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A complex COVID-19 case with rheumatoid arthritis treated with tocilizumab.
Clin Rheumatol. 2020 Sep; 39(9):2797-2802.CR

Abstract

Recurrences of COVID-19 were observed in a patient with long-term usage of hydroxychloroquine, leflunomide, and glucocorticoids due to her 30-year history of rheumatoid arthritis (RA). Tocilizumab was applied and intended to target both COVID-19 and RA. However, disease of this patient aggravated after usage of tocilizumab. After the discussion of a multiple disciplinary team (MDT) including rheumatologists, antimicrobial treatments were applied to target the potential opportunistic infections (Pneumocystis jirovecii and Aspergillus fumigatus), which were authenticated several days later via high throughput sequencing. As an important cytokine in immune responses, IL-6 can be a double-edged sword: interference in the IL-6-IL-6 receptor signaling may save patients from cytokine release storm (CRS), but can also weaken the anti-infectious immunity, particularly in rheumatic patients, who may have received a long-term treatment with immunosuppressive/modulatory agents. Thus, we suggest careful considerations before and close monitoring in the administration of tocilizumab in rheumatic patients with COVID-19. Besides tocilizumab, several disease-modifying antirheumatic drugs (DMARDs) can also be applied in the treatment of COVID-19. Therefore, we also reviewed and discussed the application of these DMARDs in COVID-19 condition.

Authors+Show Affiliations

Department of Rheumatology and Immunology, Tongji Hospital, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, China.Department of Stomatology, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China.Department of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, No. 28 Baofeng Road, Wuhan, China. drliming1992@outlook.com.Department of Rheumatology and Immunology, Tongji Hospital, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, China. tjhdongll@163.com.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

32562070

Citation

Cai, Shaozhe, et al. "A Complex COVID-19 Case With Rheumatoid Arthritis Treated With Tocilizumab." Clinical Rheumatology, vol. 39, no. 9, 2020, pp. 2797-2802.
Cai S, Sun W, Li M, et al. A complex COVID-19 case with rheumatoid arthritis treated with tocilizumab. Clin Rheumatol. 2020;39(9):2797-2802.
Cai, S., Sun, W., Li, M., & Dong, L. (2020). A complex COVID-19 case with rheumatoid arthritis treated with tocilizumab. Clinical Rheumatology, 39(9), 2797-2802. https://doi.org/10.1007/s10067-020-05234-w
Cai S, et al. A Complex COVID-19 Case With Rheumatoid Arthritis Treated With Tocilizumab. Clin Rheumatol. 2020;39(9):2797-2802. PubMed PMID: 32562070.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A complex COVID-19 case with rheumatoid arthritis treated with tocilizumab. AU - Cai,Shaozhe, AU - Sun,Wei, AU - Li,Ming, AU - Dong,Lingli, Y1 - 2020/06/19/ PY - 2020/05/17/received PY - 2020/06/09/accepted PY - 2020/06/02/revised PY - 2020/6/21/pubmed PY - 2020/8/21/medline PY - 2020/6/21/entrez KW - Coronavirus disease 2019 KW - Rheumatoid arthritis KW - Secondary opportunistic infection KW - Tocilizumab SP - 2797 EP - 2802 JF - Clinical rheumatology JO - Clin. Rheumatol. VL - 39 IS - 9 N2 - Recurrences of COVID-19 were observed in a patient with long-term usage of hydroxychloroquine, leflunomide, and glucocorticoids due to her 30-year history of rheumatoid arthritis (RA). Tocilizumab was applied and intended to target both COVID-19 and RA. However, disease of this patient aggravated after usage of tocilizumab. After the discussion of a multiple disciplinary team (MDT) including rheumatologists, antimicrobial treatments were applied to target the potential opportunistic infections (Pneumocystis jirovecii and Aspergillus fumigatus), which were authenticated several days later via high throughput sequencing. As an important cytokine in immune responses, IL-6 can be a double-edged sword: interference in the IL-6-IL-6 receptor signaling may save patients from cytokine release storm (CRS), but can also weaken the anti-infectious immunity, particularly in rheumatic patients, who may have received a long-term treatment with immunosuppressive/modulatory agents. Thus, we suggest careful considerations before and close monitoring in the administration of tocilizumab in rheumatic patients with COVID-19. Besides tocilizumab, several disease-modifying antirheumatic drugs (DMARDs) can also be applied in the treatment of COVID-19. Therefore, we also reviewed and discussed the application of these DMARDs in COVID-19 condition. SN - 1434-9949 UR - https://www.unboundmedicine.com/medline/citation/32562070/A_complex_COVID_19_case_with_rheumatoid_arthritis_treated_with_tocilizumab_ L2 - https://dx.doi.org/10.1007/s10067-020-05234-w DB - PRIME DP - Unbound Medicine ER -