COVID-19 Clinical Guidance for Adult Patients with Rheumatic Diseases
(Part 2)
Last week, we started our discussion on the treatment regimen for people with rheumatic problems and also with possible infection of the SARS-CoV-2 virus which is the reason behind the Coronavirus disease (Covid).
It is important to start discussing the impact of dosing and treatment of rheumaric disease patient considering the impact of Covid.
Millions of people worldwide are infected of Covid and some may also have rheumatic disease problems and as such we need to discuss the drugs and treatment for those who have other underlying health problems, especially rheumatic diseases.
The medications being used for stable patients or those in the absence of infection or SARS-CoV-2 exposure may include Hydroxychloroquine or chloroquine (HCQ/CQ), sulfasalazine (SSZ), methotrexate (MTX), leflunomide (LEF), immunosuppressants such as tacrolimus, cyclosporine, mycophenolate mofetil, azathioprine, biologics, Janus Kinase (JAK) inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs).
These drugs may be continued for those with rheumatic disease and this includes patients with giant cell arteritis who are using IL-6 inhibitors as part of their treatment.
Denosumab may still be given but the dosing regimen should not be longer than six months, if needed.
For patients with a history of vital organ-threatening rheumatic disease, immunosuppressants dosage should not be reduced.
In patients with systematic lupus erythematosus (SLE), for those newly diagnosed with the disease, HCQ/CQ should be started at full dose.
For pregnant women with SLE, HCQ/CQ should be continued at the same time and in standard dose.
If possible, the drug belimumab may be used for SLE.
Next week we will continue with our discussion on the proper management of rheumatic diseases in the light of Covid.