African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic

Abstract

Objectives To develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic. Method A task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a huband-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1-3, 4-6 and 7-9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a 'low' level of agreement. Results A total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting. Conclusions The preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges. Keywords African rheumatology. COVID-19. DMARD. Rheumatic and musculoskeletal diseases. Rheumatology Key Points • AFLAR has developed preliminary recommendations for the management of RMDs in the face of the COVID-19 pandemic. • COVID-19 is an unprecedented experience which has brought new concerns regarding the use of some disease-modifying anti-rheumatic drugs (DMARDs), and these recommendations seek to provide guidelines to African rheumatologists. • Hydroxychloroquine shortage has become rampant across Africa as the drug is being used as prophylaxis against COVID-19 and this may necessitate a review of the treatment plan for some patients with RMDs. • Breastfeeding should continue for as long as possible if a woman is positive for SARS-CoV-2 as there is currently no evidence that the infection can be transmitted through breast milk. This article is part of the Topical Collection on Rheumatology in Africa

Population-level interest in anti-rheumatic drugs in the COVID-19 era: insights from Google Trends

“…F u r t h e r m o r e , t h e A m e r i c a n C o l l e g e o f Rheumatology (ACR) guidelines regarding the management of rheumatic diseases during the COVID-19 pandemic (version 2) recommend that conventional (DMARDs), immunosuppressants, biologics, JAK inhibitors, and NSAIDs may be continued in patients with stable rheumatic disease in the absence of COVID-19 infection or SARS-CoV-2 exposure [9]. However, as the literature is rapidly evolving, we recommend readers to refer to the recent version of ACR, European League Against Rheumatism (EULAR), and African League Against Rheumatism (AFLAR) guidelines on the management of rheumatic diseases during the COVID-19 pandemic [9,10,43].…”

Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era

“…The coronavirus disease 2019 (COVID-19) pandemic has caused a significant burden on healthcare systems around the world, leading to substantial changes to treatment settings for patients with rheumatic diseases and inflammatory bowel disease (IBD) [ 1 – 4 ]. The highly transmissible nature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) increases the risk of nosocomial infection [ 5 , 6 ]; thus, outpatient clinics and hospital attendance have been reduced in order to improve physical distance for those patients who still need to attend in person [ 3 , 4 , 7 – 9 ]. Minimised patient management via telemedicine has become an important tool in the management of chronically ill patients [ 3 , 4 , 7 – 9 ].…”

Coronavirus Disease 2019 (COVID-19) and Immune-mediated Rheumatic Diseases. Recommendations of the Association of Rheumatologists of Russia

“…В целом отсутствие синтеза нейтрализующих антител имело место у каждого 10-го пациента (9,5%), o n l i n e fi r s t Таблица 3. Рекомендации по терапии и вакцинации пациентов с ревматическими заболеваниями в период пандемии COVID-19 [90][91][92][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108] Продолжение таблицы 3 o n l i n e fi r s t страдающего ИВРЗ, и у каждого 100-го (0,5%) в группе контроля. Наконец совсем недавно было показано, что базовое лечение МТ ассоциируется с неадекватным синтезом анти-SARS-CoV-2 (у 62,2% пациентов) и отсутствием вирусспецифической активации CD8 + -Т-клеток [169].…”