Self-care recommendations for patients with rheumatic diseases during the COVID-19 pandemic.

Dear Editor,

Since the first novel coronavirus disease 2019 (COVID-19) patient was diagnosed in the Republic of Korea on January 20, 2020, 10,780 patients have been diagnosed as of May 2, 2020. In the middle of the COVID-19 pandemic, it is important to protect patients against infection and inaccurate information [1-4]. Adherence to strict personal hygiene rules and proper treatment are important for respiratory virus protection in patients with rheumatic diseases. A task force of the Korean College of Rheumatology (KCR) examined 15 items to help their patients using a theoretical framework. Self-care against COVID-19 for Koreans with rheumatic diseases includes conduct during infectious disease outbreaks, washing hands, precautions against airborne particles or droplets, universal facial mask use, avoiding people with a fever or symptoms and public places, being physically active inside, sun exposure, a regular diet, mental health, no smoking, treatment adherence, and caution regarding health supplement advertising. The validity of the items was evaluated in a survey conducted on the Google web service. Opinions were collected from 18 experts on the KCR committee. Ultimately, 14 items were developed with over 90% agreement and officially endorsed by the KCR April 23, 2020. They were announced by both the Korean Academy of Internal Medicine under the title “A Wise COVID-19 Life” and the KCR.

Table 1 lists the final 14 items and their agreement rates. Eleven focus exclusively on general dress guidelines, hygiene, and physical and mental activity. The recommendation concerning indoor exercise will preserve joint function and prevent muscle weakness that might result from a long stay indoors due to social distancing because of COVID-19. The recommendation regarding sunbathing in a well-lit indoor space will help produce vitamin D, which is necessary to maintain immunity and body function [3, 5]. However, patients with lupus are advised to consult a rheumatologist, as sunlight can make their disease worse. Although the long-term effects of the pandemic on rheumatic diseases are not known, stress can adversely affect the management and quality of life of patients with rheumatic diseases [6, 7]. With a prolonged indoor life, it is necessary to reduce fear, illness, social isolation, and depression as much as possible. Smoking not only exacerbates rheumatic diseases but is also a risk factor for respiratory disease, so no smoking is especially important in the COVID-19 crisis [8-10]. Patients with rheumatic diseases use a variety of immunomodulators and anti-inflammatory drugs administered under the supervision of a rheumatologist. A sudden discontinuation or change of dosage without consulting a rheumatologist can lead to a deterioration in condition and disease exacerbation [3, 4]. In East Asia, including Korea, many health supplements are promoted as being good for nonspecific immune function. The effectiveness of most commercial products at preventing and treating rheumatic diseases or infectious diseases, such as COVID-19, has not been sufficiently proven. Therefore, the KCR does not recommend taking health supplements for COVID-19 in patients with rheumatic diseases.

Table 1

Korean College of Rheumatology recommendations for self-care in patients with rheumatic diseases during the COVID-19 pandemic

Items	Agreement (%)
1. Follow the National Code of Conduct standards of the Centers for Disease Control and Prevention for the COVID-19	100
2. Wash your hands thoroughly with soap for at least 30 s and strictly follow abide by the cough etiquette	100
3. Avoid touching your face, eyes, nose, and mouth with your hands	94
4. Avoid direct contact with people who have a fever or respiratory symptoms	100
5. Avoid visiting places where people gather, especially the poorly ventilated spaces	100
6. Wear a mask when going outside or visiting a medical institution	100
7. Maintain regular stretching or light exercise indoors	100
8. Spend at least 15 min for a day in a sunny spot or a sun porch in a well-lit indoor space to get vitamin D from sunlight	100
9. Ensure that rooms are well ventilated	100
10. Avoid stress and depression as much as possible	94
11. Refrain from smoking and avoid exposure to passive smoking	100
12. Do not arbitrarily stop taking or adjust the dose of any drug currently being taken without consulting a rheumatologist	100
13. In case of suspected COVID-19 infection or fever, consult a rheumatologist as adjustment of the medication may be needed	100
14. Exercise caution when taking supplements	100

We do not know how the COVID-19 pandemic will affect people with systemic autoimmune rheumatic diseases in the long term. However, rigorous patient self-care guidelines based on hygiene and expert recommendations are the minimum for caring for those with rheumatic diseases in this crisis.