Recommendations for managing rheumatic and musculoskeletal diseases in the COVID-19 era

These recommendations focus on prevention of COVID-19; managing patients in general; and managing patients who have been infected or have been in contact with a COVID-19 patient. They were simultaneously published in the Annals of the Rheumatic Diseases.

A set of recommendations on the management of patients with rheumatic and musculoskeletal diseases has been developed by EULAR [1]. These recommendations focus on prevention of COVID-19; managing patients in general; and managing patients who have been infected or have been in contact with a COVID-19 patient. The recommendations were simultaneously published in the Annals of the Rheumatic Diseases [2].

Despite the sparse evidence combined with the tremendous time pressure under which these recommendations were made, EULAR was able to develop a preliminary set of recommendations on management of patients with rheumatic and musculoskeletal diseases in the COVID-19 era.
Prof. Robert Landewé (Academic Medical Center Amsterdam and Zuyderland Medical Center Heerlen) emphasized that they are indeed preliminary and that updates are eagerly awaited. “However, for the time being, it will have to do.”

The 13 recommendations are based on 4 themes:

1. General matters of prevention of COVID-19: washing hands, mask-wearing, and social distancing are key to prevent spreading of the virus.
2. Managing patients during the COVID-19 pandemic: patients with rheumatic disease who have symptoms of COVID-19 should be tested. Moreover, treatment for their chronic condition should continue. Consultation should take place via telehealth unless there is absolute urgency for an in-person consultation.
3. Managing patients who have been in contact with COVID-19 patients or who have contracted the virus themselves: as the vast majority of people who are infected with COVID-19 are asymptomatic or have mild disease, they do not need to go to the doctor or hospital. It is up to the patient and physician to decide on this. If patients have symptoms of more severe COVID-19 disease and/or their symptoms are rapidly worsening, they should be referred to an intensivist, infectious diseases specialist or pulmonologist.
4. Pulmonary complications: doctors should be aware of this and refer patients to a pulmonologist when they think this is the case.

Full recommendations can be found online here.

References:
1. Landewé RBM. Provisional recommendations COVID-19. EULAR COVID-19 Recommendations. EULAR 2020.
2. Landewé RBM, et al. EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Ann Rheum Dis. 2020;annrheumdis-2020-217877.