Last fall, Ellen M. Gravallese, MD, was named chief of the Division of Rheumatology, Inflammation and Immunity at Brigham and Women’s Hospital and president of the American College of Rheumatology (ACR). In these roles, she is overseeing the response of the division and the ACR to the alarming spread of the novel coronavirus.
“The ACR has taken a very proactive stance to try to address COVID-19,” Dr. Gravallese said. “We understand how difficult this pandemic has been for rheumatologists in caring and making the best decisions for their patients while at the same time limiting community exposure to the SARS-CoV-2 virus as much as possible. We hope the work we are doing at the ACR will provide immediate assistance to physicians in these efforts.”
In a recent interview, Dr. Gravallese outlined the ACR’s efforts in three main areas: practice and advocacy, clinical guidance and the COVID-19 global rheumatology registry.
Practice and Advocacy
The ACR has established the Practice and Advocacy Task Force to assist members in their practices by identifying and advocating for pressing issues during this pandemic.
Output from this task force has included guidance documents for drug shortages (including hydroxychloroquine) along with informational documents on telehealth services, commercial payers’ telehealth reimbursement policies and infusion guidance in the setting of the COVID-19 pandemic. The ACR was also a co-signer of a joint statement calling on Vice President Mike Pence to address shortages of hydroxychloroquine and chloroquine.
“Since President Trump announced that hydroxychloroquine might be useful for COVID-19 [at a March 19 press conference], we’ve seen an outpouring of concerns from our membership regarding a possible shortage of this medication,” Dr. Gravallese said. “It’s on everyone’s mind, as hydroxychloroquine is one of the few drugs that’s effective in decreasing flares of systemic lupus and is used to treat several rheumatic diseases.”
Dr. Gravallese added that the ACR has been advocating at the federal level and directly to companies for increased production of hydroxychloroquine. Other areas of focus on the advocacy front include facilitating the provision of telehealth services and suspending insurers’ prior authorization requirements.
The ACR has also established the Clinical Guidance Task Force, which is comprised of experts in infectious disease, epidemiology and biologic therapies. This task force is developing best practices for the treatment of patients with underlying rheumatic disease during this pandemic.
In order to tackle the large volume of work, the task force has been divided into sub-groups that will address:
- Risk assessment and prevention of COVID-19 in patients with rheumatic disease
- Rheumatic disease therapies in areas with a high density of infection with COVID-19
- Therapies for rheumatic diseases pre- and post-exposure to COVID-19
- Recommendations for rheumatic disease therapies in the setting of COVID-19 infection
Over the past several weeks, Dr. Gravallese has also been sending members a steady stream of emails with information about COVID-19, including links to the latest research papers.
COVID-19 Global Rheumatology Registry
The ACR has been a strong supporter of the recently launched COVID-19 Global Rheumatology Alliance. This group has created an international case-reporting registry to collect information on outcomes of patients with rheumatic disease who test positive for COVID-19, with the goal of providing rheumatologists with guidance on clinical care.
Besides actively promoting the registry, the ACR will assist the alliance with data dissemination and make the alliance a section of the ACR. Dr. Gravallese believes the registry will give rheumatologists across the globe valuable insights into outcomes of rheumatic disease patients with COVID-19, especially those taking immunosuppressive agents.
“The biggest question that I was initially asked during this pandemic was, ‘What should we do with our immunosuppressed patients? Are they at greater risk for COVID-19? Should I stop or taper their therapy?'” she said. “This registry will provide us with some of that data.”
For more information on the topics covered in this article—as well as a wealth of other resources on managing rheumatic patients during this crisis — visit the ACR’s COVID-19 landing page. In addition, an article on the use of hydroxychloroquine for COVID-19 that was co-authored by Brigham rheumatologist Jeffrey A. Sparks, MD, and recently published in Annals of Internal Medicine.