3 Patients known or suspected to have COVID-19
3.1 Be aware that patients having immunosuppressant treatments may have atypical presentations of COVID‑19. For example, patients taking prednisolone may not develop a fever, and those taking interleukin 6 inhibitors may not develop a rise in C‑reactive protein.
3.2 If a patient not previously known or suspected to have COVID‑19 shows symptoms at presentation, follow UK government guidance on investigation and initial clinical management of possible cases. This includes information on testing and isolating patients.
3.3 When patients with known or suspected COVID‑19 have been identified, follow appropriate UK government guidance on infection prevention and control. This includes recommendations on patient transfers, and options for outpatient settings.
3.4 For all patients with known or suspected COVID‑19:
continue hydroxychloroquine and sulfasalazine
do not suddenly stop prednisolone
only give corticosteroid injections if the patient has significant disease activity and there are no alternatives, and refer to the British Society for Rheumatology's clinical guide on the management of patients with musculoskeletal and rheumatic conditions on corticosteroids
be aware that some patients on long-term corticosteroids may be at risk of an adrenal crisis and may need a higher dose of corticosteroids if diagnosed with COVID-19 (see the Society of Endocrinology's advice on managing adrenal crisis during COVID-19).
3.5 For adults, temporarily stop other disease-modifying antirheumatic drugs, JAK inhibitors and biological therapies, and tell them to contact their rheumatology department for advice on when to restart treatment. For children and young people, consider temporarily stopping other disease-modifying antirheumatic drugs, JAK inhibitors and biological therapies, taking account of advice in recommendation 3.6 of NICE's COVID-19 rapid guideline: children and young people who are immunocompromised.
The half-life of some drugs means that immunosuppression will continue for some time after stopping treatment. See the BNF and the summaries of product characteristics (SPCs) for specific information about individual drugs. [amended 2 July 2020]
3.6 If COVID‑19 is later diagnosed in a patient not isolated from admission or presentation, follow UK government guidance for health professionals.