Hashimoto, lupus, rheumatoid arthritis - how dangerous is Coronavirus for people with these conditions?

Are people with autoimmune diseases at risk for more severe coronavirus infection? How should they protect themselves during an epidemic? Our expert explains.

Explains Dr. Sylwia Kołtan, clinical immunologist, national consultant in the field of clinical immunology, works at the Department of Pediatrics, Hematology and Oncology at the Collegium Medicum Ludwik Rydygier in Bydgoszcz, Poland.

The immune system works in a healthy person at a constant physiological level. When it is threatened – something attacks it, e.g. a virus – it mobilizes itself and performs the task of recognizing and killing the “intruder”, and then returns to its initial state

However, in people with autoimmune diseases, this process is different because the immune system is not working properly.

There are many autoimmune diseases – in fact, any tissue and organ can be affected. There are two main types: multi-organ (systemic) and those in which only a single organ or tissue is involved in the autoimmune process. The first include rheumatoid arthritis (RA) or systemic lupus erythematosus. The second include, for example, Hashimoto’s disease, type 1 diabetes or multiple sclerosis (MS).

They become more easily infected and subject to worse symptoms

In such patients, the immune system turns against its own tissues and organs – it fails what is referred to in medicine as self-tolerance. The immune system cannot distinguish between “itself” and a “stranger” and does not know how to “protect” itself. Consequently, instead of defending it’s own cells, tissues and organs, it destroys them. They stop working as they should.

The effect of the malfunction of the immune system leading to damage to individual tissues and organs is a disruption of their function. A patient with active, decompensated or untreated autoimmune disease is more susceptible to infection! This is especially true for patients whose white blood cells are destroyed in the autoimmune process. This process occurs both in systemic diseases (e.g. in systemic lupus) and in autoimmune neutropenia (neutrophils – one of the types of white blood cells that are very important for immunity, neutropenia – reduced number of neutrophils).

“Autoimmune diseases also increase the risk of a more severe course of infection, because it results in an active inflammation that interferes with the body. On the other hand, the infection and the inflammation going on in the body can increase the symptoms of the autoimmune disease and also lead to a relapse, when it was already in remission. “

Treatment disrupts immunity

In some autoimmune diseases, e.g. in lupus, RA, juvenile idiopathic arthritis, patients are forced to take immunosuppressive drugs that suppress the pathological immune response and thereby protect tissues and organs attacked by autoantibodies. Unfortunately, these drugs not only affect diseased elements of the immune system. They also affect healthy structures of the immune system, thus reducing immunity. Under the influence of immunosuppressive drugs, the symptoms of the disease disappear, but due to the disturbed mechanisms of immunity, the patient becomes more susceptible to infection.

We must remember that in people with RA, for example, treatment usually brings more benefits than negative effects. Therefore, this decrease in immunity cannot become a reason for the patient to discontinue medication. During the current epidemic, you cannot decide on whether to discontinue or change therapy. This must always be agreed with the attending physician.

Take care of yourself during a pandemic

Therefore, people suffering from autoimmune diseases must take care of appropriate treatment during the pandemic and strictly follow medical recommendations.

At the same time, they should eliminate all factors that further reduce immunity in their lives, i.e. fatigue, malnutrition or vitamin deficiency. Therefore, it is important that they care for a hygienic lifestyle, proper diet and sleep. But they also did not drink alcohol, smoke or use drugs.

When the virus goes crazy, people with autoimmune diseases should isolate themselves and stay at home, as well as take care of hygiene, above all, often wash their hands. It is absolutely necessary to follow the recommendations given by the Chief Sanitary Inspectorate (GIS), the Ministry of Health and the World Health Organization (WHO).

Ideally, people with autoimmune diseases should not expose their body to infection. If they get sick, it’s difficult to predict how COVID-19 will take place. Previous experience from other countries indicates that the course of the disease may be more severe for them than for healthy people of the same age.

(source: (Gazeta Wyborcza- Poland’s premier daily)

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