Table 1

EULAR recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2: the November 2021 update

Overarching principlesLoA, mean (SD)% ≥8/10
1.In general, patients with RMDs do not face higher risk of contracting SARS-CoV-2 than individuals without RMDs, and do not have a worse prognosis when they contract it.8.8 (1.5)81
2.The diagnosis and treatment of COVID-19 in patients with RMDs is the primary responsibility of an expert in treating COVID-19.9.9 (0.3)100
3.Rheumatologists are the leading experts for the immunomodulatory or immunosuppressive treatments of their patients and should be involved in the decision to maintain or discontinue them.9.9 (0.4)100
4.In view of their expertise, rheumatologists should be engaged in local hospital, regional or national guideline committees for COVID-19 management.9.2 (1.2)89
5.The off-label use of immunomodulatory or immunosuppressive drugs for the treatment of COVID-19 outside of established guidelines, protocols or clinical trials should be discouraged.9.2 (1.2)93
Recommendations
1.Patients with RMDs should be strongly advised to comply with all infection prevention and control measures prescribed by public health authorities, before and after SARS-CoV-2 vaccination.9.9 (0.2)100
2.Patients with RMDs should be advised to receive SARS-CoV-2 vaccination with any of the vaccines approved in their country.9.6 (1.6)96
3.Patients with RMDs who have been vaccinated against SARS-CoV-2 should be advised to continue their treatment unchanged; those who have not been vaccinated should be advised to continue their treatment, taking into account that certain therapies have been associated with an increased risk of severe COVID-19.9.5 (0.6)100
4.If a patient with RMD receiving long-term glucocorticoid treatment develops suspected or confirmed COVID-19, this treatment should be continued.9.3 (0.9)96
5.If a patient with RMD receiving rituximab treatment contracts SARS-CoV-2, postponing the next cycle of rituximab should be considered.9.7 (0.6)100
6.Patients with RMDs and initially mild symptoms who experience worsening of COVID-19 symptoms should immediately seek further healthcare advice of an expert in treating COVID-19.9.9 (0.3)100
7.Patients with RMDs should be advised to update their general vaccination status in accordance with the EULAR recommendations for the vaccination of patients with RMDs, with a particular focus on pneumococci and influenza.9.7 (0.6)100
8.In patients with RMDs not using immunomodulatory or immunosuppressive treatment, SARS-CoV-2 vaccination should precede a treatment start with such therapy if clinically feasible.9.6 (1.1)93
9.In patients with RMDs using rituximab or another B-cell depleting therapy, SARS-CoV-2 vaccination should be scheduled in a way to optimise vaccine immunogenicity.9.6 (1.1)96
Points to consider
1.There are concerns that individuals on certain immunosuppressive or immunomodulatory drugs may not mount an adequate protective response to COVID-19 vaccination. Data are not currently available to reliably identify who might, or might not, benefit from a third primary dose of a SARS-CoV-2 vaccine. Taking a precautionary position, third primary doses are being recommended by some authorities in selected groups of individuals and EULAR supports this approach.9.7 (0.6)100
2.There are concerns that protection provided by vaccines against severe COVID-19 decreases gradually over time. Insufficient time has passed to know what levels of protection might be expected 4–6 months after the primary course. Taking a precautionary position, booster doses are being recommended by several authorities and EULAR supports this approach.9.4 (1.0)95
  • COVID-19, coronavirus disease 2019; LoA, level of agreement (between 1 and 10); Mean (SD), mean level of agreement (SD); RMDs, rheumatic and musculoskeletal diseases; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.