Basic immunology may lead to translational therapeutic rationale: SARS-CoV-2 and rheumatic diseases

Eur J Clin Invest. 2020 Sep;50(9):e13342. doi: 10.1111/eci.13342. Epub 2020 Jul 29.


COVID-19 pandemia is a major concern for patients and healthcare systems. The fear of infection by patients with concomitant rheumatic diseases (either adult or children) and connective tissue diseases is arising worldwide, because of their immunological background and immunological therapies. Analysing the basic biology of single diseases, the data suggest that there is an "immunological umbrella" that seems to protect against the infection, through IFN type 1 and NK cell function. To date, reports from China, United States and Europe did not reveal an higher risk of infection, either for rheumatoid arthritis, juvenile idiopathic arthritis nor for lupus erythematosus. Antimalarials, anti-IL6-Anti-IL6 receptor, anti-IL1, anti-GM-CSF receptor and JAK1/2/3 inhibitors, are under investigation in COVID-dedicated clinical trials to control the inflammation raised by SARS-CoV-2 infection. Initial reports on the occurrence of autoimmune phenomena in the convalescence phase of SARS-CoV-2 infection suggests that the immunological consequences of the infection need to be strictly understood. Reporting of the study conforms to broad EQUATOR guidelines (Simera et al January 2010 issue of EJCI).

Keywords: COVID-19; SARS-CoV-2; geriatrics; pathophysiology; pediatrics; rheumatology.

Publication types

  • Review

MeSH terms

  • Adaptive Immunity / drug effects
  • Adaptive Immunity / immunology
  • Aged
  • Antirheumatic Agents / administration & dosage
  • COVID-19
  • COVID-19 Drug Treatment
  • Comorbidity
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / immunology*
  • Disease Outbreaks / statistics & numerical data
  • Female
  • Humans
  • Hydroxychloroquine / administration & dosage
  • Immunity, Innate / drug effects
  • Immunity, Innate / immunology
  • Immunologic Factors / administration & dosage
  • Immunosuppressive Agents / administration & dosage*
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / immunology*
  • Rheumatic Diseases / drug therapy
  • Rheumatic Diseases / epidemiology*
  • Rheumatic Diseases / immunology
  • Risk Assessment
  • Severe Acute Respiratory Syndrome / drug therapy
  • Severe Acute Respiratory Syndrome / epidemiology*
  • Severe Acute Respiratory Syndrome / immunology


  • Antirheumatic Agents
  • Immunologic Factors
  • Immunosuppressive Agents
  • Hydroxychloroquine