ACR Issues COVID-19 Treatment Guidance for Rheumatic Disease Patients

The American College of Rheumatology has issued treatment guidance for the care of patients with rheumatic diseases during the COVID-19 pandemic.

"The recommendations address various treatment options and provide general guidance, as well as direction for when to start, stop, or reduce medications. All recommendations are based on current knowledge and will be revised as circumstances and evidence evolve," according to a statement issued by the ACR.

The recommendations include:

Patients with rheumatic disease should follow all general COVID-19 preventive measures, but in addition, rheumatology patients and providers may discuss ways to reduce the number of healthcare encounters and potential exposure to SARS-CoV-2, (e.g., monitoring blood work less frequently, using telehealth, and increasing the time between doses of intravenous medications).

• For ongoing treatment of stable patients with no SARS-CoV-2 exposure or infection:

--- Hydroxychloroquine or chloroquine, sulfasalazine, methotrexate, leflunomide, immunosuppressants (e.g., tacrolimus, cyclosporine, mycophenolate mofetil, azathioprine), biologics, Janus kinase (JAK) inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen, naproxen) may be continued.
--- Denosumab, an injectable medication used for osteoporosis, may still be given, but the time between doses may be extended to as long as 8 months, to minimize healthcare encounters and if necessary due to limited access to infusions.

• In patients with stable disease who have been exposed to SARS-CoV-2 (without known infection):

---Hydroxychloroquine, sulfasalazine and NSAIDs may be continued, but immunosuppressants, non-IL-6 biologics, and JAK inhibitors should be stopped temporarily, pending a negative test result for SARS-CoV-2 or after 2 weeks without COVID-19 infection symptoms. IL-6 inhibitors may also be continued in this situation, in select circumstances.

• In rheumatic disease patients with a confirmed SARS-CoV-2 infection, anti-malarial therapies (hydroxychloroquine, chloroquine) may be continued, but sulfasalazine, methotrexate, leflunomide, immunosuppressants, non-IL-6 biologics, and JAK inhibitors should be stopped temporarily. In select circumstances, IL-6 inhibitors may be continued.