, Kim AHJ. Reply to 'Taking a stand against the politicization of medical research: how "swinging the pendulum" poses a hazard to clinical trials, study participants, and the progress of science'. Expert Rev Clin Immunol 2020; 17:105-107. [PMID: 33290667 DOI: 10.1080/1744666x.2020.1860756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Sebastian E Sattui
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | | | - Jean W Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
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Ziadé N, Hmamouchi I, El Kibbi L, Abdulateef N, Halabi H, Abutiban F, Hamdi W, El Rakawi M, Eissa M, Masri B. The impact of COVID-19 pandemic on rheumatology practice: a cross-sectional multinational study. Clin Rheumatol 2020; 39:3205-3213. [PMID: 32996071 PMCID: PMC7524572 DOI: 10.1007/s10067-020-05428-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on rheumatology practice. METHOD A cross-sectional web survey was designed by the members of the Arab League of Associations for Rheumatology (ArLAR), validated by its scientific committee and disseminated through e-mail and social media. It included close-ended questions about the impact of the pandemic on the rheumatology activities, including outpatient visits and hospitalizations (in percentage, 100% corresponds to complete suspension) and open-ended questions about unmet needs. Univariate and multivariable logistic regression analyses were used to evaluate the predictors of impact. Suggestions were developed to improve the practice. RESULTS A total of 858 rheumatologists were included in the analysis (27.3% of registered in ArLAR), 37% were 35-44 years old, 60% were females, and 48% worked in the private sector. The impact of COVID-19 was a decrease of 69% in hospitalizations, 65% in outpatient clinic, 56% in infusion centers, and 43% in income. It was associated with the region (highest in the Gulf), use of telemedicine, impact on income and practice sector (lowest in private). There was a hydroxychloroquine shortage in 47%. Telemedicine was mostly based on traditional telephone contacts and e-mails and reimbursed in 12%. Fifteen rheumatologists (1.8%) were infected and 156 cases of COVID-19 were reported among patients. The top-cited unmet needs in rheumatology practice were access to drugs and a telemedicine platform. CONCLUSIONS The negative impact of the COVID-19 pandemic on rheumatology practice may compromise rheumatic diseases control. Better access to drugs and providing telemedicine platforms are recommended to improve the practice. Key Points • The COVID-19 pandemic had a significant negative impact on the rheumatology practice, including access to outpatient clinic, hospitalization, and to anchor drugs. • The compromised access to rheumatology care may jeopardize the control of chronic rheumatic diseases and the long-term prognosis. • Better access to drugs and providing telemedicine platforms are strongly recommended.
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Affiliation(s)
- Nelly Ziadé
- Hotel-Dieu de France Hospital, Saint-Joseph University, 6th floor, Tour des Consultations Externes, Alfred Naccache blvd. Achrafieh, Beirut, Lebanon.
| | - Ihsane Hmamouchi
- Temara Hospital, Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | | | - Nizar Abdulateef
- Rheumatology Unit, Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Hussein Halabi
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Fatemah Abutiban
- Rheumatology Unit, Department of Medicine, Jaber Alahmed Alsabah Hospital, Kuwait City, State of Kuwait
| | - Wafa Hamdi
- Rheumatology Department, Kassab Institute of Orthopedics, UR17SP04, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Manal El Rakawi
- Rheumatology Department, Douera Hospital, Faculty of Medicine, Saad Dahlab, Blida, Algeria
| | - Mervat Eissa
- Rheumatology Department, Cairo University, Cairo, Egypt
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14
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Spihlman AP, Gadi N, Wu SC, Moulton VR. COVID-19 and Systemic Lupus Erythematosus: Focus on Immune Response and Therapeutics. Front Immunol 2020; 11:589474. [PMID: 33193418 PMCID: PMC7661632 DOI: 10.3389/fimmu.2020.589474] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/12/2020] [Indexed: 01/08/2023] Open
Abstract
The SARS-CoV-2 novel coronavirus has caused the COVID-19 pandemic with over 35 million cases and over a million deaths worldwide as of early October 2020. The populations most affected are the elderly and especially those with underlying comorbidities. In terms of race and ethnicity, black and hispanic populations are affected at disproportionately higher rates. Individuals with underlying conditions that cause an immune-compromised state are considered vulnerable to this infection. The immune response is an important determinant in viral infections including coronaviruses, not only in the antiviral defense but also in the disease progression, severity, and clinical outcomes of COVID-19. Systemic lupus erythematosus is a chronic autoimmune disease which also disproportionately afflicts black and hispanic populations. In lupus patients, an aberrant immune response is characterized by the presence of circulating autoantibodies, lymphopenia, aberrant T cells, and proinflammatory cytokines along with defective regulatory mechanisms, leading to immune-mediated damage to tissues. Lupus patients are often treated with immune-suppressants and therefore are immune-compromised and more susceptible to infections and may be vulnerable to coronavirus infection. While the anti-viral immune response is important to protect from coronavirus infection, an uncontrolled proinflammatory cytokine response can lead to cytokine storm which causes damage to the lungs and other organs, causing significant morbidity and mortality. Better understanding of the underlying immune response and therapeutic strategies in lupus and COVID-19 is important to guide management of this deadly infectious disease in the context of lupus and vice-versa.
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Affiliation(s)
- Allison P Spihlman
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Boston University School of Medicine, Boston, MA, United States
| | - Nirupa Gadi
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Boston University School of Medicine, Boston, MA, United States
| | - Samantha C Wu
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Boston University School of Medicine, Boston, MA, United States
| | - Vaishali R Moulton
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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15
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Gomides A, Ferreira G, Kakehasi A, Lacerda M, Marques C, Mota L, Paiva E, Pileggi G, Provenza J, Reis-Neto E, Sampaio V, Xavier R, Pinheiro M. Impact of Chronic Use of Antimalarials on SARS-CoV-2 Infection in Patients With Immune-Mediated Rheumatic Diseases: Protocol for a Multicentric Observational Cohort Study. JMIR Res Protoc 2020; 9:e23532. [PMID: 32924956 PMCID: PMC7575340 DOI: 10.2196/23532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
Abstract
Background COVID-19, caused by the virus SARS-CoV-2, has brought extensive challenges to the scientific community in recent months. Several studies have been undertaken in an attempt to minimize the impact of the disease worldwide. Although new knowledge has been quickly disseminated, including viral mechanisms, pathophysiology, and clinical findings, there is a lack of information on the effective pharmacological management of this disease. In vitro studies have shown some benefits related to the use of antimalarials (chloroquine and hydroxychloroquine) for inhibiting SARS-CoV-2. However, the data from open clinical trials on COVID-19 patients are controversial. Objective We present the protocol for a research project that compares the potential protective effect of antimalarials in preventing moderate-to-severe forms of COVID-19 in two groups: (1) patients treated chronically with antimalarials for rheumatic diseases and (2) other members of the patients’ household who have not been diagnosed with rheumatic diseases and are not taking antimalarials. Methods This is a 24-week, prospective, observational cohort study comprising patients from public and private health services across Brazil, who chronically use antimalarials for the treatment of immune-mediated rheumatic diseases, osteoarthritis, or chikungunya-related arthropathy. A total of six sequential phone interviews were scheduled during the COVID-19 outbreak in five different regions of Brazil. Information regarding social, epidemiological, and demographic data, as well as details about rheumatic diseases, antimalarials, comorbidities, and concomitant medication, is being recorded using a specific online form in the REDCap database. Symptoms suggestive of COVID-19, including fever, cough, dyspnea, anosmia, and dysgeusia, are being self-reported and collected via phone interviews. Our main outcomes are hospitalization, need of intensive care unit, and death. Results Recruitment began at the end of March 2020, and the inclusion was done during an 8-week period (from March 29 to May 17) with a total of 10,443 individuals enrolled at baseline, 5166 of whom have rheumatic diseases, from 23 tertiary rheumatology centers across 97 Brazilian cities. Data analysis is scheduled to begin after all inclusion data have been collected. Conclusions This study, which includes a large sample of chronic antimalarial users, will allow us to explore whether SARS-CoV-2 infection may be associated with immune-mediated rheumatic diseases and long-term antimalarial usage. Trial Registration Brazilian Registry of Clinical Trials RBR–9KTWX6; http://www.ensaiosclinicos.gov.br/rg/RBR-9ktwx6/ International Registered Report Identifier (IRRID) DERR1-10.2196/23532
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Affiliation(s)
- Ana Gomides
- University Center of Brasília, Brasília, Brazil
| | - Gilda Ferreira
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Licia Mota
- University of Brasília, Brasília, Brazil
| | | | | | - José Provenza
- Sociedade Brasileira de Reumatologia, São Paulo, Brazil
| | | | | | - Ricardo Xavier
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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16
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Lauper K, Bijlsma JWJ, Burmester GR. Trajectories of COVID-19 information in the Annals of the Rheumatic Diseases: the first months of the pandemic. Ann Rheum Dis 2020; 80:26-30. [PMID: 33055081 DOI: 10.1136/annrheumdis-2020-219217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Kim Lauper
- Division of Rheumatology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland .,Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Freie Universitität und Humboldt-University Berlin, Berlin, Germany
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17
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D'Silva KM, Serling-Boyd N, Wallwork R, Hsu T, Fu X, Gravallese EM, Choi HK, Sparks JA, Wallace ZS. Clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and rheumatic disease: a comparative cohort study from a US 'hot spot'. Ann Rheum Dis 2020; 79:1156-1162. [PMID: 32457048 PMCID: PMC7456555 DOI: 10.1136/annrheumdis-2020-217888] [Citation(s) in RCA: 177] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate differences in manifestations and outcomes of coronavirus disease 2019 (COVID-19) infection between those with and without rheumatic disease. METHODS We conducted a comparative cohort study of patients with rheumatic disease and COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR), compared in a 1:2 ratio with matched comparators on age, sex and date of COVID-19 diagnosis, between 1 March and 8 April 2020, at Partners HealthCare System in the greater Boston, Massachusetts area. We examined differences in demographics, clinical features and outcomes of COVID-19 infection. The main outcomes were hospitalisation, intensive care admission, mechanical ventilation and mortality. RESULTS We identified 52 rheumatic disease patients with COVID-19 (mean age, 63 years; 69% female) and matched these to 104 non-rheumatic disease comparators. The majority (39, 75%) of patients with rheumatic disease were on immunosuppressive medications. Patients with and without rheumatic disease had similar symptoms and laboratory findings. A similar proportion of patients with and without rheumatic disease were hospitalised (23 (44%) vs 42 (40%)), p=0.50) but those with rheumatic disease required intensive care admission and mechanical ventilation more often (11 (48%) vs 7 (18%), multivariable OR 3.11 (95% CI 1.07 to 9.05)). Mortality was similar between the two groups (3 (6%) vs 4 (4%), p=0.69). CONCLUSIONS Patients with rheumatic disease and COVID-19 infection were more likely to require mechanical ventilation but had similar clinical features and hospitalisation rates as those without rheumatic disease. These findings have important implications for patients with rheumatic disease but require further validation.
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Affiliation(s)
- Kristin M D'Silva
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Naomi Serling-Boyd
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel Wallwork
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tiffany Hsu
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ellen M Gravallese
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hyon K Choi
- Clinical Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Clinical Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
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18
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Sattui SE, Liew JW, Graef ER, Coler-Reilly A, Berenbaum F, Duarte-García A, Harrison C, Konig MF, Korsten P, Putman MS, Robinson PC, Sirotich E, Ugarte-Gil MF, Webb K, Young KJ, Kim AHJ, Sparks JA. Swinging the pendulum: lessons learned from public discourse concerning hydroxychloroquine and COVID-19. Expert Rev Clin Immunol 2020; 16:659-666. [PMID: 32620062 PMCID: PMC7594186 DOI: 10.1080/1744666x.2020.1792778] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction Several months into the COVID-19 pandemic, safe and effective treatments against this global health disaster have yet to be identified. Clinical research trials around the world are underway testing a wide array of possible medications. In particular, the off-label use of hydroxychloroquine for COVID-19 prophylaxis and treatment has created many unprecedented challenges for the scientific community and the public. Areas covered We critically assessed major events from February – May 2020 that contributed to widespread use of hydroxychloroquine for the treatment and prophylaxis of COVID-19. We aimed to explore how opinions toward hydroxychloroquine may shift from early enthusiasm (based on in vitro and preliminary clinical data) to the hope for a miracle cure (through communication and promotion of questionable results) and, finally, to a rise of skepticism as more in-depth analyses are emerging. Expert opinion Mindful and rigorous acquisition of data, as well as its interpretation, are essential to an effective pandemic response. The rapid and premature promotion of results has had major implications for global crisis management, even creating distrust among the public. It is crucial for the medical and scientific community to incorporate the lessons learned from this situation.
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Affiliation(s)
- Sebastian E Sattui
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery , New York, NY, USA
| | - Jean W Liew
- Division of Rheumatology, Department of Medicine, University of Washington , Seattle, WA, USA
| | - Elizabeth R Graef
- Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA, USA
| | - Ariella Coler-Reilly
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine , St. Louis, MO, USA
| | - Francis Berenbaum
- Department of Rheumatology, Sorbonne University, INSERM CRSA, AP-HP , Paris, France
| | | | | | - Maximilian F Konig
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of Medicine , Baltimore, MD, USA
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen , Göttingen, Germany
| | - Michael S Putman
- Department of Medicine, Northwestern University , Chicago, IL, USA
| | | | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact, McMaster University , Hamilton, ON, Canada.,Canadian Arthritis Patient Alliance , Toronto, ON, Canada
| | - Manuel F Ugarte-Gil
- School of Medicine, Universidad Científica Del Sur and Hospital Nacional Guillermo Almenara Irigoyen , EsSalud, Lima, Peru
| | - Kate Webb
- Department of Paediatric Rheumatology, University of Cape Town , Cape Town, South Africa.,Francis Crick Institute , London, UK
| | - Kristen J Young
- Division of Rheumatic Diseases, UT Southwestern Medical Center , Dallas, TX, USA
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine , Saint Louis, MO, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School , Boston, MA, USA
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19
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Santos CS, Morales CM, Álvarez ED, Castro CÁ, Robles AL, Sandoval TP. Determinants of COVID-19 disease severity in patients with underlying rheumatic disease. Clin Rheumatol 2020; 39:2789-2796. [PMID: 32720259 PMCID: PMC7383119 DOI: 10.1007/s10067-020-05301-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Over the month of April, Spain has become the European country with more confirmed cases of COVID-19 infection, after surpassing Italy on April 2nd. The community of Castile and León in Spain is one of the most affected by COVID-19 infection and the province of León has a total of 3711 cases and 425 deaths so far. Rheumatic patients should be given special attention regarding COVID-19 infection due to their immunocompromised state resulting from their underlying immune conditions and use of targeted immune-modulating therapies. Studying epidemiological and clinical characteristics of patients with rheumatic diseases infected with SARS-CoV2 is pivotal to clarify determinants of COVID-19 disease severity in patients with underlying rheumatic disease. OBJECTIVES To describe epidemiological characteristics of patients with rheumatic diseases hospitalized with COVID-19 and determine risk factors associated with mortality in a third level Hospital setting in León, Spain. METHODS We performed a prospective observational study, from 1st March 2020 until the 1st of June including adults with rheumatic diseases hospitalized with COVID-19 and performed a univariate and multivariate logistic regression model to estimate ORs and 95% CIs of mortality. Age, sex, comorbidities, rheumatic disease diagnosis and treatment, disease activity prior to infection, radiographic and laboratorial results at arrival were analysed. RESULTS During the study period, 3711 patients with COVID-19 were admitted to our hospital, of whom 38 (10%) had a rheumatic or musculoskeletal disease. Fifty-three percent were women, with a mean age at hospital admission of 75.3 (IQR 68-83) years. The median length of stay was 11 days. A total of 10 patients died (26%) during their hospital admission. Patients who died from COVID-19 were older (median age 78.4 IQR 74.5-83.5) than those who survived COVID-19 (median age 75.1 IQR 69.3-75.8) and more likely to have arterial hypertension (9 [90%] vs 14 [50%] patients; OR 9 (95% CI 1.0-80.8), p 0.049), dyslipidaemia (9 (90%) vs 12 (43%); OR 12 (95% CI 1.33-108), p 0.03), diabetes ((9 (90%) vs 6 (28%) patients; OR 33, p 0.002), interstitial lung disease (6 (60%) vs 6 (21%); OR 5.5 (95% CI 1.16-26), p 0.03), cardiovascular disease (8 (80%) vs 11 (39%); OR 6.18 (95% IC 1.10-34.7, p 0.04) and a moderate/high index of rheumatic disease activity (7 (25%) vs 6(60%); OR 41.4 (4.23-405.23), p 0.04). In univariate analyses, we also found that patients who died from COVID-19 had higher hyperinflammation markers than patients who survived: C-reactive protein (181 (IQR 120-220) vs 107.4 (IQR 30-150; p 0.05); lactate dehydrogenase (641.8 (IQR 465.75-853.5) vs 361 (IQR 250-450), p 0.03); serum ferritin (1026 (IQR 228.3-1536.3) vs 861.3 (IQR 389-1490.5), p 0.04); D-dimer (12,019.8 (IQR 843.5-25,790.5) vs 1544.3 (IQR 619-1622), p 0.04). No differences in sex, radiological abnormalities, rheumatological disease, background therapy or symptoms before admission between deceased patients and survivors were found. In the multivariate analysis, the following risk factors were associated with mortality: rheumatic disease activity (p = 0.003), dyslipidaemia (p = 0.01), cardiovascular disease (p = 0.02) and interstitial lung disease (p = 0.02). Age, hypertension and diabetes were significant predictors in univariate but not in multivariate analysis. Rheumatic disease activity was significantly associated with fever (p = 0.05), interstitial lung disease (p = 0.03), cardiovascular disease (p = 0.03) and dyslipidaemia (p = 0.01). CONCLUSIONS Our results suggest that comorbidities, rheumatic disease activity and laboratorial abnormalities such as C-reactive protein (CRP), D-Dimer, lactate dehydrogenase (LDH), serum ferritin elevation significantly associated with mortality whereas previous use of rheumatic medication did not. Inflammation is closely related to severity of COVID-19. Key Points • Most patients recover from COVID-19. • The use of DMARDs, corticosteroids and biologic agents did not increase the odds of mortality in our study. • Rheumatic disease activity might be associated with mortality.
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Affiliation(s)
- C Sieiro Santos
- Rheumatology Department, Complejo Asistencial Universitario de León, Leon, Spain.
| | - C Moriano Morales
- Rheumatology Department, Complejo Asistencial Universitario de León, Leon, Spain
| | - E Díez Álvarez
- Rheumatology Department, Complejo Asistencial Universitario de León, Leon, Spain
| | - C Álvarez Castro
- Rheumatology Department, Complejo Asistencial Universitario de León, Leon, Spain
| | - A López Robles
- Rheumatology Department, Complejo Asistencial Universitario de León, Leon, Spain
| | - T Perez Sandoval
- Rheumatology Department, Complejo Asistencial Universitario de León, Leon, Spain
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20
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Hausmann JS, Sufka P, Bhana S, Liew JW, Machado PM, Wallace ZS, Costello W, Robinson PC, Yazdany J, Grainger R, Sirotich E. Conducting research in a pandemic: The power of social media. Eur J Rheumatol 2020; 7:S85-S88. [PMID: 32716838 DOI: 10.5152/eurjrheum.2020.2066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jonathan S Hausmann
- Program in Rheumatology, Department of Immunology, Boston Children's Hospital, Boston, MA, USA.,Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | - Jean W Liew
- Division of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Pedro M Machado
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Wendy Costello
- Irish Children's Arthritis Network (iCAN), Tipperary, Ireland
| | - Philip C Robinson
- School of Clinical Medicine, Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Emily Sirotich
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
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21
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Santos-Moreno P, Buitrago-Garcia D, Villarreal L, Aza A, Cabrera M, Rivero W, Rojas-Villarraga A. Emergency arising from patients' fear of taking antimalarials during these COVID-19 times: are antimalarials as unsafe for cardiovascular health as recent reports suggest? Ann Rheum Dis 2020; 81:e154. [PMID: 32647029 DOI: 10.1136/annrheumdis-2020-218259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/03/2022]
Affiliation(s)
| | | | | | - Anggie Aza
- Rheumatology, Biomab IPS, Bogotá, Colombia
| | - Michael Cabrera
- Statistics and Clinical Reports, Biomab IPS, Bogotá, Colombia
| | - Wilberto Rivero
- Pharmacy and Pharmacovigilance, Biomab IPS, Bogotá, Colombia
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22
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Liew JW, Graef ER, Sparks JA, Kim AH. Response to: 'Emergency arising from patients' fear of taking antimalarials during these COVID-19 times: are antimalarials as unsafe for cardiovascular health as recent reports suggest?' by Santos-Moreno et al. Ann Rheum Dis 2020; 81:e155. [PMID: 32647030 DOI: 10.1136/annrheumdis-2020-218432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Jean W Liew
- Division of Rheumatology, Boston University, Boston, Massachusetts, USA
| | - Elizabeth R Graef
- Division of Rheumatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jeffrey A Sparks
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alfred Hyoungju Kim
- Medicine/Rheumatology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
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23
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
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24
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Plüß M, Chehab G, Korsten P. Concerns and needs of patients with systemic lupus erythematosus regarding hydroxychloroquine supplies during the COVID-19 pandemic: results from a patient-centred survey. Ann Rheum Dis 2020; 80:e52. [DOI: 10.1136/annrheumdis-2020-217967] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 11/03/2022]
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25
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Gianfrancesco M, Hyrich KL, Al-Adely S, Carmona L, Danila MI, Gossec L, Izadi Z, Jacobsohn L, Katz P, Lawson-Tovey S, Mateus EF, Rush S, Schmajuk G, Simard J, Strangfeld A, Trupin L, Wysham KD, Bhana S, Costello W, Grainger R, Hausmann JS, Liew JW, Sirotich E, Sufka P, Wallace ZS, Yazdany J, Machado PM, Robinson PC. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020; 79:859-866. [PMID: 32471903 PMCID: PMC7299648 DOI: 10.1136/annrheumdis-2020-217871] [Citation(s) in RCA: 819] [Impact Index Per Article: 204.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES COVID-19 outcomes in people with rheumatic diseases remain poorly understood. The aim was to examine demographic and clinical factors associated with COVID-19 hospitalisation status in people with rheumatic disease. METHODS Case series of individuals with rheumatic disease and COVID-19 from the COVID-19 Global Rheumatology Alliance registry: 24 March 2020 to 20 April 2020. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Age, sex, smoking status, rheumatic disease diagnosis, comorbidities and rheumatic disease medications taken immediately prior to infection were analysed. RESULTS A total of 600 cases from 40 countries were included. Nearly half of the cases were hospitalised (277, 46%) and 55 (9%) died. In multivariable-adjusted models, prednisone dose ≥10 mg/day was associated with higher odds of hospitalisation (OR 2.05, 95% CI 1.06 to 3.96). Use of conventional disease-modifying antirheumatic drug (DMARD) alone or in combination with biologics/Janus Kinase inhibitors was not associated with hospitalisation (OR 1.23, 95% CI 0.70 to 2.17 and OR 0.74, 95% CI 0.37 to 1.46, respectively). Non-steroidal anti-inflammatory drug (NSAID) use was not associated with hospitalisation status (OR 0.64, 95% CI 0.39 to 1.06). Tumour necrosis factor inhibitor (anti-TNF) use was associated with a reduced odds of hospitalisation (OR 0.40, 95% CI 0.19 to 0.81), while no association with antimalarial use (OR 0.94, 95% CI 0.57 to 1.57) was observed. CONCLUSIONS We found that glucocorticoid exposure of ≥10 mg/day is associated with a higher odds of hospitalisation and anti-TNF with a decreased odds of hospitalisation in patients with rheumatic disease. Neither exposure to DMARDs nor NSAIDs were associated with increased odds of hospitalisation.
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MESH Headings
- Adolescent
- Adult
- Aged
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Antimalarials/therapeutic use
- Antirheumatic Agents/therapeutic use
- Arthritis, Psoriatic/complications
- Arthritis, Psoriatic/drug therapy
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/drug therapy
- Betacoronavirus
- Biological Products/therapeutic use
- COVID-19
- Coronavirus Infections/complications
- Coronavirus Infections/mortality
- Coronavirus Infections/therapy
- Female
- Glucocorticoids/therapeutic use
- Hospitalization/statistics & numerical data
- Humans
- Janus Kinase Inhibitors/therapeutic use
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/drug therapy
- Male
- Middle Aged
- Multivariate Analysis
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/mortality
- Pneumonia, Viral/therapy
- Prednisone/therapeutic use
- Protective Factors
- Registries
- Rheumatic Diseases/complications
- Rheumatic Diseases/drug therapy
- Risk Factors
- SARS-CoV-2
- Severity of Illness Index
- Spondylarthropathies/complications
- Spondylarthropathies/drug therapy
- Tumor Necrosis Factor Inhibitors/therapeutic use
- Vasculitis/complications
- Vasculitis/drug therapy
- Young Adult
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Affiliation(s)
- Milena Gianfrancesco
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Sarah Al-Adely
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | | | - Maria I Danila
- Division of Clinical Immunology and Rheumatology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Zara Izadi
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Lindsay Jacobsohn
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Patricia Katz
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Saskia Lawson-Tovey
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal
| | - Stephanie Rush
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Gabriela Schmajuk
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Julia Simard
- Health Research & Policy, Division of Epidemiology and Department of Medicine, Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
| | - Anja Strangfeld
- Forschungsbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
| | - Laura Trupin
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | | | | | - Wendy Costello
- Irish Children's Arthritis Network (iCAN), Tipperary, Ireland
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jonathan S Hausmann
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jean W Liew
- University of Washington, Seattle, Washington, USA
| | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | | | - Zachary S Wallace
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jinoos Yazdany
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London (UCL), London, UK
- University College London Hospitals (UCLH) National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS trust, London, UK
| | - Philip C Robinson
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Metro North Hospital & Health Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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26
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Seyahi E, Poyraz BC, Sut N, Akdogan S, Hamuryudan V. The psychological state and changes in the routine of the patients with rheumatic diseases during the coronavirus disease (COVID-19) outbreak in Turkey: a web-based cross-sectional survey. Rheumatol Int 2020; 40:1229-1238. [PMID: 32572609 PMCID: PMC7306572 DOI: 10.1007/s00296-020-04626-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/12/2020] [Indexed: 01/08/2023]
Abstract
We hypothesized that patients with rheumatic diseases (RD) would have increased psychological distress during the COVID-19 outbreak; therefore, assessed their psychological symptoms and changes in their routine. A web-based questionnaire survey was conducted in a cross-sectional design in three groups of participants: (1.) patients with RD, (2.) hospital workers, and (3.) high-school teachers/academic staff. Psychiatric status was evaluated using Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised scale. Overall response rate was 34.7%. We studied 771 patients with RD, 535 hospital workers, and 917 teachers/academic staff. Most of the patients with RD were unwilling to go to the hospital (86%), while 22% discontinued their medications. Biological DMARDS were the most frequent drugs whose doses were altered. Only 4% were willing to take hydroxychloroquine for protection. Moreover, the frequency of anxiety (20%), depression (43%), and post-traumatic stress (28%) among patients with RD were found to be comparable to that found among the teachers/academic staff (23%, 43% and 29%, respectively), whereas significantly less than that observed among the hospital workers (40%, 62%, and 46%, respectively) (p < 0.001). Female gender, use of social media, having a comorbid disease, or a psychiatric disorder were found to be independently associated with psychiatric symptoms in total study population. The majority of the patients were unwilling to attend outpatient visits and one-fifth skipped or stopped their immunosuppressive agents. Psychiatric symptoms in patient's and teacher's populations were of considerable clinical concern, despite being significantly lower than that observed among the hospital workers.
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Affiliation(s)
- Emire Seyahi
- Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310, Turkey.
| | - Burc Cagri Poyraz
- Cerrahpasa Medical Faculty, Department of Psychiatry, Division of Geriatric Psychiatry, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Necdet Sut
- Department of Biostatistics and Medical Informatics, Trakya University Medical Faculty, Edirne, Turkey
| | - Selma Akdogan
- Cerrahpasa Medical Faculty, Department of Internal Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Vedat Hamuryudan
- Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310, Turkey
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27
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Graef ER, Liew JW, Kim AH, Sparks JA. Response to: 'Case series of acute arthritis in COVID-19 admission' by López-González et al. Ann Rheum Dis 2020; 80:e59. [PMID: 32471896 DOI: 10.1136/annrheumdis-2020-217989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Elizabeth R Graef
- Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jean W Liew
- Department of Medicine, Division of Rheumatology, University of Washington, Seattle, Washington, USA
| | - Alfred Hj Kim
- Medicine/Rheumatology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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28
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López-González MDC, Peral-Garrido ML, Calabuig I, Tovar-Sugrañes E, Jovani V, Bernabeu P, García-Sevila R, León-Ramírez JM, Moreno-Perez O, Boix V, Gil J, Merino E, Vela P, Andrés M. Case series of acute arthritis during COVID-19 admission. Ann Rheum Dis 2020; 80:e58. [PMID: 32471899 DOI: 10.1136/annrheumdis-2020-217914] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Affiliation(s)
| | | | - Irene Calabuig
- Reumatología, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Vega Jovani
- Rheumatology, Hospital General de Alicante, Alicante, Spain
| | - Pilar Bernabeu
- Reumatología, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - Oscar Moreno-Perez
- Endocrinologia y Nutricion, Hospital General Universitario de Alicante, Alicante, Spain.,Medicina Clínica, Universidad Miguel Hernandez de Elche, Elche, Spain
| | - Vicente Boix
- Medicina Clínica, Universidad Miguel Hernandez de Elche, Elche, Spain.,Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Alicante, Spain
| | - Joan Gil
- Neumología, Hospital General Universitario de Alicante, Alicante, Spain
| | - Esperanza Merino
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Alicante, Spain
| | - Paloma Vela
- Medicina Clínica, Universidad Miguel Hernandez de Elche, Elche, Spain.,Rheumatology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Mariano Andrés
- Seccion de Reumatologia, Hospital General Universitario de Alicante, Alicante, Spain .,Medicina Clínica, Universidad Miguel Hernandez de Elche, Elche, Spain
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29
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Graef ER, Liew JW, Kim AHJ, Sparks JA. Response to: ‘Antimalarial use and arrhythmias in COVID-19 and rheumatic patients: a matter of dose and inflammation?’ by Erre et al. Ann Rheum Dis 2020; 80:e30. [DOI: 10.1136/annrheumdis-2020-217923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/25/2022]
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30
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Erre GL, Ferraccioli ES, Piga M, Mangoni A, Passiu G, Gremese E, Ferraccioli G. Antimalarial use and arrhythmias in COVID-19 and rheumatic patients: a matter of dose and inflammation? Ann Rheum Dis 2020; 80:e29. [DOI: 10.1136/annrheumdis-2020-217828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 01/08/2023]
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