Article Text

Download PDFPDF
Management of rheumatic diseases in the time of covid-19 pandemic: perspectives of rheumatology practitioners from India
  1. Latika Gupta1,
  2. Durga Prasanna Misra1,
  3. Vishwesh Agarwal2,
  4. Suma Balan3,
  5. Vikas Agarwal1
  1. 1 Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
  2. 2 Mahatma Gandhi Mission's Medical College, Navi Mumbai, Maharashtra, India
  3. 3 Department of Paediatric Rheumatology, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
  1. Correspondence to Dr Vikas Agarwal, Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India; vikasagr{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

With respect to observations by Monti et al,1 a survey featuring 31 questions related to rheumatic diseases (RDs) during the covid-19 pandemic was administered to members of the Indian Rheumatology Association.

Of 861 invitees, 221 (25.7%; 92.7% adult rheumatologists, 52.2% academicians) responded. Most perceived the need for a change in the management of RDs (online supplementary files). Almost half (47.5%) reduced the usage of biological disease modifyinig anti rheumatic drugs (bDMARDs), whereas only 12.2% did so for csDMARDs (figure 1). Of the respondents, 66.5% were more inclined to initiate hydroxychloroquine (HCQ) in patients with borderline indications, whereas 14% disagreed with this approach. Nearly two-thirds (64.2%) were less inclined to change the major immunosuppressant (IS) for impending flare, with 58.3% deferring rituximab (RTX), followed closely by cyclophosphamide, antitumour necrosis factors (anti-TNFs), Janus kinase inhibitors (JAKinibs) and other bDMARDs. An earlier taper of glucocorticoids was preferred by 57.9% in inactive disease. There was lack of consensus on continuing IS infusions.

Supplemental material


Supplemental material


Supplemental material


Figure 1

Opinion of rheumatologists on change in management of rheumatic diseases in the time of covid-19 pandemic. ARBs, angiotensin receptor blockers; AZA, Azathioprine; bDMARDs, biological disease modifying …

View Full Text


  • Twitter @LatikaGupta_

  • Correction notice This article has been corrected since it published Online First. Figure 1 has been replaced.

  • Contributors All authors were involved in ideation, data collection and manuscript preparation. All authors agree with the submitted version of the manuscript, take responsibility for the content of the entire manuscript and affirm that any queries related to any aspect of the same are appropriately managed.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Exemption from review was obtained from the institute ethics committee of SGPGIMS, Lucknow as per local guidelines. The survey was completely anonymised and informed consent taken from the respondents at the beginning of the exercise.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement All data pertaining to the study are included in the manuscript and as supplementary material. Pre-prints are available at Medarxive at Gupta L, Misra D, Agarwal V, et al. Management of rheumatic diseases in the times of COVID-19 pandemic- perspectives of rheumatology practitioners from India. Rheumatology 2020. doi:10.1101/2020.04.03.20048389.

Linked Articles