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.
Clin Rheumatol. 2020 Sep;39(9):2797-2802. doi: 10.1007/s10067-020-05234-w. Epub 2020 Jun 19.
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.
COVID-19 的复发发生在一位患有类风湿关节炎（RA）长达 30 年的患者身上，该患者长期使用羟氯喹、来氟米特和糖皮质激素。应用托珠单抗来同时针对 COVID-19 和 RA。然而，在使用托珠单抗后，该患者的病情加重。经过包括风湿病学家在内的多学科团队（MDT）的讨论，针对潜在的机会性感染（卡氏肺孢子虫和烟曲霉）应用了抗菌治疗，几天后通过高通量测序证实了这些感染。白细胞介素 6（IL-6）作为免疫反应中的一种重要细胞因子，可谓一把双刃剑：干扰 IL-6-IL-6 受体信号可能使患者免于细胞因子释放综合征（CRS），但也会削弱抗感染免疫，尤其是在接受免疫抑制/调节药物长期治疗的风湿病患者中。因此，我们建议在 COVID-19 合并风湿病患者中使用托珠单抗之前和治疗期间进行仔细考虑和密切监测。除了托珠单抗，还有几种改善病情的抗风湿药物（DMARDs）也可用于 COVID-19 的治疗。因此，我们还回顾和讨论了这些 DMARDs 在 COVID-19 情况下的应用。
