Purpose
To ascertain Australian rheumatologists’ opinions and approach in the management of systemic inflammatory disorders at the onset of the Covid-19 pandemic, in order to provide a potential point of reference for practitioners in developing their own responses to the principal issues.
Methods
The survey was conducted under the aegis of the Australian Rheumatology Association at the onset of the pandemic. A questionnaire consisted of thirteen multiple choice questions were sent to all clinician members (n = 488). Initial mail out was on 7 April 2020 with an identical follow up mailing on 17 April.
Results
There were 108 (22%) responses. There was an almost equal division among rheumatologist on the question of whether patients with rheumatic disease are at increased risk of contracting COVID-19, and of having an increased risk of serious complications if infected. 40% also issued a general warning to patients that they were at increased risk.
Most (67%) felt that good disease control was important and would put patients in a better position to resist contracting COVID19 and to deal with the complications if infected. In the event of infection, the great majority (>80%) indicated that they would stop all conventional and biologic disease modifying drugs including JAK inhibitors. 65% would also stop non-steroidal anti-inflammatories. Notably however 80% would continue corticosteroids and 90% would continue hydroxychloroquine with 11% indicating they would consider adding it in the case of patients not already on it.
At the practice impact level, most (88%) indicated they would transition to Telehealth. The pandemic has also impacted half who have rural appointments. 57% indicated dissatisfaction with the telehealth item number as it was at the time of the survey, which preceded the amendment of 20 April.
Conclusion
Australian Rheumatologists’ approach at the onset of the pandemic correctly anticipated the currently evolving evidence regarding the risks and outcomes of Covid-19 amongst patients with systemic inflammatory disorders.