Brigham Clinicians Help Develop COVID-19 Clinical Guidelines

“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

COVID-19 Driving Evolution in Rheumatology Teaching

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

Creating a Roadmap to Negotiating Cytokine Storm in COVID-19

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

Rheumatologists as Patient Advocates in the COVID-19 Era

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

Rapid Innovation in the Fight Against COVID-19

With expertise that spans basic, translational and clinical research, Brigham and Women’s Hospital clinicians and investigators are working tirelessly to address the most urgent needs related to the COVID-19 pandemic.

To help reduce the spread of COVID-19, the Brigham has shut down most of its physical research labs. But many labs are still performing COVID-19 research remotely to better understand SARS-CoV-2 and COVID-19 in order to develop treatment strategies against them. Read More

Enhancing Safety of Clinicians Intubating COVID-19 Patients

Emergency medicine doctors and anesthesiologists at Brigham and Women’s Hospital have worked together to create lightweight hoods that provide a physical barrier between COVID-19 patients and clinicians during intubation. These homemade devices, each constructed with less than $20 worth of materials, offer an additional, urgently needed layer of protection when treating COVID-19 patients. Read More

Preventing Two Potentially Fatal Complications of COVID-19

A decision by Brigham and Women’s Hospital in the early days of the COVID-19 pandemic is helping patients hospitalized with the virus avoid two potentially fatal complications: deep vein thrombosis (DVT) and pulmonary embolism (PE). The Brigham’s protocol to give all hospitalized patients a prophylactic anticoagulant dose of low-molecular-weight heparin (LMWH) addresses blood clot risk factors that are particularly acute in patients with COVID-19. Read More

Finding the Right Time for Tracheotomy in COVID-19 Patients

Dr. Matthew Rochefort and Dr. Anthony Coppolino performing a bedside percutaneous tracheostomy in a COVID positive patient.Dr. Matthew Rochefort and Dr. Anthony Coppolino prepared to perform a bedside percutaneous tracheostomy in a COVID+ patient.

How does one determine when to employ tracheotomy in COVID-19 patients requiring prolonged mechanical ventilation? It’s difficult to say given what relatively little we know about the disease at this point. Stephanie L. Nitzschke, MD, an acute care surgeon, trauma surgeon and surgical intensivist, is one of the clinicians developing guidelines on tracheotomy timing at Brigham and Women’s Hospital.

Dr. Nitzschke said that in order to balance the safety of patients and health care workers, the Brigham is delaying consideration of tracheotomy until 21 days after a positive test for COVID-19. But she stressed that all protocols related to this disease are subject to change. Read More

Setting the Record Straight About Hydroxychloroquine, NSAIDs and COVID-19

As the scope of the coronavirus pandemic broadens, it is only natural for people to look to the scientific and research communities for solutions. In recent weeks, however, the thirst for viable treatment options has contributed to drug shortages and misinformation for patients with rheumatic diseases.

Two cases in point involve hydroxychloroquine and ibuprofen. Laura L. Tarter, MD, and Daniel Hal Solomon, MD, MPH, of the Brigham and Women’s Hospital’s Division of Rheumatology, Inflammation and Immunity offer their perspectives on each of these issues, which carry significant implications for rheumatic care during this health crisis. Read More

Rheumatologists Worldwide Pulling Together in Face of Coronavirus Pandemic

Rheumatologists have a critical role to play in optimizing the response to COVID-19 and outcomes for our patients with rheumatic diseases. In just the past few weeks, rheumatologists at Brigham and Women’s Hospital and around the world have joined forces for this purpose.

“I’ve been very impressed by how quickly the rheumatology community has come together,” said rheumatologist Susan Y. Ritter, MD, PhD, associate medical director of the Brigham’s Arthritis Center. “I’ve seen multiple people communicating via email, Twitter and Facebook to get the word out to rheumatologists and make sure we have as much data as possible.” Read More