COVID-19 has been one of the most significant disruptions for rheumatology patients and providers in generations. SARS-CoV-2 not only produced wave after wave of infectious disease, it created significant changes in thinking and in practice for the use of vaccines in immunocompromised patients and in understanding a wide range of vasculopathies.
“COVID has brought us important challenges in the delivery of care to patients with rheumatic disease, and rheumatologists have stepped up,” said Minna Kohler, MD, RhMSUS, Founder and Director of the Rheumatology Musculoskeletal Ultrasound Program at Massachusetts General Hospital. “We’ve all heard the saying about when life gives you lemons, you make lemonade. That is exactly what we have done in rheumatology. No one could have anticipated the focus or the research that we suddenly devoted to areas like vaccine response in immunocompromised individuals or the details of vasculopathy, but those were some of the challenges that COVID presented. New research that affects our patients every day is still emerging.”
Dr. Kohler will co-moderate COVID “Lemonade”: Lessons Beyond the Disruption of the Pandemic on Sunday, November 13, from 12–1 p.m. ET, with Meggan Mackay, MD, MS, Professor and Co-Director of the Clinical Trials Unit, The Center for Autoimmune, Musculoskeletal, and Hematopoietic Diseases, Feinstein Institutes for Medical Research, and Associate Professor of Molecular Medicine and Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. Meeting participants have the option to attend the session in person in Room 113 of the Pennsylvania Convention Center or to view the session on demand.
Judith A. James, MD, PhD, will discuss the practical implications of the latest findings on vaccine response in immunocompromised individuals. She is the Lou C. Kerr Endowed Chair in Biomedical Research, the George Lynn Cross Professor of Research and Professor of Medicine and of Pathology, Oklahoma University Health Sciences Center, and Vice President of Clinical Affairs, Oklahoma Medical Research Foundation. Her rheumatology research focuses on systemic lupus erythematosus.
“There has been significant interest in how our rheumatic disease patients have been responding to COVID vaccines, especially when they are on immunosuppressive therapy that might interfere with vaccine efficacy,” Dr. Kohler said. “The mRNA vaccine technology is new, and we’ve been very lucky that COVID vaccines and boosters have been very efficacious. However, our patients on immunosuppressive therapies such as mycophenolate mofetil, methotrexate, and B cell-depleting therapies like rituximab have not shown the same antibody and T cell responses to vaccines as the general population. We are already using new research prompted by COVID to adjust our approaches to vaccines and to immunosuppression.”
COVID-19 has generated similar lessons in pathology, which Cynthia M. Magro, MD, Faculty Distinguished Professor in Pathology and Laboratory Medicine, Professor of Dermatopathology in Dermatology, and Director of Dermatopathology at Weill Cornell Medicine, will discuss. Dr. Magro was on the front line when COVID-19 exploded in New York City.
“We can all learn from her experience in the initial days and weeks of COVID and the ways vasculopathy can occur related to COVID infection,” Dr. Kohler said.
Potential vascular manifestations of COVID-19 continue to be reported by rheumatologists worldwide.
“COVID has done more than disrupt care—it has changed the way rheumatologists have had to think about patients’ medications and how medications may need to be adjusted or timed differently,” Dr. Kohler said.