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- arthritis, rheumatoid
- anti-inflammatory agents, non-steroidal
- spondylitis, ankylosing
- arthritis, psoriatic
- biological therapy
We have read with interest the report by Monti et al 1 concerning the clinical course of coronavirus disease (Covid-19) in patients with chronic inflammatory arthritis. However, we could not find data about the use of non-steroidal anti-inflammatory drugs (NSAID) among their patients.
Whether concomitant NSAID treatment may be harmful or safe in patients with Covid-19 is unknown. However, anti-inflammatory therapies might prevent fatal cytokine storm of Covid-19. Ibuprofen, a commonly prescribed NSAID, was found to reduce interleukin-6 (IL-6) in human tissues,2 and in sputum.3 Accordingly, several clinical trials of anti-IL-6 therapies for the treatment of severe Covid-19 are actively recruiting.
NSAIDs are still broadly used for the treatment of chronic inflammatory arthritides such as rheumatoid arthritis and spondyloarthritis. The European League Against Rheumatism recommends NSAIDs as effective symptomatic therapies in early arthritis, under the condition to be used at the minimum effective dose for the shortest time possible, and after evaluation of gastrointestinal, renal and cardiovascular risks.4 Importantly, it is established that uncontrolled inflammation due to active arthritis is associated with an increased risk of infection.5
We believe it is important to report the use of NSAIDs in clinical studies of Covid-19 as there have been inappropriate warnings against the use of these drugs, and consequent confusion in the general audience and medical community. The WHO declared to press that there is no evidence of an increased risk of death with the use of NSAIDs in Covid-19. Until more evidence is available, we are recommending our patients with chronic inflammatory arthritis not to discontinue the NSAIDs they are already taking as a regular prescription.
Contributors AG provided the conception of the study and drafted the article. AG, GA, LI, MR and DG revised the article critically for important intellectual content and gave final approval of the version to be submitted.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.