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Hydroxychloroquine in Rheumatological Disorders: The Potential Buffer Against COVID-19

Background: Hydroxychloroquine (HCQ) is a well prescribed drug in rheumatological disorders. The repurposed drug HCQ was also used for SARS-CoV-2 as prophylactic and therapeutic strategy in Indian context. The present study aimed to describe that either rheumatological disorder had threatening effect on COVID-19 or advantageous particularly with the use of HCQ. 
 
Methods: The present retrospective, observational study included 4100 COVID-19 patients of SMS Medical college and Hospitals, Jaipur, India. The patient’s data (after anonymizing and de-linking) concerning underlying chronic medical illness especially focused on rheumatological disorders was extracted from their medical records. The data from rheumatological patients concerning medical history, clinical manifestation, severity of COVID-19, extension of disease, treatment history and outcome were collected and analyzed. 
 
Results: Out of large study cohort of 4100 patients of COVID-19, rheumatological disorders found only in seven patients (0.17%) including rheumatoid arthritis (RA) in four patients, systemic lupus erythematous (SLE) in two patients and Wegener granulomatosis in one patient. All rheumatologic patients of study group had symptomatic presentations with one patient had critical, another one had severe, two had moderate and three patients had mild illness. Only one patient was on hydroxychloroquine (HCQ) treatment (200 mg daily) who presented with mild illness of COVID-19. One patient of SLE with lupus nephritis on glucocorticoids and immunosuppressive agents but not on HCQ, developed critical illness and later on succumbed to life. 
 
Conclusion: The present study showed that patients with rheumatological disorders might not be at increased risk of acquiring COVID-19 or a more severe disease. Moreover, HCQ has some protective role against COVID-19 in patients of rheumatological disorders and it also play an important role in reducing the disease severity. 
 
Funding Statement: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not for profit sectors. 
 
Declaration of Interests: All authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential. 
 
Ethics Approval Statement: This study approved by ethical and research committee of SMS medical college and Hospital, Jaipur, India.