Risk stratification of patients with autoimmune rheumatic diseases.
| Risk factor | Score |
|---|---|
| Corticosteroid dose of ≥20 mg (0.5 mg/kg) prednisolone (or equivalent) per day for more than 4 weeks | 3 |
| Corticosteroid dose of ≥5 mg prednisolone but <20 mg (or equivalent) per day for more than 4 weeks | 2 |
| Cyclophosphamide at any dose orally or IV within last 6 months | 3 |
| One immunosuppressive medication,* biologic/monoclonal† or small molecule immunosuppressant‡ | 1 |
| Two or more immunosuppressive medications,* biologic/monoclonal† or small molecule immunosuppressant‡ | 2 |
| Any one or more of these: age >70, diabetes mellitus, pre-existing lung disease, renal impairment, history of ischaemic heart disease or hypertension§ | 1 |
| Hydroxychloroquine or sulfalsalazine alone or in combination | 0 |
Adapted from BSR.39 To be used in conjunction with BSR guidance published 22 March 2020.38 Score of 3 or more: patients to shield; score of 2: patients to self-isolate or maintain social distance at their discretion; score of 1 or less: patients to maintain social distance.
↵*Immunosuppressive medications include: azathioprine, leflunomide, methotrexate, mycophenolate (mycophenolate mofetil or mycophenolic acid), ciclosporin, tacrolimus, sirolimus. It does NOT include hydroxychloroquine or sulphasalazine, either alone or in combination.
↵†Biologic/monocolonal includes: rituximab within last 12 months; all anti-TNF drugs (etanercept, adalimumab, infliximab, golimumab, certolizumab and biosimilar variants of all of these); tociluzimab; abatacept; belimumab; anakinra; seukinumab; ixekizumab; ustekinumab; sarilumumab; canakinumab.
↵‡Small molecules includes: all JAK inhibitors – baracitinib, tofacitinib etc.
↵§Patients who have rheumatoid arthritis (RA) or interstititial lung disease (ILD) related to connective tissue disease are at additional risk and may need to be placed in the shielding category. All patients with pulmonary hypertension are placed in the shielding category.