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American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the
Ted R Mikuls1, Sindhu R Johnson2, Liana Fraenkel3
1University of Nebraska Medical Center, Omaha, Nebraska and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska.
Insights
This guidance offers rheumatology providers best practices for managing adult rheumatic diseases during the COVID-19 pandemic. It provides expert consensus on patient care amidst evolving scientific understanding.
Area of Science:
- Rheumatology
- Infectious Diseases
- Pandemic Management
Background:
- The coronavirus disease 2019 (COVID-19) pandemic significantly impacts the management of adult rheumatic diseases.
- Rheumatology providers require updated guidance for optimal patient care during this public health crisis.
Purpose of the Study:
- To develop evidence-based guidance for rheumatology providers managing adult rheumatic diseases during the COVID-19 pandemic.
- To synthesize expert opinion and available evidence into actionable clinical recommendations.
Main Methods:
- A task force of rheumatologists and infectious disease specialists was assembled.
- A modified Delphi process, including anonymous voting and webinars, was employed to reach consensus on clinical questions.
- Consensus levels were determined based on a 1-9 scoring system and vote dispersion.
Main Results:
- Approved guidance statements were consolidated to form the final recommendations.
- The process facilitated expert agreement on key management strategies for rheumatic diseases during the pandemic.
Conclusions:
- The provided guidance aims to optimize care for patients with rheumatic diseases during the COVID-19 pandemic.
- Recognizing the evolving nature of the pandemic and literature, this guidance is a living document subject to future updates.
Objective:
To provide guidance to rheumatology providers on the management of adult rheumatic disease in the context of the coronavirus disease 2019 (COVID-19) pandemic.
Methods:
A task force, including 10 rheumatologists and 4 infectious disease specialists from North America, was convened. Clinical questions were collated, and an evidence report was rapidly generated and disseminated. Questions and drafted statements were reviewed and assessed using a modified Delphi process. This included asynchronous anonymous voting by email and webinars with the entire panel. Task force members voted on agreement with draft statements using a 1-9-point numerical scoring system, and consensus was determined to be low, moderate, or high based on the dispersion of votes. For approval, median votes were required to meet predefined levels of agreement (median values of 7-9, 4-6, and 1-3 defined as agreement, uncertainty, or disagreement, respectively) with either moderate or high levels of consensus.
Results:
Draft guidance statements approved by the task force have been combined to form final guidance.
Conclusion:
These guidance statements are provided to promote optimal care during the current pandemic. However, given the low level of available evidence and the rapidly evolving literature, this guidance is presented as a "living document," and future updates are anticipated.
