EULAR & ACR COVID-19 Recommendations: How to Manage Patients During the COVID-19 Pandemic

3D generator; JPC-PROD / shutterstock.com

Editor’s note: EULAR 2020, the annual European congress of rheumatology, which was originally scheduled to be held in Frankfurt, Germany, starting June 3, was canceled and moved to a virtual format due to the COVID-19 pandemic.

EULAR 2020 e-CONGRESS—As rheumatologists grapple with how to manage patients in the COVID-19 era, the ACR and European League Against Rheumatism (EULAR) recommend joint decision making between patients and rheumatologists, limiting in-person visits for many patients and continuing treatment with glucocorticoid use, but at the lowest dose possible.

These and other suggestions—assembled in separate efforts by the two organizations, but which have much overlap—are subject to change as more data become available about the virus and rheumatic disease, experts said in a session of the European e-congress of rheumatology. Both organizations have pledged to revisit the recommendations frequently.

Dr. Landewé

According to EULAR
Robert Landewé, MD, PhD, professor of rheumatology, Department of Clinical Immunology and Rheumatology, University of Amsterdam, who leads a task force developing the recommendations for EULAR, said that so far there is no evidence that people with rheumatic and musculoskeletal diseases are at greater risk for contracting the virus, or that they’ll fare worse if they do.¹ But he indicated there’s legitimate reason to monitor the situation carefully.

“The rheumatological community rapidly got very concerned,” Dr. Landewé said. “We treat patients with autoimmune disease and those patients using immunosuppressive drugs. And immune suppression and infection do not go along very well.”

Dr. Landewé said some physicians treating COVID-19 have reportedly stopped the use of immunosuppressive drugs on their own.

“We should try to avoid that situation,” he said, adding that the diagnosis and treatment of COVID-19 should be the primary responsibility of a pulmonologist, infectious disease expert or internist. Because of their expertise in immunosuppressive treatment, however, the task force recommends rheumatologists make themselves available for COVID guideline committees.

Patients with rheumatic and musculoskeletal diseases who are stable can have their in-person visits and blood monitoring postponed temporarily, potentially using remote visits instead, Dr. Landewé said. But in cases of active disease or signs of drug toxicity, the patient and physician should consider a visit, weighing the risks and benefits together.

The EULAR task force says it’s more important than ever to aim for the lowest possible dose of glucocorticoids, although they should be continued. The group couldn’t come to a consensus on action to be taken for patients with mild COVID-19 symptoms, so it suggests handling such cases on an individual basis. But when COVID-19 is worsening, patients should seek immediate expert advice and follow their local treatment recommendations.