key: cord-0973532-23x0btii
authors: Lewandowski, Laura B; Hsieh, Evelyn
title: Global rheumatology in the time of COVID-19
date: 2020-04-06
journal: Lancet Rheumatol
DOI: 10.1016/s2665-9913(20)30091-6
sha: dee30ddf145103a54d6345837569c950d622eccc
doc_id: 973532
cord_uid: 23x0btii

nan

The global coordinated and rapid response to this devastating out break shows the tenets of global health: that humans are all connected, and that the health of a person in one part of the world is relevant to the health of humans every where. Rheumatology professionals care for patients with diseases that have a high risk of morbidity and mortality and manage rare dis eases; a global collaboration enables these professionals to collect enough data to inform clinical decisions. The sharing and dissemination of information about the diagnosis and management of rheumatic dis eases worldwide is important at all times, but is especially crucial during these uniquely uncharted times. Rheumatologists are managing a new threat, but the development of tools, such as telehealth platforms and opensource algorithms, can help inform strategies for global educa tion and communication within the rheumatology community beyond the COVID19 threat. We believe that the global community created in this dire time has the power and

At the 2019 American College of Rheumatology (ACR) annual meeting, we chaired a session entitled "Frontiers and Opportunities in Global Rheumatology Research", which was a call to action for the rheumatology community to think globally about the burden of rheumatic and musculoskeletal diseases. The current outbreak of a novel coronavirus has caught the attention of the medical community and the world at large. A local out break of a respiratory illness was first reported to WHO on Dec 31, 2019, in Wuhan, China. The causative agent was identified as a novel coronavirus now known as severe acute respiratory syndrome coronavirus 2 (SARSCoV2), and the resulting disease is now known as coronavirus disease 2019 (COVID19). 1 The virus spread quickly throughout China, and subsequently the world. At the time of the ACR session in November, 2019, noone could have imagined the global pandemic that is now unfolding.

The rheumatology community has responded rapidly to SARSCoV2, a highly contagious virus with a case fatality rate ranging from 0·9% overall to 5·0-10·0% in patients older than 70 years in the Chinese population. 2 There is substantial concern among rheumatologists regarding a poten tially increased risk of infection and death among patients who are immuno suppressed, including those with rheumatic disease. Few data on this possible risk exist to date; at the time of this Correspondence being published, there is a regis tered retrospective study in China for patients with rheumatic disease and a case series from the USA listing rheumatic disease as a preadmission comorbidity. 3 As studies regard ing treatments for and outcomes of COVID19 emerge, it seems pos sible that immunomodulation could alter the disease course of COVID19.

Many reports have cited the use of medications commonly found in the rheumatology armamentar ium for the management of COVID19, includ ing hydroxychloroquine, gluco corticoids, intravenous immuno globulin, anti interleukin (IL)1 and antiIL6 therapies, and Janus kinase inhibitors. 4 The world is watch ing with great interest to see if those drugs can save lives during this pandemic. In addition to the rapid progression of respiratory failure, COVID19 seems to be most fatal when it triggers a cytokine storm. 5 However, there are currently no tools to identify patients at greatest risk of develop ing this complication, and the mechanisms by which this reaction occurs in the setting of COVID19 are not fully understood.

In the rheumatology community, an international coalition, the COVID19 Global Rheumatology Alliance, has come together to launch a global registry of patients with rheumatic and musculoskeletal diseases with COVID19, for physicians world wide to report these cases of COVID19 and support the collection of patient reported cases. The alliance was developed and publicised through social media, email listservs, and personal and professional networks. Within 48 h of inception, the COVID19 Global Rheumatology Alliance had engaged rheumatologists across six continents; support from non profit organisations promoting the health of patients with rheumatic diseases and major rheumatology journals followed soon after, with approximately 100 organisations endorsing the alliance at the time of this Correspondence. The COVID19 Alliance will obtain data on any patient with rheumatic disease who tests positive for SARSCoV2, capturing the range from mild to severe cases, with the goal of informing risk and best practice during the outbreak. With this novel pathogenic threat, there is much that is not yet known, and many ways this virus could impact the rheumatology community (panel). commitment to remain unified when the pandemic has passed. Our modern world is more interconnected now than during any era before; let the rheuma tology community reflect that, now and after the COVID19 pandemic.

Covid19 -Navigating the Uncharted

Characteristics of and important lessons from the coronavirus disease 2019 (COVID19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention

Characteristics and outcomes of 21 critically ill patients with COVID19 in Washington State

COVID19 treatment: a review of early and emerging options

Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China

We declare no competing interests. LL was funded in part by the Intramural Research Programme of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health. EH was supported by the Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (K01TW009995).