Rheumatology practice amidst the COVID-19 pandemic: a pragmatic view

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has come with many challenges for healthcare providers and patients alike. In addition to the direct burden it has placed on societies and health systems, it had a significant impact in the care of patients with chronic diseases, as healthcare resources were deployed to fight the crisis, and major travel and social restrictions were adopted. In the field of rheumatology, this has required notable efforts from departments and clinicians to adapt to the novel status quo and assure the follow-up of patients with rheumatic and musculoskeletal diseases. In the present viewpoint, we provide a practical approach to tackle this reality. Key measures include setting up preventive team management strategies, optimising communication with patients and reorganising patient care in all its dimensions. We then anticipate the nuances of rheumatology practice as restrictive measures are progressively lifted, while an effective vaccine is still pending. This includes the need to reimpose the same strategy as further waves unfold. Finally, we look ahead and address the lessons we can incorporate into post-COVID-19 rheumatology.

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

“…It is recognized that the fear of glucocorticoid use in the era of COVID-19 may expose patients with organ-threatening diseases such as the vasculitides and aggressive connective tissue diseases to greater risks if appropriate interventions using the required immunosuppressive agents are not promptly adopted. Undoubtedly, patients with these conditions may face short-term risks of major organ damage or mortality without appropriate treatment [ 18 ]. Therefore, in the context of these severe diseases, the appropriate dose of glucocorticoids including high and pulse doses may be unavoidable [ 3 ].…”

“…This may imply re-organizing services and optimizing the line of communication between the healthcare service and the patient. Due to the increasing recognition of in-hospital transmission of SARS-CoV-2, limiting attendance will likely serve to reduce the anxiety of the healthcare workers and the patients [ 18 ]. As many patients with RMDs also have co-morbidities that put them at higher risk of severe COVID-19 such as metabolic syndrome, cardiovascular diseases and advanced age, it is important to explain this risk to patients and help them understand the purpose of reducing face-to-face interactions [ 25 ].…”

“…Where indicated, there is no evidence to avoid administering intra-articular steroids for patients where this is the best option of care after weighing the risk of hospital attendance. However, standard procedures regarding the use of personal protective equipment should be observed to limit the risk of transmission of SARS-CoV-2 infection between healthcare professionals and patients where such procedures are deemed justified [18].…”

“…Some of these can be allayed in the patient by keeping an open line of communication and maintaining easy and rapid access to reaching the rheumatologist helpline for advice. In this period, it will not be unexpected for patients to be unusually anxious, and this state may be helped by having reliable access to guidance regarding the management of their RMD treatments and queries around their RMDs [18].…”

“…This may be from environmental contamination, a risk that is likely higher in both rural African communities and in urban slums. As children of all ages have been shown to develop COVID-19 without any gender disparity, healthcare professionals would do well to not exercise prolonged inertia in embarking upon appropriate testing of these patients, but it is advisable to limit the number of parents or family members attending with the patient to the barest minimum [18].…”