American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID-19 Pandemic:
Version 3 (Part 2)
The experts have drafted basic guidelines for the management of rheumatic diseases in patients during the Coronavirus disease (Covid) pandemic.
Of the 81 proposed guidelines considered, 77 received median vote ratings of 7, 8, or 9 from the expert panel and were also associated with moderate consensus or high consensus, the predefined threshold for approval, from the members of the expert panel of the American College of Rheumatology (ACR).
There were at least 2 draft statements getting a median vote rating and 2 additional statements with a median vote rating accompanied by low consensus.
The process resulted in 25 final guidance statements that were posted online by the ACR in draft form on April 13, 2020.
The guidelines touched on the areas such as :
1) considerations related to risk assessment, prevention, and the use of glucocorticoids, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers (ARBs),
2) current treatment of patients with stable disease in the absence of Covid exposure and considerations specific to systemic lupus erythematosus (SLE),
3) treatment of newly diagnosed or active disease in the absence of Covid exposure,
4) treatment of rheumatic disease after Covid exposure and
5) treatment in the context of documented or presumptive Covid exposure. Additional 2 guiselines were added to the final 25 guidelines.
There are a total of 27 guidelines for the treatment of rheumatic disease in the midst of the pandemic.
There are guidance statements specific to the use of hydrochloroquine/chloroquine (HCQ/CQ) were revised following initial publication.
Based on ACR’s knowledge, there is currently no compelling evidence identifying risk factors for poor outcome with Covid that are linked to rheumatic disease.
Based on initial cohort studies, risk factors for poor outcome with Covid include older age and select comorbidities such as chronic lung disease, hypertension, cardiovascular disease, chronic kidney disease, obesity, and diabetes mellitus.
These conditions are frequently shown execessively among patients with rheumatic disease.
Preventive measures focused on preventing infection risk and the impact of Covid has been widely publicized by the Centers for Disease Control and Prevention (CDC) and other public health agencies.
The ACR understands the importance of these measures, recommending that rheumatic disease patients need to know how to avoid getting infected by observing: hand hygiene, social distancing, and wearing a mask in public.
With social distancing emerging as a key strategy aimed at preventing Covid infection, this may create problems in the provision of rheumatology care. This may come with efforts to reduce doctor or nurse encounters as a way of preventing virus spread among the health care frontliners.
We will start next week with the specific guidelines on the management of rheumatic disease in the midst of the Covid pandemic.
Edited and approved dr cora lim article