The Rheumatologist’s Role in COVID-19

SARS-CoV-2 Infection-Associated Hemophagocytic Lymphohistiocytosis: An autopsy series with clinical and laboratory correlation

“…39 In addition, a variety of targeted approaches against inflammatory cytokines traditionally used in the setting of autoimmune disease-associated MAS have been proposed. 7,8 Of note, patient 1 who had definitive SARS-CoV-2 associated HLH in our cohort received anakinra (IL-1R antagonist) with persistence of hemophagocytosis at autopsy. Hemophagocytosis but not HLH was seen in one of two patients who received sarilumab (anti-IL-6R mAb).…”

“…5 The latter has raised clinical concerns for hemophagocytic lymphohistiocytosis (HLH) and the overlapping disorder, macrophage activation syndrome (MAS), highlighting the potential for therapeutic cytokine blockade. [6][7][8] Despite these clinical observations, there has been relatively little clinicopathologic correlation with the post-mortem findings in COVID-19 which to date have generally focused on the pulmonary histology of diffuse alveolar damage. [9][10][11][12] Herein we report the first cases of SARS-CoV-2 associated HLH diagnosed post-mortem using histologic, clinical and laboratory criteria.…”

Absence of Severe Complications From SARS-CoV-2 Infection in Children With Rheumatic Diseases Treated With Biologic Drugs

“…(2) In those critically ill patients, there are both clinical signs and symptoms, as well as laboratory abnormalities, that suggest a CSS is occurring in response to the viral infection. (1) In contrast with adults, pediatric patients with COVID-19 seem to have a milder clinical course and asymptomatic SARS-CoV-2 infections may be frequent. (3) However, albeit rarely, severe infections may occur even in children, with PICU admission or high-flow ventilation.…”

Practical aspects of targeting IL-6 in COVID-19 disease

“…These include marked and progressively rising elevations in serum CRP, ferritin, IL-6, and D-dimer and lymphopenia. 13,14 Of note, in most medical centers, IL-6 measurement is a "send-out" test that entails a delay in obtaining the results.…”