American College of Rheumatology Guidance for the Management of Rheumatic

Disease in Adult Patients during the COVID-19 Pandemic: Version 3

(Conclusion)

We now move to the conclusion of this series on the guidelines released by the American College of Rheumatology (ACR) on the treatment of people with rheumatic disease (RD) and at risk of Coronavirus disease (Covid),

The ACR guidelines serve as a tool for health care providers to promote the best health care for RD patients in the context of the ongoing Covid pandemic. The guidelines, as provided, should not be construed to be proscriptive nor should these be used to limit treatment options available for patients with RD considering the pandemic that everyone is still experiencing.

While the guidelines are based on a considerable number of sources, the resulting guidelines are supported only by very low-quality evidence. In nearly all cases, the evidence identified was indirect and included indications which are focused on either different infectious maladies or retrospective cohorts of patients with Covid without consideration of RD impact.

In this case, the guidelines should be considered conditional.

However, the guidelines are rapidly changing as doctors are advised to look for updates whenever possible.

It is anticipated that current knowledge gaps will be addressed as soon as new discoveries and evidence are found and presented.

The production of the guideline is basically in response to the urgency of the situation to provide guidance for clinicians treating patients with RD who are at risk of Covid.

The expert panel involved with the production of the guidelines included both rheumatologists and infectious disease specialists with broad expertise in relevant clinical areas.

The ACR acknowledge limitations of the effort to come up with a guideline for the treatment of RA patients at this time of the pandemic.

The set of guidelinez is not comprehensive and does not follow the rigorous guideline methodology routinely used by the ACR when formal clinical practice guidelines.

However, even if this document addresses the many different rheumatology treatments, it does not provide guidance on other drugs used in rheumatology.  As such other questions remain.The ACR assures that answers to questions shall be made available once there are information that are available, too,  as the guidelines will be revised accordingly based on new pieces of information or evidences.