The crossroad between scleroderma and Covid-19

The COVID-19 pandemic has, and continues to be, a challenging and confusing period of almost everyone's lives, with many still adapting to the supposed 'new normal'. Early July has seen the lifting of some lockdown measures imposed in late March in the form of pubs, cinemas and hairdressers opening, however each of UK nations have enforced their own rules within this. Whilst many people will be pleased to see these relaxations in the restrictions, those who have been asked to shield will likely be feeling uncertain about the coming months, coupled with the additional anxiety stemming from the statement that from 1^st August 2020, people in England who are at high risk from coronavirus will no longer be advised to shield. The lifting of lockdown measures is especially significant to SRUK's community, several of whom will have been in the moderate risk group or the high risk group (who will have been shielding). A team of researchers from the University of Florence and Shantou investigated the potential of Covid-19 complicating interstitial lung disease in scleroderma as well as the effects on routine clinical care and psychosocial implications, arising from the last 4 months and which may continue into the future.

A large proportion of SRUK's community have scleroderma associated interstitial lung disease (SSc-ILD), whereby the alveoli in the lungs undergo scarring and inflammation, making it harder for the person to breathe. The authors of the paper noted that there are considerable similarities between SSc-ILD and Covid-19, especially in terms of the pneumonia that the latter can lead to. This makes it challenging to recognise a combination of Covid-19 and ILD or a worsening of SSc-ILD. It is also possible that those with ILD may develop a more severe form of Covid-19 infection, as the virus that makes up Covid-19 tends to sit in the lower respiratory tract (e.g. the lungs). There is a pressing need to be aware of the possibility that it may not just be SSc-ILD progression but early phases of Covid-19 infection, and to test rapidly for this as both infection and worsening of underlying SSc-ILD should prompt treatment. Due to the pandemic, the International Societies of Rheumatology published a set of recommendations to decrease the risk of communities with rheumatic conditions who are on immunosuppressive therapies from being infected with Covid-19.

The research team also highlighted the necessity of paying particular attention to the psychosocial implications of this pandemic, as the burden placed on mental health by the facts and figures on the infection and mortality rates of Covid-19 is now becoming more and more evident. This will likely have an extreme impact on those who have comorbidities and are living with chronic diseases especially, such as SSc, and will add to the stress experienced when there were concerns of potential drug shortages that are needed for normal treatment pathways. Negative influences on quality of life may also arise from loss of income or employment, and from social distancing and isolation. Stress is a widely agreed trigger for causing flare-ups for a number of autoimmune diseases, and it is thus crucial to acknowledge the potential for this to result in the need for more medical interventions.

It is important that strategies are implemented that focus on the ongoing protection of moderate and high risk individuals, for whom the symptoms of chronic illnesses may be compounded by the effects of Covid-19. The study's authors suggested that this may be achieved by medical teams, many of whom have been redeployed and overstretched during this pandemic, to attempt to maintain regular communications with their patients over the coming months. This may go some way in both alleviating the stress experienced by the community and in remaining vigilant to any changes in the health of their patients. What is critical is that people are encouraged to maintain their therapies and medical appointments, which may be over telephone or Skype, alongside practising measures to help reduce the likelihood of them being infected, as maintenance of the condition will also lessen the need of sudden visits and hospitalisations.

SRUK are committed to continuing to provide accurate and accessible information to our community. If you have any questions about Raynaud's and scleroderma, and the impact of Covid-19, then please do get in touch with us at info@sruk.co.uk and we will endeavour to help. SRUK's helpline is also still available every day on 0800 311 2756, and we have a number of support groups across the country, the list of which can be found here.

References:

1) Orlandi M, Lepri G, Bruni C, et al. The systemic sclerosis patient in the COVID-19 era: the challenging crossroad between immunosuppression, differential diagnosis and long-term psychological distress. Clin Rheumatol. 2020;39(7):2043-2047. doi:10.1007/s10067-020-05193-2