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Picking the Right Arthritis Medication

If you use a disease-modifying anti-rheumatic drug (DMARD) — whether it’s a traditional DMARD like methotrexate or a biologic DMARD like adalimumab (Humira) — you likely know that these medications may make you more likely to develop infections because they work on your immune system. Yet rheumatologists, gastroenterologists, dermatologists, and other health care providers have been advising and continue to recommend that most patients continue using these medications right now because the risk of stopping them is greater than the risk of this potential side effect, even in light of the COVID-19 pandemic.

Now, a new small study on rheumatology patients from Italy confirms that this advice is sound.

The study, published in the journal Annals of the Rheumatic Diseases, involved 320 people in Italy with rheumatoid arthritis (RA) or spondyloarthritis (SpA), all of whom were using a traditional or biological DMARD when COVID-19 first hit in the region.

During the first month of the outbreak, four of the participants were officially diagnosed with COVID-19; another four had symptoms that suggested they probably had the virus.

All the participants with confirmed or suspected cases of COVID-19 temporarily stopped their DMARD medication after they developed symptoms, which did not appear to endanger them as far as their rheumatic condition or coronavirus complications were concerned. “To date, there have been no significant relapses of the rheumatic disease,” the authors wrote.  None of them developed severe respiratory complications of COVID-19 either.

Although the researchers were quick to point out that their study does not prove anything about how likely people with rheumatic disease are to contract COVID-19 or to recover from it, they concluded that their “preliminary experience shows that patients with chronic arthritis treated with [biologic] DMARDs or [traditional] DMARDs do not seem to be at increased risk of respiratory or life-threatening complications from [COVID-19] compared with the general population.”

In the paper, they also noted that mortality rates for people with rheumatic diseases taking immunosuppressive medication were not higher during earlier outbreaks of similar viruses (SARS and MERS).

The authors concluded by saying that rheumatologists should continue to urge patients who use DMARDs to stick with them — unless they develop signs of COVID-19. (It is common practice to withhold these medications for certain patients when they get infections — whether that is a bad cold, flu, or COVID-19 — to help their immune systems recover more quickly.)

“Although continuous surveillance of patients with rheumatic diseases receiving immunosuppressive drugs is warranted, these data can support rheumatologists for the management and counselling of their patients, avoiding the unjustifiable preventive withdrawal of DMARDs, which could lead to an increased risk of relapses and morbidity from the chronic rheumatological condition,” the authors wrote.

As this study included a small group of patients and is preliminary, the authors also state that “a high level of vigilance and strict follow-up should be maintained on [rheumatology patients who develop COVID-19].”

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Monti S, et al. Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies. Annals of the Rheumatic Diseases. doi: http://dx.doi.org/10.1136/annrheumdis-2020-217424.