New provisional recommendations for people with rheumatic musculoskeletal diseases who test positive for Covid-19 has been published by the European League Against Rheumatism.
The body says that while there is no evidence that these patients face more risk of contracting the new coronavirus than those without, nor do they have a worse prognosis when they contract it, rheumatologists should be involved with any decision-making about their patients’ use of immunosuppressive treatments.
It confirms that the diagnosis and treatment of Covid-19 is the primary responsibility of the local Covid-19 specialists – but that rheumatologists should make themselves available for local-hospital, regional or national guideline committees for Covid-19 because the use of immunosuppressive drugs for the virus should be a multidisciplinary decision.
EULAR also states that availability and distribution of, and access to, sDMARDs and bDMARDs for the treatment of patients with RMD as well as for patients with Covid-19 without RMD is a “delicate societal responsibility”.
It says that the off-label use of DMARDs in Covid-19 outside the context of clinical trials should be discouraged.
Five overarching principles have been developed by a EULAR multidisciplinary task force, in addition to 13 recommendations covering the four generic themes of: general measures and prevention of SARS-CoV-2 infection; the management of RMD when local measures of social distancing are in effect; the management of Covid-19 in the context of RMD; and the prevention of infections other than SARS-CoV-2.
The new provisional recommendations are designed to supplement country-level government guidelines, and support rheumatologists and healthcare professionals who care for people with RMD, physicians involved in treating Covid-19, as well as RMD patients and their families.
EULAR said this “living document” will be updated as soon as new developments with potential impact on patients with RMD become available.
Landewé RB, Machado PM, Kroon F, et al; EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Annals of the Rheumatic Diseases 5 June 2020; doi: 10.1136/annrheumdis-2020-217877
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