EULAR & ACR COVID-19 Recommendations: How to Manage Patients During the COVID-19 Pandemic

The ACR guideline task force will meet monthly and is prepared to make changes to the guidance just as frequently, if needed.

The Data
Féline Kroon, MD, rheumatologist in training at Zuyderland Medical Center, the Netherlands, described the yawning gap between the need for data and what actually exists in the literature. She found 104 publications on COVID-19 and rheumatic diseases. Just 23—all published within the previous two months—were case studies or observational cohorts with any original data; the rest were viewpoint pieces or “narrative reviews.”

The case studies had a median number of patients of one. The cohort studies had a median of 165 patients, but the number of patients with COVID-19 in those studies is far lower, Dr. Kroon said.

The news that spread recently about hydroxychloroquine is a cautionary tale, she said. In vitro results suggesting a benefit in COVID-19 led to anecdotal publications that had serious limitations. Nonetheless, the drug found its way into many clinical protocols, because physicians were desperate for safe and effective treatments.

“An oversimplification and also a quick dissemination of these publications was done in the lay press, and this was amplified by social media,” Dr. Kroon said. “You can see how important it is that we interpret the evidence that we have in the right way. … Our interpretation can have large societal implications.”

Thomas R. Collins is a freelance writer living in South Florida.

References

1. Landewé RB, Machado PM, Kroon F, et al. EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Ann Rheum Dis. 2020 Jun 5;annrheumdis-2020-217877. [Online ahead of print]
2. Mikuls T, Johnson S, Fraenkel L, et al. American College of Rheumatology guidance for the management of rheumatic disease in adult patients during the COVID-19 pandemic. Arthritis Rheumatol. 2020 Apr 29. [Online ahead of print]