Journal of Rheumatic Diseases

Table. 1.

Recommendations for the management of patients with SRD during the COVID-19 pandemic

General principles Appropriateness*

Median ≥7/9 (%)
1. Patients with SRD are at a higher risk for severe COVID-19. 8.5 73
2. Immediate diagnostic testing is required for patients with SRD with suspected COVID-19. 9 100
3. Shared decision-making is fundamental, and the disease status, comorbidities, and presence or absence of COVID-19 should be considered when treating patients with SRD. 9 100
4. Patients should be provided with information regarding public preventive measures against COVID-19, such as washing hands, wearing a face mask, and social distancing. 9 100


1. Regular exercise within the personal space, smoking cessation, and vaccinations against influenza and pneumococcus are encouraged in patients with SRD. 9 100
2. For stable SRD patients without COVID-19, current medication, including glucocorticoids, DMARDs, and other immunosuppressants, may be continued. 9 100
3. NSAIDs may be used, if indicated, for SRD patients, except for patients with severe COVID-19. 8 100
4. A. Glucocorticoids, at the minimum effective dose required, can be used to control disease activity in active SRD patients without COVID-19. 9 100
B. Even in patients with COVID-19, current treatment with glucocorticoids for SRD should not be abruptly terminated. 9 100
5. A. csDMARDs can be initiated or used for active SRD patients without COVID-19. 9 100
B. In patients with COVID-19, treatment with csDMARDs, except for hydroxychloroquine and sulfasalazine, should be temporarily terminated. 7.5 70
6. A. bDMARDs can be initiated or used for active SRD patients without COVID-19. 9 100
B. In patients with COVID-19, treatment with bDMARDs, except for interleukin-6 inhibitors, should be temporarily terminated. 8 70
7. A. The initiation of tsDMARDs may be postponed until the cessation of the COVID-19 pandemic if an alternative therapy is available. 8 87
B. In patients with COVID-19, treatment with tsDMARDs should be temporarily discontinued. 8 80
8. Continuing the use of denosumab is suggested for patients with osteoporosis. 8 100
9. The intervals for and methods of monitoring the disease status and drug toxicities may be appropriately adjusted for patients with stable SRD. 9 100

SRD: systemic rheumatic diseases, COVID-19: Coronavirus disease 2019, DMARDs: NSAIDs nonsteroidal anti-inflammatory drugs, csDMARDs: conventional synthetic SRD systemic rheumatic diseases, bDMARDs: biological disease-modifying antirheumatic drugs, tsDMARDs: targeted synthetic DMARDs. *Appropriateness was evaluated according to RAND/University of California, Los Angeles (UCLA) appropriateness method (Appropriate [A] was defined as a median rating of 7∼9 without disagreement)

J Rheum Dis 2020;27:218~232
© J Rheum Dis