Patients living with inflammatory conditions have been especially hard hit by the COVID-19 pandemic. Setting aside their risk of contracting the virus, they are also dealing with disrupted medical care from their providers and concerns about their medications and infection risk.1-2 Physicians and patients alike are scrambling to make sense of the abundance of ever-changing information surrounding the virus. As a result, this topic is of great interest at many of the leading rheumatology congresses this year, and likely will be for years to come.
As information around COVID-19 continues to evolve, the way you are conducting patient visits has undoubtedly changed.3 Perhaps you’ve been seeing patients virtually, postponing visits, or limiting in-person visits to the highest-priority cases.3 Patient care has always been about more than providing treatment, but for many physicians, the approach to patient care has transformed due to the pandemic.
Many rheumatologists are now fielding questions from their patients, patients’ families, and other physicians; contributing to the COVID-19 response on topics such as concerns about RA treatments and stress; and so much more.2 Due to their expertise in managing inflammation and experience with anti-inflammatory therapies, rheumatologists have been called on by many who are looking for guidance on how best to manage patients with COVID-19 and rheumatic diseases.4
At the upcoming virtual ACR Convergence 2020 and beyond, there will be considerable amounts of new information offering perspectives on managing patients diagnosed with or suspected of having COVID-19. Given how quickly new data are emerging, it is important to be armed with the tools to evaluate the new data you have been seeing with a critical eye—both for yourself and for your practice. As more information is sure to be shared in the coming months, we have some questions to consider when evaluating the research you are seeing:
- Does the study have enough participants to support the claims made?
- Does the study report pre-existing conditions and comorbidities?
- Does the study compare the study drug with a placebo or standard of care? What is the standard of care?
- How are critical, severe, moderate, and mild disease defined?
- Does the study adjust for confounders?
- How long does the study follow their patients? (Keeping in mind that the virus has been present for less than a year)
The urgency of the COVID-19 epidemic has driven much research, but the nature of the studies and the level of peer review can vary. Both EULAR and ACR, and other international organisations as well, have established dedicated task forces to evaluate and summarise key findings into guidance relevant for rheumatologists’ practices. Some of these sources include5-7:
- The EULAR COVID-19 task force, which recently released guidelines for managing patients with rheumatic diseases during the pandemic
- The ACR task force, which has published guidelines for commonly used treatments in patients with rheumatic diseases
- COVID-19 Global Rheumatology Alliance registry, which is a larger registry collecting data from regional registries throughout the world
Some good news from a recent evidence review performed by the ACR COVID-19 task force is that, to date, there are no data to indicate that patients with rheumatic diseases have a higher risk of contracting COVID-19 than the general population.6
As our understanding of COVID-19 is constantly evolving, be sure to check these sources regularly and keep in close communication with your patients. Now more than ever, it is important to address patient questions and concerns to support their adherence to therapy.
Make sure to check back after the meeting to read Dr. Roberto Caporali’s take on the emerging data and discussions around COVID-19 in RA from the ACR Convergence 2020 meeting.
ACR, American College of Rheumatology; EULAR, European League Against Rheumatism; RA, rheumatoid arthritis.
References: 1. Schett G, Manger B, Simon D, Caporali R. Nat Rev Rheumatol. 2020;16:465-470. 2. Minniti A, Maglione W, Pignataro F, Cappadona C, Caporali R, Del Papa N. Clin Rheumatol. 2020;39(7):2063-2065. 3. Michaud K, Wipfler K, Shaw Y, et al. ACR Open Rheum. 2020;2(6):335-343. 4. Favalli EG, De Lucia O, Biggioggero M, et al. Ann Rheum Dis. Published online June 19, 2020. doi: 10.1136/annrheumdis-2020-218068 5. Landewé RB, Machado PM, Kroon F, et al. Ann Rheum Dis. 2020; 79(7):851-858. 6. Mikuls TR, Johnson SR, Fraenkel L, et al. Arthritis Rheumatol. 2020;72(9):e1-e12. 7. COVID-19 Global Rheumatology Alliance. Accessed October 9, 2020. https://rheum-covid.org