COVID-19: A Primer for the Rheumatologist

Abstract and Introduction

Abstract

Purpose of review: There are currently many unanswered questions surrounding the management of patients with immune-mediated inflammatory diseases during the COVID-19 pandemic and several 'rapid' guidelines have been released, although are subject to be updated and changed in the near future. The purpose of this review is to discuss the approach to management of patients with immune-mediated diseases during the COVID-19 pandemic.

Recent findings: At present, there is little evidence to suggest an increased risk of COVID-19 infection or its complications in patients with immune-mediated diseases or associated with conventional or biologic disease modifying antirheumatic drugs; however, glucocorticoid use does appear to have negative associations.

Summary: Currently, conventional and biologic disease modifying antirheumatic drugs can be continued in the absence of SARS-CoV-2 exposure. In the case of exposure, with the exception of hydroxyhcloroquine and sulfasalazine, immunosuppression should be held for 2 weeks. Our recommendations and the guidelines we discuss here are based on C-level recommendations but help provide a framework for how to counsel our patients during this pandemic.

Introduction

The pace of COVID-19-related publications relevant to the field of rheumatology and patients with immune-mediated diseases (IMIDs) is unprecedented, and at the time of this publication much more will have been put into press. Attempting to keep up with this data surge is a Sisyphean task (see review by Putman et al. in this issue of the journal). At present, much has been written in terms of recommendations for immunosuppressed patients in the setting of COVID-19, including the American College of Rheumatology (ACR), National Institute for Health and Care Excellence (NICE) and the European League Against Rheumatism (EULAR).^[1–3] These documents serve as 'rapid' guidelines and evidence summaries that address various treatment options and provide general guidance about patient care and disease management during the pandemic. Undoubtedly by the time this publication has been released there will be floods of new information. These 'rapid' guidelines are based on what we know now, and designed to be revised as the evidence evolves. Here we attempt to distill snapshots of the pertinent highlights from these guidelines though a series of questions to which rheumatologists want answers.