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Management of rheumatic diseases in the time of covid-19 pandemic: perspectives of rheumatology practitioners from India
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  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}yahoo.com

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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

[annrheumdis-2020-217509supp001.pdf]

Supplemental material

[annrheumdis-2020-217509supp002.pdf]

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[annrheumdis-2020-217509supp003.pdf]

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 …

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