American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID-19 Pandemic: Version 1

Arthritis Rheumatol. 2020 Aug;72(8):1241-1251. doi: 10.1002/art.41301. Epub 2020 Jun 5.


Objective: To provide guidance to rheumatology providers on the management of adult rheumatic disease in the context of the coronavirus disease 2019 (COVID-19) pandemic.

Methods: A task force, including 10 rheumatologists and 4 infectious disease specialists from North America, was convened. Clinical questions were collated, and an evidence report was rapidly generated and disseminated. Questions and drafted statements were reviewed and assessed using a modified Delphi process. This included 2 rounds of asynchronous anonymous voting by e-mail and 3 webinars with the entire panel. Task force members voted on agreement with draft statements using a 1-9-point numerical scoring system, and consensus was determined to be low, moderate, or high based on the dispersion of votes. For approval, median votes were required to meet predefined levels of agreement (median values of 7-9, 4-6, and 1-3 defined as agreement, uncertainty, or disagreement, respectively) with either moderate or high levels of consensus.

Results: The task force approved 77 initial guidance statements: 36 with moderate and 41 with high consensus. These were combined, resulting in 25 final guidance statements.

Conclusion: These guidance statements are provided to promote optimal care during the current pandemic. However, given the low level of available evidence and the rapidly evolving literature, this guidance is presented as a "living document," and future updates are anticipated.

Publication types

  • Consensus Development Conference
  • Practice Guideline

MeSH terms

  • Adult
  • Advisory Committees
  • Angiotensin Receptor Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antirheumatic Agents / therapeutic use*
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / complications
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / prevention & control
  • Delivery of Health Care
  • Delphi Technique
  • Deprescriptions
  • Glucocorticoids / therapeutic use*
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Immunosuppressive Agents / therapeutic use*
  • Infection Control
  • Janus Kinase Inhibitors / therapeutic use
  • Pandemics / prevention & control
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / prevention & control
  • Rheumatic Diseases / complications
  • Rheumatic Diseases / drug therapy*
  • Rheumatology
  • SARS-CoV-2
  • Tumor Necrosis Factor Inhibitors / therapeutic use


  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Anti-Inflammatory Agents, Non-Steroidal
  • Antirheumatic Agents
  • Glucocorticoids
  • Immunosuppressive Agents
  • Janus Kinase Inhibitors
  • Tumor Necrosis Factor Inhibitors
  • Hydroxychloroquine