Rheumatology Department, 424 General Military Hospital, Thessaloniki, Greece
Periklis Vounotrypidis
Volume 31, Issue 3 - Supplement 2, September 2020
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44355517
Mediterr J Rheumatol 2020;31(Supp 2):275-83
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COVID-19: An Archetype Innate Immunity Reaction and Modes of Treatment
Abstract
The magnitude of the SARS-CoV-2 pandemic found health systems unprepared, not allowing for prompt evaluation, collaboration among specialities and treatment of severely ill patients admitted to intensive care units, with many of them having an unfortunate outcome.
Current data demonstrate an acute immune dysregulation in severe forms of the disease. The above is concluded by clinical evolution and laboratory findings, indicating a severe inflammatory response of the innate immune system, initiating predominately with the involvement of the respiratory tract epithelial cells, occasionally progressing to thrombotic diathesis and related complications. Besides the clinical manifestations, the immune response expresses an extremely high acute phase reactants repertoire including hyperferritinemia, hyper-fibrinogenaemia, and a storm of cytokines that require an alternative view and collaboration with rheumatologists. Thrombotic diathesis in some cases may not attribute only to a possible disseminated intravascular coagulation, but also to an additional activation of adaptive immunity and the development of the antiphospholipid syndrome.
Unifying speciality evaluation and treatment may improve patient outcomes by recognizing early the evolving syndromes, treating properly, in a stratifying manner, with medications that alleviate the inflammatory reaction. Corticosteroids, colchicine, hydroxychloroquine/chloroquine, and possibly potent immunosuppressants are in the armamentarium. Additionally, biologics that interrupt the innate immune dysfunction, such as IL-1, IL-6 and selective JAK inhibitors, are also used. Convalescent plasma therapy and human immunoglobulin may be restricted for those whom the proposed treatments are found inadequate. The above combined with antiretroviral medications may improve the outcome until the development of safe and effective vaccination.
https://doi.org/10.31138/mjr.31.3.275
This work is licensed under a Creative Commons Attribution 4.0 International License. 
©Vounotrypidis P.
Article Submitted: 6 May 2020; Revised Form: 14 Jul 2020; Article Accepted: 31 Jul 2020; Available Online: 8 Sep 2020
Keywords: SARS-CoV-2, rheumatology, hyperferritinaemia, immunotherapy, corticosteroids, disease-modifying anti-rheumatic drugs
