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We thank Dr Giollo et al 1 for their interest and comment on our published paper on the outcome of covid-19 in patients with rheumatic diseases.2 The authors highlighted the importance of reporting on the use of non-steroidal anti-inflammatory drugs (NSAIDS) commonly prescribed to patients with chronic arthritis. The effect of NSAIDS on the course of covid-19 is still unknown. It can be speculated that NSAIDs might have a beneficial role in the relief of symptoms resulting from prostaglandin and proinflammatory cytokines, including interleukin-6 overproduction, with potential strict interactions with the cytokine-release syndrome believed to occur in some patients during covid-19. However, the role of NSAIDs during viral infections is controversial,3 and the selective inhibition of interferon-gamma production by natural killer and T cells has been described to be associated with a worsening of clinical outcome during some viral infections.4 Given the unknown effects that the use of NSAIDs in patients with rheumatic diseases might have on covid-19, we agree with Dr Giollo et al 1 that data on this class of drugs should be collected. Nevertheless, the extensive, often unreported use of NSAIDs through self-medication over-the-counter practice5 limits the reliability of observational data on this aspect. We suggest that specific, controlled studies on the use of NSAIDs could be informative, especially for patients with rheumatic diseases, who frequently require NSAIDs as complementary drugs to control their chronic condition.
Handling editor Josef S Smolen
Contributors SM and CM contributed equally to the article.
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 Commissioned; internally peer reviewed.