key: cord-0862797-vnu8e5pq
authors: Hsu, Jeffrey; Liu, Chin‐Hsiu; Wei, James C.
title: American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID‐19 Pandemic: Version 3: Comment on the Article by Mikuls et al
date: 2021-06-08
journal: Arthritis Rheumatol
DOI: 10.1002/art.41889
sha: 68333050d9aeb7eb468574a24d389a9c21c589fd
doc_id: 862797
cord_uid: vnu8e5pq

It is with great pleasure that we read the work by Mikuls and colleagues (1) regarding pertinent consensus‐based guidelines for managing rheumatic diseases under the context of COVID‐19. We would first like to note that our nationwide retrospective cohort studies have shown that hydroxychloroquine treatment not only presents no increased risk of cardiac arrythmia in multiple rheumatic diseases (2), but also likely provides cardiovascular protection (3). Therefore, we believe the task force should reconsider the implications of halting hydroxychloroquine treatment in the context of SARS‐CoV‐2 infection.

It is with great pleasure that we read the work by Mikuls and colleagues (1) regarding pertinent consensus-based guidelines for managing rheumatic diseases under the context of COVID-19. We would first like to note that our nationwide retrospective cohort studies have shown that hydroxychloroquine treatment not only presents no increased risk of cardiac arrythmia in multiple rheumatic diseases (2) , but also likely provides cardiovascular protection (3) . Therefore, we believe the task force should reconsider the implications of halting hydroxychloroquine treatment in the context of SARS-CoV-2 infection. Finally, we would like to highlight the need for the guidelines to stratify based on gender and age. A recent cohort study by Avouac et al. demonstrated an association between rituximab treatment and poorer COVID-19 outcomes (6) . However, older men were specifically more likely to be treated with rituximab, further confounding the potential causes of this association. Another study highlighted lower risks of hospitalizations for rheumatic disease patients treated with DMARDs or JAKi, under the frameworks of a predominantly older female patient cohort (7). These potential differences in age-and gender-related disease outcomes in rheumatic diseases and COVID-19 brings to attention the need for guidelines that address the risk-to-benefit ratio of rheumatologic treatments at an age-and genderspecific level.

American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID-19 Pandemic: Version 3

Hydroxychloroquine Does Not Increase the Risk of Cardiac Arrhythmia in Common Rheumatic Diseases: A Nationwide Population-Based Cohort Study

Cardiovascular Protection of Hydroxychloroquine in Patients with Sjögren's Syndrome

JAK inhibition reduces SARS-CoV-2 liver infectivity and modulates inflammatory responses to reduce morbidity and mortality

Baricitinib plus Remdesivir for Hospitalized Adults with Covid-19

COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study

Rheumatic Musculoskeletal Diseases and COVID-19 A Review of the First 6 Months of the Pandemic

Accepted Article

The authors declare no conflict of interest.