COVID-19 Clinical Guidance for Adult Patients with Rheumatic Diseases
(Part 1)
This week, we will start a new topic regarding the guidelines on the treatment of rheumatism patients with Coronavirus disease (Covid).
The guideline’s purpose is to provide guidance to rheumatology providers on the management of adult rheumatic disease patients in the context of COVID-19.
These guidelimes are not supposed to replace clinical judgment. Changes to the treatment plans, particularly in complicated rheumatic disease patients, are highly disease, patient, geography, and time-specific and, therefore, must be individualized as part of a shared decision-making process.
The guideline is rapidly evolving based on evidence and the anticipated need for frequent updates as such evidence becomes available.
The North American Task Force, including 10 rheumatologists and 4 infectious disease specialists, met on March 26, 2020.
Questions were gathered, and an evidence report was created and disseminated to the panel. Questions and drafted statements were read and assessed using a well-established method of consensus building.
The risk of poor results from Covid appears to be related primarily to general risk factors such as age and comorbidity.
As such patients need to observe prevention methods such as social distancing, wearing of masks, and frequent hand washing.
As part of a shared decision-making process between patients and rheumatologists, select methods to reduce healthcare encounters and potential exposure to the Covid may be reasonable, such as reduced frequency of lab monitoring, optimal use of telehealth, increased dosing intervals.
If needed, glucocorticoids should be used at the lowest dose possible to control rheumatic disease, regardless of exposure or infection level.
Glucocorticoids should not be abruptly stopped, regardless of exposure or infection level.
If being used, angiotensiconverting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) should be continued in full doses.
We will continue our discussion regarding the guidelines in our column next week.