TABLE 2.
Summary of consensus statements
| Consensus statements | Grade of evidence | Agreement | Strength of recommendation |
|---|---|---|---|
| C1. Patients with immune‐mediated RMD may be at a higher risk of COVID‐19 and of respiratory failure than the general population. | Very low | 90% | Not applicable |
| C2. Those potentially at high risk include patients on glucocorticoids (≥10 mg prednisolone/d). | Moderate | 100% | Not applicable |
| C3. Patients with RMD should be strongly advised to follow all preventive measures as stipulated by the healthcare authorities in their countries, as for patients without RMD. | Low | 94% | Strong |
| C4. There is no evidence to support a different diagnostic strategy for COVID‐19 in patients with RMD from that of non‐RMD patients. | Expert opinion | 100% | Not applicable |
| C5. Patients with RMD should be tested as soon as they develop any symptoms of COVID‐19 because of the potential increased risk of poorer outcomes. | Expert opinion | 100% | Strong |
| C6. In the absence of contrary evidence, patients with newly diagnosed RMD without COVID‐19 should be treated as per standard of care during the pandemic. | Expert opinion | 100% | Strong |
| C7. Therapeutic options alternative to rituximab, sulfasalazine, and cyclophosphamide may be considered on a case‐by‐case basis. | Very low | 82% | Weak |
| C8. For patients with RMD who do not have COVID‐19 symptoms and do not have documented COVID‐19, but who have had close contact with a highly suspected or documented COVID‐19 case, the recommendations for RMD medications vary depending on risk. | Expert opinion | 84% | Weak |
| C9. For asymptomatic RMD patients without documented infection, if stopped after exposure, antirheumatic medications may be resumed once a negative test has been certified, or after approximately 2 wk of symptom‐free observation from the day of exposure, if a test was not performed. | Expert opinion | 84% | Weak |
| C10. Rheumatologists should explore the perceptions of patients and address their concerns to ensure treatment adherence during the COVID‐19 pandemic. | Moderate | 100% | Strong |
| C11. The use of telemedicine should be strongly encouraged, especially in areas of high community transmission levels, for follow‐up of appropriate patients with RMD if implementing such an intervention is feasible and accepted by patients. | Moderate | 100% | Strong |
| C12. It is recommended that patients with RMD receive an approved SARS‐CoV‐2 vaccine as soon as it becomes available to them. | Expert opinion | 100% | Strong |
| C13. RMD patients with normal or altered immunocompetence should receive vaccination based on current country, regional and/or international guidelines for vaccinations. | Expert opinion | 100% | Strong |
| C14. Immunization schedules of RMD patients should be maintained while adhering strictly to the safety protocols of COVID‐19 prevention. | Expert opinion | 100% | Strong |
| C15. Clinical manifestations mimicking RMDs, laboratory reports of positive antinuclear antibodies, antiphospholipid antibodies, and lupus anti‐coagulant have been reported with COVID‐19 patients. These patients should be followed for the possibility of persistent intermediate‐ to long‐term immune dysregulation. | Expert opinion | 95% | Strong |
| C16. The clinical presentation of COVID‐19 in patients with RMD is similar to that in patients without RMD. Nonetheless, RMD patients who experience worsening of respiratory symptoms should immediately seek further healthcare advice of an expert in treating COVID‐19 (eg, pulmonologist, infectious diseases specialist, or general internist) according to local recommendations. | Low | 100% | Strong |
| C17. HCQ, NSAIDs, and ACEi/ARBs may be continued but should be individualized based on disease condition. | Moderate | 100% | Strong |
| C18. The clinician should consider stopping or withholding csDMARDs (other than HCQ), tsDMARDs, and bDMARDs, on a case‐by‐case basis. | Moderate | 94% | Weak |
| C19. RMD patients with COVID‐19 should be treated according to the standard of care. | Low | 92% | Strong |
| C20. Glucocorticoids should be used at the lowest possible dose to control RMD and should not be abruptly stopped. | High | 94% | Strong |
| C21. Immunosuppressants (azathioprine, cyclophosphamide, cyclosporine, mycophenolate, tacrolimus) should be discontinued in patients with COVID‐19. | Low | 82% | Strong |
| C22. In general, RMD treatments may be re‐introduced at least 2 wk after recovery from acute COVID‐19. They may need to be individualized based on the clinical scenario and the physician's judgment. | Low | 100% | Weak |
| C23. For asymptomatic individuals, RMD treatment may be re‐introduced approximately 10 d after diagnosis of COVID‐19. | Low | 100% | Weak |
| C24. SARS‐CoV‐2 infection has a negative impact on the QoL of RMD patients, particularly the mental health component. | Expert opinion | 95% | Not applicable |
| C25. Social isolation or shielding has a negative impact on the QoL (both mental and physical) of RMD patients during the COVID‐19 pandemic. | Expert opinion | 90% | Not applicable |
Abbreviations: ACEi, angiotensin‐converting enzyme inhibitors; ARB, angiotensin receptor blockers; bDMARDs, biologic disease‐modifying antirheumatic drugs (DMARDs); COVID‐19, coronavirus disease 2019; csDMARDs, conventional synthetic DMARDs; HCQ, hydroxychloroquine; NSAIDs, non‐steroidal anti‐inflammatory drugs; QoL, quality of life; RMD, rheumatic and musculoskeletal disease; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2; tsDMARDs, targeted synthetic DMARDs.
This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.