Patients with rheumatoid arthritis should be more vigilant

Doctors advice not to use Hydroxychloroquine for the prevention and treatment of COVID-19 without the advice of a specialist doctor

Patients, COVID-19, Hydroxychloroquine, Treatment of COVID-19, Specialist doctor, JAK inhibitors, National Rheumatoid Arthritis Society, NRAS, Disease Control, US President Donald Trump, Raju Vaishya, Orthopedic Surgeon

Given the current outbreak of Coronavirus (COVID-19), Orthopedic experts recommend patients with Rheumatoid Arthritis to be extra cautious because people with the rheumatic disease may be at greater risk of developing infections and more severe infections.

“Rheumatology patients on steroids, biologics, or JAK inhibitors are likely to have a lowered immune resistance. However, the poorly controlled rheumatic disease can also lower resistance to infection, and as well as causing all the complications of Rheumatoid arthritis. And it can be harmful due to a sudden reduction in the dose of steroid medication. Therefore, the advice of the experts must be sought and take all sensible precautions to keep safe,” said Dr. (Prof.) Raju Vaishya, Senior Orthopedic Surgeon at Indraprastha Apollo Hospitals, New Delhi, and President of Arthritis Care Foundation (ACF).

According to the Centers for Disease Control and Preventions (CDC) of the USA, “based upon limited in-vitro and anecdotal data, chloroquine or hydroxychloroquine are currently being used for the treatment of hospitalized COVID-19 patients in several countries”.

As per the National Rheumatoid Arthritis Society (NRAS) of the UK, both chloroquine and hydroxychloroquine have known safety profiles,  but still, the main concerns being cardiac toxicity with prolonged use (in patients with liver and kidney dysfunction) and immune suppression. Moreover, there are no currently available data to inform clinical guidance on the use, dosing, or duration of hydroxychloroquine for prophylaxis or treatment of CORONA infection. Moreover, the optimal dosing and duration of hydroxychloroquine for the treatment of COVID-19 are also unknown. Hydroxychloroquine and Chloroquine are oral prescription drugs that have been used for the treatment of malaria, and certain inflammatory joint diseases like Rheumatoid Arthritis.

Dr. (Prof.) Vaishya said that Hydroxychloroquine is not entirely safe; its use may be associated with several side effects like nausea, stomach cramps, and diarrhea. The most serious adverse effects affect the eye (retinopathy) and the heart.  Children are especially vulnerable to developing adverse effects from hydroxychloroquine. Hence, its use for the prevention and treatment of Coronavirus cannot be justified presently, without the advice of a specialist doctor”.

It may be noted that chloroquine and hydroxychloroquine are being used for the treatment for COVID-19 in India also. Recently US President Donald Trump underlined the significance of chloroquine formulations as a potential answer for treatment of COVID-19, but the FDA has not yet approved chloroquine and hydroxychloroquine for treating COVID-19.