ABSTRACT
At times, unusual presentations may lead to an erroneous diagnosis of an idiopathic vasculitis, connective tissue disorders, or hyperinflammatory syndromes of unclear origin in the event of false-negative COVID-19 PCR. [...]it is imperative to maintain a high degree of clinical suspicion during the pandemic period and actively look out for relatively specific signs of COVID-19 like anosmia for timely diagnosis. On occasion, classic dermatomyositis-like presentations, replete with classic rashes have been reported, raising the case for de novo virus-triggered autoimmune disease. [...]similarities are seen between anti MDA5 antibody-associated muscle-lung syndromes and COVID-19 since both involve a 'cytokine storm' (a maladaptive overproduction of inflammatory cytokines including IL-1, IL6, and TNF-alpha) and ultimately diffuse alveolar damage (the clinical presentation being acute respiratory distress syndrome) with similar radiological and histological findings (5). While immunosuppressive therapy has had mixed results in the management of COVID-19, corticosteroids have come to the forefront of this battle with a decrease in mortality in hospitalized patients with severe COVID19 Even though COVID-19 is an acute disease, some effects last greater than 3 months or even longer in nearly three-quarters of those afflicted with the virus.
ABSTRACT
Depression is a common co-morbidity among rheumatoid arthritis (RA) patients, which may translate into difficulty performing activities of daily living. COVID-19 is an unprecedented disaster that has disrupted lives worldwide and led to a rise in the incidence of mental health disorders. Given the widespread economic devastation due to COVID-19, many RA patients, already susceptible to mental illness, maybe at an increased risk of inaccessibility to medical care, accentuated stress, and consequent worsening of existent mental health disorders, or the onset of new mental health disorders such as anxiety, post-traumatic stress disorder, or depression. The objective of this review is to assess if there is an increased risk of mental health disorders in patients with RA during the COVID-19 pandemic. Telemedicine has bridged the transition to remote chronic care in the pandemic period, though certain accessibility and technological challenges are to be addressed. Decreased access to care amid lockdowns and a proposed triggering of disease activity in patients with autoimmune disorders may potentially herald a massive spike in incidence or flares of patients diagnosed with RA in the coming months. Such a deluge of cases may be potentially devastating to an overburdened healthcare system. Rheumatologists may need to prepare for this eventuality and explore techniques to provide adequate care during these challenging times. The authors found that there is a significant association between the adverse impact on the mental health of RA patients and the COVID-19 pandemic. However, more research is needed to highlight individual risk factors.