Infectious Disease

COVID-19 encourages rheumatologists to wear additional “immunologist, virtualist” hats

17th August 2021

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Cron-RQ. The role of rheumatologists in COVID-19. Presented at: Congress of Clinical Rheumatology-East annual symposium; 12-15 August 2021 (hybrid meeting).

Disclosure:
Cron reports that he has advised Novartis and Sironax, participated in clinical trials for Pfizer, and served as spokesperson and advisor for Sobi.

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During the COVID-19 pandemic, rheumatologists have seen a dramatic expansion of their typical roles, adopting the attributes of immunologists and virtualists to effectively manage care, according to a moderator here.

“Thank goodness there are infectious disease doctors, ED docs and intensive care physicians.” Randall Q. Cron, MD, PhD, Director of Pediatric Rheumatology at the University of Alabama at Birmingham, told the participants of the Congress for Clinical Rheumatology 2021-East. “You have done a great job, but we as rheumatologists also have a role to play.”

COVID-19 prevention

“Learn as much immunology as you can, because that’s us,” Randall Q. Cron, MD, PhD told participants. “As rheumatologists, we are immunologists, and we understand these drugs because we use them on our patients.” Source: Adobe Stock

Cron noted that in the early days of COVID-19, in severe cases of COVID-19, clinicians reported an inflammation pattern similar to cytokine storm syndrome, which is known to occur in certain rheumatological conditions. Involvement in cytokine storms was often fatal in both rheumatology and the COVID-19 environment, having set the stage for rheumatologists to be on the front lines in the fight against the virus.

“The traits that were recorded, both clinical and laboratory, shared traits with other cytokine storms,” ​​said Cron. “It has been suggested to some of us that the therapies we are using to treat cytokine storm – which we were more familiar with – might be beneficial in treating the sickest of the sick.”

Randall Q. Cron

Bringing in this expertise, however, has not been without resistance, noted Cron. “Based on the data available in early January / February 2020, steroids were a no-go,” he said. “I was part of our local effort to develop treatment plans for our patients, and I received a lot of backlash for believing that an IL-1 blockade or glucocorticoids could help these patients.”

As more and more evidence has shown that the drugs used to treat similar traits in other cytokine storms can work in severe COVID-19 cases, rheumatologists are increasingly turning to a huge arsenal of therapies, including IL-1 and IL-1 for their expertise IL-6 inhibition.

In response, Cron urged attendees to “learn as much immunology as possible, because that’s us. As rheumatologists, we are immunologists, and we understand these drugs because we use them on our patients. “

Additionally, the pandemic has spurred rheumatologists to become “virtualists,” noted Cron, as COVID-19 has forced an otherwise hesitant field to take advantage of virtual medicine.

“Before COVID, I kind of fought and fought telemedicine, mainly because, like many people, I don’t like changes, but also because there was data – at least in pediatrics – that people would still have preferred to drive 6 hours than it to do virtually, “said Cron. “As a pediatric rheumatologist – and as a rheumatologist in general – I never would have thought that we could, for example, perform great joint examinations or other parts of our holistic examination virtually, considering that we treat patients from head to toe. Still, I’m a big convert. “

With the University of Alabama at Birmingham being one of the few pediatric rheumatology clinics in the state, Cron found that telemedicine makes things a lot easier for families who were previously forced to travel 4 to 5 hours for an exam. Although Cron noted some distinct drawbacks of telemedicine in rheumatology – “It’s difficult to get subtle insights into the video device being used, and as such, I don’t think it’s ideal for new patients” – telemedicine has cut travel times, there as well missed school and work days for parents of pediatric patients.

“It has definitely opened up access for rare doctors like pediatric rheumatologists or even adult rheumatologists,” said Cron. “Telehealth is hopefully here to stay when third-party payers can’t make it a monthly issue of whether or not they’ll pay for it.”

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Congress for Clinical Rheumatology Annual Meeting

Congress for Clinical Rheumatology Annual Meeting

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