COVID-19 Clinical Guidance for Patients with Rheumatic Disea
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Patients with rheumatic diseases who test positive for COVID-19 should temporarily discontinue all treatments with sulfasalazine, methotrexate, leflunomide, immunosuppressants, non-IL-6 biologics and JAK inhibitors, according to new recommendations released by the American College of Rheumatology’s COVID-19 Clinical Guidance.

The summary states that patients with rheumatic diseases who have been confirmed to have COVID-19 may continue with anti-malarial therapies — namely hydroxychloroquine and chloroquine — and, in select circumstances, IL-6 inhibitors.

These statements are not intended to replace clinical judgment, Modifications made to treatment plans, particularly in complex rheumatic disease patients, are highly disease-, patient-, geography- and time-specific as part of a shared decision-making process.

Key Recommendations :

-Patients with rheumatic disease appear to be at risk for poor outcomes from COVID-19, primarily due to general risk factors such as age and comorbidity.

-In addition to following all general COVID-19 preventive measures, patients with rheumatic disease and their providers should discuss ways to reduce the number of health care encounters and potential exposure to coronavirus, including monitoring blood work less frequently, using telehealth and increasing the time between doses of intravenous medications.

-For ongoing treatment of stable patients with no coronavirus exposure or infection, hydroxychloroquine or chloroquine, sulfasalazine, methotrexate, leflunomide, immunosuppressants — such as tacrolimus, cyclosporine, mycophenolate mofetil and azathioprine — biologics, JAK inhibitors and NSAIDs may be continued.

-Stable patients without COVID-19 exposure or infection may still receive denosumab for osteoporosis, but the time between doses may be extended to as long as 8 months, to minimize health care encounters and, if necessary, due to limited access to infusions.

-Patients with stable disease who have been exposed to coronavirus but do not have a known infection may continue with hydroxychloroquine, sulfasalazine and NSAIDs, but immunosuppressants, non-IL-6 biologics and JAK inhibitors should be discontinued temporarily, pending a negative test result COVID-19 or after 2 weeks without infection symptoms.

-IL-6 inhibitors may also be continued, in select circumstances, among patients with stable rheumatic disease who have been exposed to coronavirus but have not yet tested positive for COVID-19.

This list is a brief compilation of some of the key recommendations included in the Guideline and is not exhaustive and does not constitute medical advice.

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