From 7T MRI performed at Brigham and Women’s Hospital in Study Patient 1. This is a T2* gradient-echo sequence (0.8 mm isotropic voxels) showing a typical MS lesion (arrow) as oval, and bright, containing a central (dark) vessel.
During the COVID-19 pandemic, patients with multiple sclerosis (MS) and their clinicians have had questions and concerns about whether immunotherapies for MS could influence risk for infection or lead to an unfavorable outcome.
Remdesivir has emerged as a promising therapeutic candidate for the treatment of COVID-19 due to its ability to inhibit pathogenic animal and human coronaviruses, including severe acute respiratory syndrome 2 (SARS-CoV-2) and Middle East Respiratory Syndrome coronavirus (SARS-CoV-1).
SARS-CoV-2 and influenza A (H1N1) are in the same category of virus and both infect the respiratory tract. However, research has shown distinctive vascular changes in the lungs of patients with COVID-19 compared to those with H1N1.
Early reports of the COVID-19 outbreak in Wuhan, China included evidence of coagulation abnormalities in some patients. Since then, studies have shown an increase in venous thromboembolism (VTE)—including deep vein thrombosis (DVT) and pulmonary embolism (PE)—in some patients with COVID-19. Higher rates of incidence have been observed in patients in the intensive care unit (ICU) than in other hospitalized COVID-19 patients.
At Brigham and Women’s Hospital, nephrologists have observed an increased risk of acute kidney injury (AKI) in COVID-19 patients. Within the intensive care units (ICUs) at the Brigham, about 15 to 20 percent of COVID-19 patients have developed AKI. In some hospitals, the incidence of AKI has been reported to be as high as 25 percent.
Despite being highly contagious, a significant portion of people infected with COVID-19 don’t experience any symptoms. Those people who do exhibit symptoms most commonly experience dry cough, fever and difficulty breathing. However, there are also a myriad of atypical symptoms that may be under-reported.
“Who knew that rheumatology patients would be right in the middle of the COVID-19 crisis?”
This question was posed by rheumatologist Karen H. Costenbader, MD, MPH, director of the Brigham and Women’s Hospital Lupus Program and chair of the Medical and Scientific Advisory Council for the Lupus Foundation of America. In these roles, she has found herself at the center of the controversy around the use of hydroxychloroquine (HCQ) and other rheumatology medications in COVID-19. Read More
In the span of just a few months, the COVID-19 pandemic has transformed the practice of rheumatology and the entire field of clinical medicine. Traditional ways of doing things, from seeing patients to leading teaching rounds, have been temporarily or permanently abandoned.
Nevertheless, teaching hospitals must stay true to their mission of educating the next generation of clinicians. And so, many are striving to adapt to this strange new reality. Read More
Cytokine storm syndromes are associated with autoimmune diseases such as systemic juvenile idiopathic arthritis (sJIA), adult onset Still’s disease and systemic lupus erythematosus. Speculation is mounting that they may also play a role in severe cases of COVID-19.
“We don’t know for sure yet if there’s cytokine storm in COVID-19, but it certainly looks that way in some patients,” said Peter A. Nigrovic, MD, director of the Brigham and Women’s Hospital Center for Adults with Pediatric Rheumatic Illness and the principal investigator of a basic science laboratory focused on mechanisms of inflammation. “Based on some of the findings in the blood of the sickest individuals, it may well be that the immune system mediates damage rather than serving to protect the host. We want to be able to recognize those cases where immunosuppression could optimize patient outcomes.” Read More
As of early May 2020, the United States had 1.19 million confirmed coronavirus cases and nearly 70,000 deaths due to COVID-19. In the urgent quest for therapeutic solutions, some have looked to antimalarial medications such as hydroxychloroquine (HCQ).
A recent paper in Annals of the Rheumatic Diseases argues that rheumatologists as well as “researchers and patient partners must advocate for the appropriate distribution and use of HCQ, as millions of people with rheumatic diseases worldwide depend on HCQ to control disease activity and maintain quality of life.” Read More