Guidance from the American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients during the COVID-19 Pandemic: Version 3
(Part 6)
This week, we shift our focus on the discussion of the role of conventional synthetic disease modifying anti-rheumatic drugs (csDMARDS).
The risks of serious infection with hydroxychloroquine (HCQ), chloroquine (CQ), sulfasalazine (SSZ), leflunomide (LEF), and methotrexate (MTX) are relatively tiny, when administered as monotherapies. This enabled the American College of Rheumatology (ACR) task force’s recommendation to continue using these medicines, when needed, in the absence of Coronavirus disease (Covid) infection or exposure to a person known to be positive for Covid.
The task force is saying that SSZ may be used after Covid exposure but temporarily suspending the use of m HCQ/CQ, SSZ, LEF, and MTX for active Covid cases.
This recommendation by the task force is due primarily from possible adverse effects such as stomach upset, diarrhea, hepatitis, cytopenias, and pneumonitis.
These said health problems may be confused for the presence of a Covid infection and that temporarily discontinuing the usage of cs DMARDs will less likely result in rheumatic disease flares.
Even if there are no rigorously conducted clinical trials, HCQ and CQ have been widely used in the treatment of Covid infection. As a result, supply of the said medicines has been reported. The task force recommended that other csDMARDs could be used in place of HCQ/CQ to treat inflammatory arthritis.
The task force said that on the issue of drug availability, new prescriptions of HCQ/CQ should be limited to patients with Food and Drug Administration (FDA)-approved indications.
The task force advises the continued use of HCQ/CQ in the management of systemic lupus erythematosus (SLE).
It is known that therapeutic drug levels can be achieved with optimal HCQ dosing strategies. Low dose strategies may lead to SLE disease flares. The continued use of HCQ in SLE lowers the risk of flare and as well as morbidity and mortality.
We will continue our discussion on csDMARD and other recommended therapies for people with rheumatic disease as we continue to grapple with the challenges posed by the Covid pandemic.