American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID-19 Pandemic: Version 3 

(Part 1)

This week, we are introducing a new topic which involves the American College of Rheumatology (ACR) and the treatment of rheumatoid arthritis (RA) in the light of the Coronavirus disease (Covid) pandemic.

Since Covid’s initial outbreak in Wuhan, China, it has rapidly evolved into a pandemic. The disease is characterized by infection caused by severe acute respiratory syndrome coronavirus 2 (SARS–CoV-2),

Covid has affected millions of lives and has killed a lot of people worldwide. This pandemic provides a substantial challenge for both rheumatology providers and patients as serious infection is a known cause of morbidity and mortality across a wide range of rheumatic diseases.

Thus, there is a need to address important questions regarding Covid risk and prevention as well as the safety on the use of rheumatic disease treatments.

The ACR formed the Covid Clinical Task Force on March 26, 2020, to rapidly provide protocol to rheumatology providers to the management of rheumatic disease in adults during the pandemic.

The protocol created from this effort is intended to help in the care of RA patients, but it is not meant to replace the traditional decision-making of the practitioners.

There are changes to treatment plans because of the pandemic particularly in patients with challenging conditions, highly affecting disease activity. The treatments are patient-specific, geography-specific, and time-specific and, therefore, must be customized as part of a shared decision-making process between the clinician and the patient.

There is enough attention given to the use of rheumatology treatments such as hydroxychloroquine [HCQ], chloroquine [CQ], interleukin-6 [IL-6] receptor inhibition, being used in the prevention and management of Covid.

We need to understand that the ACR guidelines given in this report are limited to the management of RA or rheumatic disease (RD) and does not help manage Covid and/or its complications.

Furthermore, the protocol given by the ACR may change as evidence is evolving and the ACR understands the need for updates of this guidance as new information becomes available.

Next week we will be having a deeper dive on this topic as it is timely and relevant to our present situation.