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Spring 2021 (Volume 31, Number 1)

COVID-19:
Innovations in Delivering Science to Rheumatologists and Patients

By Sindhu R. Johnson, MD, PhD

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In order to efficiently meet the needs of our patients during the COVID-19 pandemic, innovations in the way we conduct science and disseminate new knowledge have emerged. In my capacity as Chair of the American College of Rheumatology (ACR) Quality of Care Committee, I have had the opportunity to participate in or oversee a few COVID-19 initiatives.

Global Rheumatology Alliance
The Global Rheumatology Alliance (GRA) is a grassroots organization with origins in social media and a vision of “bringing together the global rheumatology community to curate and disseminate accurate and comprehensive knowledge to advance rheumatology care in the
COVID-19 pandemic.” Many Canadian rheumatologists have been involved in this effort, in conjunction with the Canadian Rheumatology Association (CRA), including Dr. Diane Lacaille, Dr. Marie Hudson, Dr. Carter Thorne, Dr. Evelyn Sutton and Dr. Louis Bessette. To achieve this vision, the GRA has four research arms:

  • Provider registries
  • Patient experience survey
  • Systematic reviews
  • Patient telemedicine survey

In a year, this collaboration has been shockingly productive. The ability to leverage social media to bring people together, to collect data, to write collaboratively, and publish needed information in a short time period is remarkable. The GRA is a new model of not only doing business, but of doing science. For a list of COVID-19 related publications from the GRA and ACR, visit rheum-covid.org/publications/ and rheumatology.org/Practice-Quality/Clinical-Support/COVID-19-Guidance.

ACR COVID-19 Vaccine Clinical Guidance Task Force
In 2019, the ACR Board approved the creation of the Guidance Subcommittee, charged with overseeing the development of guidance documents for clinical areas the membership wanted guidance on; areas for which the evidence is insufficient or timeline too short for more formal, GRADE-process driven guidelines. The ACR Guidance subcommittee includes Canadian rheumatologists Dr. Shahin Jamal and Dr. Alex Legge.

The ACR convened two task forces to address the needs of rheumatology providers during the COVID‐19 pandemic, in which I had leadership roles. First, the COVID-19 Clinical Task Force was charged by ACR leadership to rapidly provide guidance to rheumatology providers relevant to the management of rheumatic disease in adult patients during the pandemic. Clinical guidance generated from this effort was intended to aid in the care of individual patients, but not meant to supplant clinical decision‐making. Early in the pandemic, this document provided guidance on the use of rheumatic disease treatments including ACE inhibitors, ARBs, NSAIDs, glucocorticoids, and immunosuppressives following known SARS–CoV‐2 exposure and in the context of active or presumptive COVID-19.

Second, the ACR COVID-19 Vaccine Clinical Guidance Task Force was struck, consisting of North American rheumatologists, infectious disease specialists and public health experts with current or past employment at the Center for Disease Control and Prevention (CDC). Using a balance of consensus-based methods and largely indirect evidence from the literature, guidance on the use of the COVID-19 vaccine in individuals with rheumatic and musculoskeletal diseases (RMD), and in particular individuals with autoimmune and inflammatory rheumatic disease (AIIRD) was created. Topics included risk of COVID-19 infection and outcomes in RMD patients, vaccine immunogenicity in the setting of active disease or immunosuppressive therapy and vaccine safety. No evidence was found to support a concern regarding the use or timing of immunomodulatory therapies in relation to mRNA vaccine safety. Therefore, guidance regarding immunomodulatory medication and vaccination timing was given considering the intent to optimize vaccine response. Highlights from the ACR COVID-19 Vaccine Clinical Guidance are summarized in Tables 1 and 2. The draft summary was approved by the ACR Board of Directors on February 8, 2021; and a full manuscript is pending journal peer review.

Dissemination of rapidly changing information
Given that information regarding the intersection of RMD, risk of
COVID-19 infection and outcomes, and immunogenicity/ safety of the COVID-19 vaccine is rapidly emerging, mechanisms to update and release new information needed to be developed. In his capacity as Associate Editor at the journal Arthritis and Rheumatology, Dr. Brian Feldman has been integral to the rapid review and dissemination of COVID-related manuscripts from the ACR Quality of Care Committee. Using a new model, the ACR COVID-19 Guidance documents are considered “living documents.” As new information is published, the guidance documents are updated.

In short, Canadian rheumatologists have been active participants in a variety of facets related to the conduct and dissemination of science during the COVID-19 pandemic. We will continue to work together for the betterment of the patients we serve.

Sindhu R. Johnson, MD, PhD
Associate Professor of Medicine, University of Toronto
Clinician-Scientist, Toronto Western Hospital, Mount Sinai Hospital
Associate Director,
Clinical Epidemiology & Health Care Research Program,
Institute of Health Policy, Management and Evaluation
Toronto, Ontario



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