Management of Osteoarthritis During the COVID-19 Pandemic

Abstract

The pandemic spread of the new coronavirus disease 2019 (COVID-19) infection in China first, and all over the world at present, has become a global health emergency due to the rapidly increasing number of affected patients. Currently, a clear relationship between COVID-19 infection incidence and/or complications due to chronic or occasional treatments for other pathologies is still not clear, albeit the COVID-19 pandemic may condition the treatment strategy of complex disorders, such as osteoarthritis (OA). Importantly, OA is the most common age-related joint disease, affecting more than 80% of people older than the age of 55, an age burden also shared with the highest severity in COVID-19 patients. OA patients often show a large array of concomitant pathologies, such as diabetes, inflammation, and cardiovascular diseases that are again shared with COVID-19 patients and may therefore increase complications. Moreover, different OA treatments, such as NSAIDs, paracetamol, corticosteroids, opioids, or other molecules have a wide array of iatrogenic effects, potentially increasing COVID-19 secondary infection incidence or complications. In this review we critically analyze the evidence on either negative or positive effects of drugs commonly used to manage OA in this particular scenario. This would provide orthopedic surgeons in particular, and physicians, pharmacologists, and clinicians in general, a comprehensive description about the safety of the current pharmacological approaches and a decision-making tool to treat their OA patients as the coronavirus pandemic continues.

Figure 1

Classification of COVID‐19 disease states and overlay with OA‐associated treatments. The figure shows the escalating phases of disease progression with COVID‐19, with associated symptoms and the relevance of OA treatments with their possible continuation, discontinuation, or cost/benefit depending on available literature data. ARDS, acute respiratory distress syndrome; COVID‐19, coronavirus disease 2019; IL, interleukin; IS, immunosuppressive; mAbs, monoclonal antibodies; MIP, macrophage inflammatory protein; NSAIDs, nonsteroidal antiiflammatory drugs; OA, osteoarthritis; SIRS, systemic inflammatory response syndrome; TNF, tumor necrosis factor. [Colour figure can be viewed at wileyonlinelibrary.com]