COVID-19 NICE Guidance - patients with rheumatological conditions

The purpose of this guideline is to maximise the safety of children and adults with rheumatological autoimmune, inflammatory and metabolic bone disorders during the COVID-19 pandemic.

  1. Communicating with patients and minimising risk
  • Communicate with patients and support their mental wellbeing, signposting to charities and support groups such as ARMA
  • Minimise face-to-face contact
  • Advise patients to contact:
  • NHS 111 by phone or via the website for advice on COVID-19
  • Their rheumatology team about any rheumatological medicines issues or if their condition worsens
  • Tell patients who still need to attend services to follow relevant parts of UK government guidance
  1. Patients not known to have COVID-19
  • If patients have to attend the rheumatology department, ask them to come without a family member or carer if they can, to reduce the risk of contracting or spreading the infection
  • Minimise a patient’s possible exposure to infection while at the hospital by:
  • Encouraging them not to arrive early
  • Texting them when staff are ready to see them, so that they can wait outside the building, for example in their car
  • Providing a ‘clean route’ through the hospital to the department
  • Reducing and ideally eliminating, the time patients spend in waiting areas through careful scheduling
  • Delivering treatment promptly
  • Ensuring prescriptions are dispensed rapidly.
  1. Patients known or suspected to have COVID-19
  • When patients with known or suspected COVID-19 have been identified, follow appropriate UK government guidance on infection prevention and control
  • In patients known or suspected to have COVID-19:
  • Continue hydroxychloroquine and sulfasalazine
  • Do not suddenly stop prednisolone
  • Only give corticosteroid injections of the patient has significant disease activity and there are no alternatives
  • Temporarily stop other disease-modify antirheumatic drugs, JAK inhibitors and biological therapies and tell them to contact their rheumatology department for further guidance.
  • If COVID-19 is later diagnosed in a patient not isolated from admission or presentation, follow the UK government guidance.
  1. Treatment considerations
  • Be aware that patients having immunosuppressant treatments may have atypical presentations of COVID-19
  • If a patient not previously known or suspected to have COVID-19 shows symptoms at presentation, follow UK government guidance
  • Discuss with each patient the benefits of treatment compared with the risks of becoming infected.
  • Advise patients taking a non-steroidal anti-inflammatory drug for a long-term condition such as rheumatoid arthritis that it does not need to be stopped
  • Advise patients taking prednisolone that it should not be stopped suddenly
  • Only use methylprednisolone for treating major organ flares.
  • Assess whether the frequency of intravenous immunoglobulins can be reduced in patients attending day-care services
  1. Drug monitoring
  • Assess with each patient whether it is safe to increase the time interval between blood tests for drug monitoring, particularly if 3-monthly blood tests have been stable for more than 2 years
  • Patients starting a new disease-modifying antirheumatic drug should follow recommended blood monitoring guidelines

You can read the full NICE guidance here.

Stay up to date with the latest NHS advice here.

Stay up to date with the latest HSE advice here.