In general, you are advised to continue your medicine as prescribed and should stay home and away from people as much as possible. You should practice frequent and thorough hand washing, including the use of hand sanitizers, and avoid touching of mouth, nose, or eyes with bare hands/fingers.

Don’t stop or change your treatment without checking with your rheumatologist.

Patients at high risk for COVID-19 and likely to be exposed to crowded conditions (e.g., an office) should be advised to ask their employer for special accommodations, including option of remote work, etc.

For close/household contacts of individuals with high risk for COVID-19 exposure (e.g., frontline health care workers), continuous evaluation of risk and standard measures to reduce transmission are recommended.

Yes, if you have any symptom that may be related to COVID-19, you should stop your immunosuppressive treatment (except cortisone & Hydroxychloroquine ) and get tested for COVID-19 according to your local national guidelines.

Replace NSAIDs with paracetamol.

Check with your rheumatologist about the adequate timing to go back to your treatment.

Immunosuppressive medications:

Prednisone (Cortisone) ≥ 20 mg/d , Azathioprine (Imuran®), Leflunomide (Arava® / Avara®), Mycophenolate mofetil (CellCept®, Myora®), Tacrolimus (Prograf®), Cyclophosphamide (Endoxan®), Methotrexate, Biologic therapies treatments like: Adalimumab (Humira®), Etanercept (Enbrel®), Certolizumab pegol (Cimzia®), Golimumab (Simponi®), Abatacept (Orencia®), Secukinumab (Cosentyx®), Tocilizumab (Actemra®), Ustekinumab (Stelara®) , Infliximab (Remicade®), Rituximab (MabThera®) & Belimumab (Benlysta®), Janus kinase (JAK) inhibitors (Xeljanz®, Olumiant®), Biosimilar to Infliximab (Remsima®) , Biosimilar to Adalimumab (Amgevita®) and Biosimilar to Rituximab (Truxima®)

Currently, there are no specific data on COVID-19 in patients with rheumatologic disease. Some anti-rheumatic drugs are in fact being tested for the treatment of COVID-19.

There are currently no prophylactic or therapeutic measures beyond supportive care recommended for this virus.

Importance of hand hygiene, with frequent and effective hand washing, as well as avoidance of people who are ill, especially those who are coughing or sneezing.

The routine wearing of masks is encouraged to all individuals.

Patients must receive all appropriate vaccinations, including seasonal influenza, pneumonia, pertussis, and shingles vaccines.

These will not prevent COVID-19 but may lessen the chance of a secondary infection and will prevent illnesses that could be confused with COVID-19.

Patients should employ frequent handwashing and in general avoid touching their face or mucous membranes.

In addition, patients should be advised to keep ample stocks (e.g., one-month supply) of necessary medications on hand in case they are prevented from refilling prescriptions in a timely manner.

No, only social distancing and good personal hygiene can prevent COVID-19.

Some biologic medications have been used experimentally in the setting of severe COVID-19 infection in an attempt to reduce the inflammatory response. However, there is no evidence to suggest that these medications treat or provide protection from infection with COVID-19.

Yes.

Eat healthy, practice exercise, drink plenty of water.

You should only get tested if you have symptoms and follow your national guidelines for testing.

You should practice thoroughly the general recommendations:

• Wash your hands frequently

• Regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them with soap and water (at least 20 seconds).

• Avoid touching eyes, nose and mouth

• Practice respiratory hygiene

• Make sure you, and the people around you, follow good respiratory hygiene by covering your mouth and nose with your bent elbow or tissue when you cough or sneeze.

• Maintain social distancing

• Maintain at least 1-meter distance between yourself and anyone.

• Avoid busy public transport

• Avoid large groups gatherings

• Avoid unnecessary travel

Mask It is strongly recommended for healthy individuals including patients with rheumatic diseases to wear a mask to prevent any contamination from infected asymptomatic individuals or those showing highly suspected symptoms of COVID-19.

Before putting on a mask, clean hands with alcohol-based hand rub or soap and water. If you wear a mask, then you must know how to use it and dispose it properly.

Seek medical care immediately. Check with your rheumatologist if you have any question!