German Society of Rheumatology COVID Pandemic Recommendations Save

The Annals of Rheumatic Disease has published the preliminary recommendations of the German Society of Rheumatology for the management of Inflammatory rheumatic diseases patients during the SARS-CoV-2/Covid-19 pandemic. 

These preliminary recommendations are based on an expert consensus from 17 experienced German rheumatologists, who recommend: 

Prevention of infection

1. Patients with inflammatory rheumatic diseases may have an increased risk of infection. Especially with age, comorbidity steroids, prior serious infections, DMARDs, biologics, high disease activity, cyclophosphamide and immunodeficiencies. It is not know whether this also applies to SARS-CoV-2 infections
2. It is not known whether Covid-19 is more severe in patients with inflammatory rheumatic diseases or whether immunosuppressive therapy represents an additional risk for a severe course. Therefore,
3. Inflammatory rheumatic diseases should: observe hygiene measures, avoid contacts to other individuals and discuss with their employer to which extent contact avoidance can be implemented. Patients can be issued a certificate that they are receiving immunosuppressive/immunomodulating therapy, with which they can contact physicians in charge for their companies/public health officers/employers.
4. Avoid contact between SARS-CoV-2-infected persons and rheumatologists, or between infected persons and rheumatological care facilities until the infection has subsided (>14 days after the end of symptoms).
5. Ensure necessary disease monitoring, consider if monitoring intervals may be prolonged with stable disease and therapy.

Antirheumatic Drug Therapy during Covid-19 Pandemic

1. A general interruption or reduction of immunosuppression is not recommended
2. Immunosuppressive therapies for remission induction (eg, for vasculitis) should not be delayed or underdosed
3. Regimes with lower glucocorticoid doses should be preferred
4. Hydroxychloroquine should not be discontinued (may be more beneficial than harmful in with SARS-CoV-2).
5. Do not discontinue steroids, csDMARDs, biologics or tsDMARDs in suspected patients or those who test positive but are asymptomatic.
6. Patients with COVID-19 infection should interrupt antirheumatic medication but continue long-term GC therapy at the same dose.