Dear Colleagues,

PReS would like to share important recommendations for patients, families and doctors in the context of the COVID-19 outbreak.
1. Be updated and follow the individual country’s Ministry of Health/National public health care body’s recommendations.

2. Ensure you meticulously follow all hygiene recommendations. Please note that the new coronavirus may remain viable for hours or days on many surfaces such as handles, doorknobs, light switches, mobile phones, computer keyboards, remotes, keys, elevator buttons, toilets, sinks, tables, hard-backed chairs, etc.

Simple measures are likely to help to preserve your health and that of your family and friends:

Wash your hands very regularly for at least 20 seconds using soap and water. Dry hands thoroughly afterwards.
Try to avoid touching your face.
Coughing or sneezing should be into an elbow or tissue paper and the latter should be discarded safely.
Use disposable tissues.
Wear a mask when you are ill; if there are no symptoms it is not necessary to wear a mask. The mask cannot completely prevent virus transmission, but it is a good reminder, not to touch your face and serves to warn others that you may not be well.
Practice sensible social distancing especially from people who appear to be ill, e.g. coughing or sneezing. One meter is recommended.
We should greet each other without shaking hands, and avoid hugs.

3. At the moment for children with rheumatic diseases on medication, we recommend continuing all therapies as usual.

4. Don’t stop your medications including methotrexate (MTX) and biologics, without consulting your rheumatologist. This may cause a flare of your rheumatic disease.

5. If you are on corticosteroid therapy – consult your rheumatologist regarding possible dose adjustment.

6. Patients in isolation or quarantine (without symptoms) should continue therapy as usual.

7. In case of fever and suspicion of infectious diseases follow your national advice for access to health care and to test for Covid-19. In the meantime, withhold MTX and, if taking biologics, get in touch with your treating rheumatologist for guidance.

8. In the event that you have a routine rheumatology appointment consider asking your primary care physician, or rheumatologist if this is essential, or can be safely delayed, or if it can be performed by telephone or some other remote device. This facility may vary in availability across different health care settings.

9. For all individuals, including patients with pediatric rheumatic diseases – avoid unnecessary travelling and crowding.

10. Wishing you good health and back to regular track soon.

See the EULAR website for further patient guidance regarding the COVID-19 outbreak.
Sincerely,
The Pediatric Rheumatology European Society (PReS)