COVID-19 NICE Guidance - patients with rheumatological conditions

The purpose of this guideline is to maximise the safety of children and adults with rheumatological autoimmune, inflammatory and metabolic bone disorders during the COVID-19 pandemic.

1. Communicating with patients and minimising risk

• Communicate with patients and support their mental wellbeing, signposting to charities and support groups such as ARMA
• Minimise face-to-face contact
• Advise patients to contact:
• NHS 111 by phone or via the website for advice on COVID-19
• Their rheumatology team about any rheumatological medicines issues or if their condition worsens
• Tell patients who still need to attend services to follow relevant parts of UK government guidance

2. Patients not known to have COVID-19

• If patients have to attend the rheumatology department, ask them to come without a family member or carer if they can, to reduce the risk of contracting or spreading the infection
• Minimise a patient’s possible exposure to infection while at the hospital by:
• Encouraging them not to arrive early
• Texting them when staff are ready to see them, so that they can wait outside the building, for example in their car
• Providing a ‘clean route’ through the hospital to the department
• Reducing and ideally eliminating, the time patients spend in waiting areas through careful scheduling
• Delivering treatment promptly
• Ensuring prescriptions are dispensed rapidly.

3. Patients known or suspected to have COVID-19

• When patients with known or suspected COVID-19 have been identified, follow appropriate UK government guidance on infection prevention and control
• In patients known or suspected to have COVID-19:
• Continue hydroxychloroquine and sulfasalazine
• Do not suddenly stop prednisolone
• Only give corticosteroid injections of the patient has significant disease activity and there are no alternatives
• Temporarily stop other disease-modify antirheumatic drugs, JAK inhibitors and biological therapies and tell them to contact their rheumatology department for further guidance.
• If COVID-19 is later diagnosed in a patient not isolated from admission or presentation, follow the UK government guidance.

4. Treatment considerations

• Be aware that patients having immunosuppressant treatments may have atypical presentations of COVID-19
• If a patient not previously known or suspected to have COVID-19 shows symptoms at presentation, follow UK government guidance
• Discuss with each patient the benefits of treatment compared with the risks of becoming infected.
• Advise patients taking a non-steroidal anti-inflammatory drug for a long-term condition such as rheumatoid arthritis that it does not need to be stopped
• Advise patients taking prednisolone that it should not be stopped suddenly
• Only use methylprednisolone for treating major organ flares.
• Assess whether the frequency of intravenous immunoglobulins can be reduced in patients attending day-care services

5. Drug monitoring

• Assess with each patient whether it is safe to increase the time interval between blood tests for drug monitoring, particularly if 3-monthly blood tests have been stable for more than 2 years
• Patients starting a new disease-modifying antirheumatic drug should follow recommended blood monitoring guidelines