Recently rheumatologists have been surprised by the presentations and potential parallels with autoimmune diseases and systemic sclerosis (SSc). Professor Denton, a global expert in systematic sclerosis, has been working on the frontline in COVID-19 care at the Royal Free Hospital in London, and will be questioned by Dr Stephanie Kaye-Barrett, Consultant Physician and Rheumatologist, about the parallel aspects of autoimmune diseases, systemic sclerosis and COVID-19.
So far, Professor Denton has found the following:
”There does seem to be some parallels with severe SSc in subsets of patients that have an IL6 driven inflammation with pneumonitis and myocarditis. This may fit with the classical “biphasic” subset of COVID that has upper respiratory symptoms for 5-7days, malaise/myalgia 5-7days then lower respiratory symptoms and can evolve into hyper-inflammation (and often is the point of hospitalisation with oxygen dependence). This is also the subset that may respond to tocilizumab (from Chinese experience) – Recovery trial and Roche trial in progress. By analogy, we have now shown in 2 trials in early active dcSSc (with Roche) that lung and heart complications are very much reduced by tocilizumab and the link between IL6 and early fibrosis is strong in SSc. Our data suggest that there is a subset of early dcSSc where IL6 drives early progressive lung and heart decline.”
”However there are other relevant subgroups and I would also highlight those with less parenchymal lung disease (on imaging) and more hypoxia that would fit with acute pulmonary vasculopathy/microvascular disease. There is speculation this could involve intravascular thrombosis. Active discussion with our PH colleagues about pulmonary vasodilators and anticoagulants – including LMWH. Some literature to support this as well (from China).”
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