Correspondence

Global rheumatology in Many reports have cited the use of The global coordinated and rapid
medications commonly found in the response to this devastating out­
the time of COVID-19 rheumatology armamentar­ium for the break shows the tenets of global
At the 2019 American College management of COVID-19, includ­ing health: that humans are all connected, Lancet Rheumatol 2020
of Rheumatology (ACR) annual hydroxychloroquine, gluco­corticoids, and that the health of a person in Published Online
meeting, we chaired a session entitled intravenous immuno­globulin, anti- one part of the world is relevant April 6, 2020
https://doi.org/10.1016/
“Frontiers and Opportunities in Global interleukin (IL)-1 and anti-IL-6 to the health of humans every­ S2665-9913(20)30091-6
Rheumatology Research”, which was therapies, and Janus kinase inhibitors.4 where. Rheumatology professionals
a call to action for the rheumatology The world is watch­ing with great care for patients with diseases that
community to think globally about interest to see if those drugs can save have a high risk of morbidity and
the burden of rheumatic and lives during this pandemic. In addition mortality and manage rare dis­eases;
musculoskeletal diseases. The current to the rapid progression of respiratory a global collaboration enables these
outbreak of a novel coronavirus has failure, COVID-19 seems to be most professionals to collect enough data to
caught the attention of the medical fatal when it triggers a cytokine storm.5 inform clinical decisions. The sharing
community and the world at large. However, there are currently no tools and dissemination of information
A local out­ break of a respiratory to identify patients at greatest risk of about the diagnosis and management
illness was first reported to WHO develop­ing this complication, and the of rheumatic dis­eases worldwide is
on Dec 31, 2019, in Wuhan, China. mechanisms by which this reaction important at all times, but is especially
The causative agent was identified occurs in the setting of COVID-19 are crucial during these uniquely uncharted
as a novel coronavirus now known not fully understood. times. Rheumatologists are managing
as severe acute respiratory syndrome In the rheumatology community, an a new threat, but the development
coronavirus 2 (SARS-CoV-2), and the international coalition, the COVID-19 of tools, such as telehealth platforms For the COVID-19 Global
resulting disease is now known as Global Rheumatology Alliance, has and open-source algorithms, can help Rheumatology Alliance see
https://rheum-covid.org
coronavirus disease 2019 (COVID-19).1 come together to launch a global inform strategies for global educa­
The virus spread quickly throughout registry of patients with rheumatic tion and communication within the
China, and subsequently the world. and musculoskeletal diseases with rheumatology community beyond
At the time of the ACR session in COVID-19, for physicians world­wide the COVID-19 threat. We believe
November, 2019, no-one could have to report these cases of COVID-19 that the global community created
imagined the global pandemic that is and support the collection of patient- in this dire time has the power and
now unfolding. reported cases. The alliance was
The rheumatology community has developed and publicised through
Panel: Scientific and clinical challenges facing the
responded rapidly to SARS-CoV-2, a social media, email listservs, and
rheumatology community during the COVID-19 pandemic
highly contagious virus with a case personal and professional networks.
fatality rate ranging from 0·9% overall Within 48 h of inception, the COVID-19 • Elucidating the host response to viral infection and risk factors
to 5·0–10·0% in patients older than Global Rheumatology Alliance had for progression to severe or critical disease and mortality,
70 years in the Chinese population.2 engaged rheumatologists across particularly in the context of the aging immune system
There is substantial concern among six continents; support from non- • Identifying potential genetic susceptibility factors that
rheumatologists regarding a poten­ profit organisations promoting the influence the risk of acquisition of SARS-CoV-2 and mortality
tially increased risk of infection health of patients with rheumatic from COVID-19
and death among patients who are diseases and major rheumatology • Identifying optimal management strategies for patients on
immuno­suppressed, including those journals followed soon after, with immunosuppressant medications with consideration of
with rheumatic disease. Few data approximately 100 organisations SARS-CoV-2
• Understanding the short-term and long-term multisystem
on this possible risk exist to date; endorsing the alliance at the time of
effects of COVID-19
at the time of this Correspondence this Correspondence. The COVID-19
• Measuring the outcomes of patients with specific
being published, there is a regis­ Alliance will obtain data on any patient
rheumatological conditions who are infected with SARS-CoV-2
tered retrospective study in China with rheumatic disease who tests
• Addressing anticipated drug shortages for
for patients with rheumatic disease positive for SARS-CoV-2, capturing hydroxychloroquine, tocilizumab, anakinra, and other
and a case series from the USA listing the range from mild to severe cases, medications commonly in use in rheumatology
rheumatic disease as a pre-admission with the goal of informing risk and • Working through unprecedented logistical and ethical
comorbidity. 3 As studies regard­ best practice during the outbreak. With challenges (eg, rapidly setting up global registries and en
ing treatments for and outcomes this novel pathogenic threat, there masse transitions to telehealth)
of COVID-19 emerge, it seems pos­ is much that is not yet known, and
COVID-19=coronavirus disease 2019. SARS-CoV-2=severe acute respiratory syndrome
sible that immunomodulation could many ways this virus could impact the coronavirus 2.
alter the disease course of COVID-19. rheumatology community (panel).

www.thelancet.com/rheumatology Published online April 6, 2020 https://doi.org/10.1016/S2665-9913(20)30091-6 1

 Correspondence

commitment to remain unified when

the pandemic has passed. Our modern
world is more interconnected now than
during any era before; let the rheuma­
tology community reflect that, now
and after the COVID-19 pandemic.
We declare no competing interests. LL was funded
in part by the Intramural Research Programme of
the National Institute of Arthritis and
Musculoskeletal and Skin Diseases of the National
Institutes of Health. EH was supported by the
Fogarty International Center, National Institutes of
Health, Bethesda, MD, USA (K01TW009995).

*Laura B Lewandowski, Evelyn Hsieh

[email protected]
National Institute of Arthritis, Musculoskeletal,
and Skin Diseases, National Institutes of Health,
Department of Health and Human Services,
Bethesda, MD 20892-1102, USA (LBL); Section of
Rheumatology, Allergy, and Immunology, Yale
School of Medicine, New Haven, CT, USA (EH);
and Section of Rheumatology, Veteran Affairs
Connecticut Healthcare System, West Haven, CT,
USA (EH)
1 Fauci AS, Lane HC, Redfield RR. Covid-19 —
Navigating the Uncharted. N Engl J Med 2020;
382: 1268–69.
2 Wu Z, McGoogan JM. Characteristics of and
important lessons from the coronavirus
disease 2019 (COVID-19) outbreak in China:
summary of a report of 72 314 cases from the
Chinese Center for Disease Control and
Prevention. JAMA 2020; published online
Feb 24. DOI:10.1001/jama.2020.2648.
3 Arentz M, Yim E, Klaff L, et al. Characteristics
and outcomes of 21 critically ill patients with
COVID-19 in Washington State. JAMA 2020;
published online March 19. DOI:10.1001/
jama.2020.4326.
4 McCreary EK, Pogue JM. COVID-19 treatment:
a review of early and emerging options.
Open Forum Infect Dis 2020; published online
March 23. DOI:10.1093/ofid/ofaa105.
5 Wu C, Chen X, Cai Y, et al. Risk factors associated
with acute respiratory distress syndrome and
death in patients with coronavirus disease 2019
pneumonia in Wuhan, China. JAMA Intern Med
2020; published online March 13. DOI:10.1001/
jamainternmed.2020.0994.

2 www.thelancet.com/rheumatology Published online April 6, 2020 https://doi.org/10.1016/S2665-9913(20)30091-6