Updated APLAR consensus statements on care for patients with rheumatic diseases during the COVID‐19 pandemic

Abstract

Aim To update previous guidance of the Asia Pacific League of Associations for Rheumatology (APLAR) on the management of patients with rheumatic and musculoskeletal diseases (RMD) during the coronavirus disease 2019 (COVID‐19) pandemic. Methods Research questions were formulated focusing on diagnosis and treatment of adult patients with RMD within the context of the pandemic, including the management of RMD in patients who developed COVID‐19. MEDLINE was searched for eligible studies to address the questions, and the APLAR COVID‐19 task force convened 2 meetings through video conferencing to discuss its findings and integrate best available evidence with expert opinion. Consensus statements were finalized using the modified Delphi process. Results Agreement was obtained around key aspects of screening for or diagnosis of COVID‐19; management of patients with RMD without confirmed COVID‐19; and management of patients with RMD with confirmed COVID‐19. The task force achieved consensus on 25 statements covering the potential risk of acquiring COVID‐19 in RMD patients, advice on RMD medication adjustment and continuation, the roles of telemedicine and vaccination, and the impact of the pandemic on quality of life and on treatment adherence. Conclusions Available evidence primarily from descriptive research supported new recommendations for aspects of RMD care not covered in the previous document, particularly with regard to risk factors for complicated COVID‐19 in RMD patients, modifications to RMD treatment regimens in the context of the pandemic, and COVID‐19 vaccination in patients with RMD.

Potential Triggers for Thrombocytopenia and/or Hemorrhage by the BNT162b2 Vaccine, Pfizer-BioNTech

“…Patients with RMD are at higher risk of hospitalization due to COVID-19 and may have worse outcomes compared to the general population. Therefore, the American College of Rheumatology and the Asia Pacific League of Associations for Rheumatology strongly recommend vaccination ( 22 , 23 ). In response to these recommendations, the Japanese College of Rheumatology has also placed RMD patients who are using steroids equivalent to more than 5 mg/day of PSL or immunosuppressive agents, biological agents, or Janus kinase inhibitors at the priority ranking for vaccination ( 24 ).…”

A bond between rheumatic diseases and cancer in the elderly: The interleukin‐6 pathway

“…OA is considered a chronic, low-grade inflammatory disease with a high cytokine content, involving the entire joint rather than the cartilage surface. [15][16][17][18] OA etiopathogenic pathways can include epigenetic modifications, cellular senescence, and an age-related rise in a resulting continuous pro-inflammatory state, defined as "inflammaging". 1,18,19 Synovial fluid contains a variety of pro-inflammatory cytokines, at low concentrations (IL-1β, TNF) or at high concentrations (IL-6).…”

“…1,18,19 Synovial fluid contains a variety of pro-inflammatory cytokines, at low concentrations (IL-1β, TNF) or at high concentrations (IL-6). 15 Therefore, biological drugs that inhibit inflammatory mediators, such as IL-1, TNFα, and IL-6, have been proposed to block cartilage catabolism. 20 Indeed, targeted inhibition of these cytokines has been hypothesized to down-regulate chemotactic cascades and matrix enzyme proteases, preventing and delaying the progression of OA disease.…”

How the COVID-19 pandemic has affected rheumatology research

“…Questionnaire-based data generation with my existing cohorts of patients with autoimmune rheumatic diseases was another strategy, and I am currently trying to create some short communications and correspondences on the basis of that data. As a senior rheumatologist, I was also part of a couple of task forces and was involved in Delphi exercises and recommendations related to rheumatic diseases, anti-inflammatory treatment and vaccination-related issues, some of which have been published 2 .…”