Panel 1: Key Recommendations for Managing Patients With Rheumatic Diseases During The COVID-19 Epidemic
Potential risk factors for SARS-CoV-2 infection in patients with rheumatic diseases
- On immunosuppressive agents
- Chronic kidney disease e.g. lupus nephritis
- With lung involvement e.g. interstitial lung disease
- Elderly patients
- Frequently visiting medical clinic
- With underlying health conditions, such as smoking, obesity, hypertension and diabetes
- Who are pregnant
Medication for patients with rheumatic diseases #
- Continue current treatment if disease is stable, and contact your doctor for suitable medicine if disease has flared
- Use of hydroxychlorquine (HCQ) and sulphasalazine [SLZ] should be continued and should not increase the risk of infection
- Use of other conventional synthetic disease modifying drugs (csDMARDs e.g. methotrexate, leflunomide) and immunosuppressants (e.g. cyclophosphamide, azathioprine, mycophenolate mofetil, tacrolimus) should be continued
- Corticosteroid use can be continued
- A new prescription of immunosuppressant or increase in dose of an ongoing immunosuppressant would need to be carefully discussed in epidemic areas.
- Use of all biologic DMARDs should be continued if possible
- If infliximab infusion is not accessible, switching to other anti-TNF injection at home is encouraged
- Targeted synthetic DMARDs (JAK inhibitors) including Tofacitinib/ Baricitinib/ Upadacitinib can be continued
Surgery
- Postpone elective surgery e.g. joint replacement surgery
- Screening for COVID-19 (symptoms suggestive of COVID-19, complete blood count, nasopharyngeal swab and chest x-ray or chest CT according to local recommendation) before emergency surgery
Patients with RD and fever*
- Contact your rheumatologist about potential option to visit fever outpatient clinic with personal protection provisions if temperature continues over 38°C
- Patients must not suddenly stop prednisolone
- Suspend the use of immunosuppressants and biological agents after consultation with your rheumatologist, and follow appropriate local guidance for suspected COVID-19 if COVID-19 cannot be ruled out
- Patients can continue HCQ and SLZ if they are infected with COVID-19.
# Concerning glucocorticoids, immunosuppressants, csDAMRDs, bDMARDs and JAK inhibitors, the balance of safety and efficacy in viral infection as well as pulmonary inflammation remains unclear.
