American College of Rheumatology Guidance for the Management of Adult Patients with Rheumatic Disease During the COVID-19 Pandemic.

OBJECTIVE: To provide guidance to rheumatology providers on the management of adult rheumatic disease patients in the context of the COVID-19 pandemic. METHODS: A task force, including 10 rheumatologists and 4 infectious diseases 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 two rounds of asynchronous anonymous voting by email and three webinars with the entire panel. Task force members voted on agreement with draft statements using a 9-point numeric scoring system (1 to 9), and consensus was determined to be "low", "moderate", or "high", based on the dispersion of votes. For approval, median votes were required to meet pre-defined 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.