American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID‐19 Pandemic: Version 1

Abstract

Objective. To provide guidance to rheumatology providers on the management of adult rheumatic disease in the context of the coronavirus disease 2019 (COVID-19) pandemic.Methods. A task force, including 10 rheumatologists and 4 infectious disease specialists from North America, was convened. Clinical questions were collated, and an evidence report was rapidly generated and disseminated. Questions and drafted statements were reviewed and assessed using a modified Delphi process. This included 2 rounds of asynchronous anonymous voting by e-mail and 3 webinars with the entire panel. Task force members voted on agreement with draft statements using a 1-9-point numerical scoring system, and consensus was determined to be low, moderate, or high based on the dispersion of votes. For approval, median votes were required to meet predefined levels of agreement (median values of 7-9, 4-6, and 1-3 defined as agreement, uncertainty, or disagreement, respectively) with either moderate or high levels of consensus.Results. The task force approved 77 initial guidance statements: 36 with moderate and 41 with high consensus. These were combined, resulting in 25 final guidance statements.Conclusion. These guidance statements are provided to promote optimal care during the current pandemic. However, given the low level of available evidence and the rapidly evolving literature, this guidance is presented as a "living document," and future updates are anticipated.

The impact of the COVID-19 Pandemic on Patients with Chronic Rheumatic Diseases: A Study in 15 Arab Countries

“…Whether they have a higher risk of infection with SARS-CoV-2 is uncertain (7)(8)(9)(10)(11)(12), and, although several recommendations were developed worldwide (13)(14)(15)(16)(17), strong evidence is lacking to guide treatment decisions. Moreover, di culty to access the rheumatology clinic drove some patients to self-modify their treatment (18), which put them, along with the signi cant stress factor, at high risk of CRD are.…”

Immunomodulatory Therapeutic Proteins in COVID‐19: Current Clinical Development and Clinical Pharmacology Considerations

“…The American College of Rheumatology recommended temporarily holding or stopping all non-IL-6 biologics in the context of documented or presumptive COVID-19, as well as in COVID-19 following known SARS-CoV-2 exposure. 85 Similarly, the American Academy of Dermatology recommended that patients discontinue or postpone biologic therapy until they recover from COVID-19. 86 The academy also recommended benefit/risk assessment for patients currently considered candidates for biologic therapy.…”

COVID-19 Pandemic in Women–Rheumatologist’s Perspective

“…In a patient with suspected or proven COVID-19, immunomodulators except antimalarials may be withheld. 40 Cyclophosphamide use has been classified in the high-risk group for acquiring COVID-19 by British Society of Rheumatology (BSR). 41 While ongoing treatment may be continued, decision to start biologic DMARDS or targeted synthetic DMARDS may be individualized (►Table 1).…”

“…IL-6 inhibitors may be continued as a part of a shared decision-making process. 40 The Global Rheumatology Alliance group have suggested the possible role of anti TNF therapy in protection from severe COVID-19 infection. 13 There is currently no evidence indicating that TNF inhibition is harmful to patients in the context of COVID-19.…”