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31 March 2020

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Terence Gore

Fred

Osteoarthritis while quite debilitating is quite different than Rheumatoid arthritis. I work as physical therapy assistant and was treating a gentleman whose wife with RA would get very quick onset pneumonia.

"RA is known to be associated with an increased risk of serious infection. Even more than 50 years ago, observational studies showed a greater than 2-fold increased risk of serious infection in RA. This was reinforced by various subsequent cohort studies. The elevated susceptibility of patients with RA can be explained by the pathobiology of the disease itself, the impact of chronic comorbid conditions, as well as sequelae of immunosuppressive treatment. It has been suggested that premature ageing of the immune system in RA contributes to weakened protection against infectious organisms. In addition, chronic comorbid conditions such as diabetes or chronic lung or kidney disease, disease-related functional disability, as well as lifestyle factors such as smoking, increase the risk in individual patients. For a long time glucocorticoids (GCs) have been used as potent immunosuppressive drugs in RA. There is evidence that they increase the risk of serious infections up to 4-fold in a dose-dependent manner. TNF-α inhibitors increase the serious infection risk up to 2-fold. They have, however, the potential to outweigh their risk when higher GC doses can be tapered down. If patients need higher dosages of GCs in addition to treatment with biologic agents, their risk of infection is substantial. This combination should be used carefully and, if possible, avoided in patients with additional risk factors such as older age or comorbid conditions."

https://www.ncbi.nlm.nih.gov/pubmed/23192911

Terence Gore

Fred

Sorry that was worked as in past tense. I also should have been more clear in my original post as regard to RA. Since we were discussing Plaquenil my background would suggest RA as a given

Mark K Logan

JJackson,

It appears they are digging into exactly how this virus kills, and according to this it's the victim's own immune system that's the enemy in a lot of cases, particularly the younger ones. About 15% of the population carries traits that makes them suceptable to a cytokine storm reaction. This accounts for those who get sick, seem to get better, and suddenly fail.

https://www.nytimes.com/2020/04/01/health/coronavirus-cytokine-storm-immune-system.html

The good news is suppressing the immune system is fairly old-hat. The caveat: Not a simple matter for people to prescribe for themselves.

Sound plausible?

My confirmation bias is going ape with it. We may be close to effective therapeutics. Whole 'nother game if so.

zartogg2

Dang. All the world health agencies missed it and Z-pac too. Are we the smartest dudes on earth or what?

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