Table 1.

COVID-19: Identifying patients for shielding in England

Risk stratification guide	Patients to shield	Patients to self-isolate or maintain social distance at their discretion	Patients to maintain social distance
Immunosuppressive medication	Corticosteroid dose of ≥20 mg (0.5 mg/kg) prednisolone (or equivalent) per day for more than 4 weeks Cyclophosphamide at any dose orally or within last 6 months IV Corticosteroid dose of ≥5 mg prednisolone (or equivalent) per day for more than four weeks plus at least one other immunosuppressive medication,^* biologic/monoclonal^† or small molecule immunosuppressant (eg JAK inhibitors)^‡ Any two agents among immunosuppressive medications, biologics/monoclonals^† or small molecule immunosuppressants with any co-morbidity^§	Well-controlled patients with minimal disease activity and no comorbidities on single agent broad spectrum immunosuppressive medication, biologic/monoclonal^† or small molecule immunosuppressant Well-controlled patients with minimal disease activity and no comorbidities on single agent broad spectrum immunosuppressive medication plus sulphasalazine and/or hydroxychloroquine Well-controlled patients with minimal disease activity and no comorbidities on a single agent broad spectrum immunosuppressive medication^* at standard dose (eg methotrexate up to 25 mg per week) plus single biologic (eg anti-TNF or JAKi^†,‡)	Single agent 5-ASA medications(eg mesalazine) Single agent 6-mercaptopurine Only inhaled or rectally administered immunosuppressant medication Hydroxychloroquine Sulphasalazine

Adapted from BSR guidance.³⁸
↵*Immunosuppressive medications include: azathioprine, leflunomide, methotrexate, mycophenolate (mycophenolate mofetil or mycophenolic acid), ciclosporin, cyclophosphamide, tacrolimus, sirolimus. They do NOT include hydroxychloroquine or sulphasalazine either alone or in combination.
↵^†Biologic/monoclonal 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.
↵^‡Small molecules include: all JAK inhibitors (baracitinib, tofacitinib etc).
↵^§Co-morbidity includes: age >70, diabetes mellitus, any pre-existing lung disease, renal impairment, any history of ischaemic heart Disease or hypertension. Patients who have rheumatoid arthritis (RA) or interstitial lung disease (ILD) related to connective tissue disease (CTD) 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.
Note this advice applies to adults, children and young people with rheumatic disease. We do NOT advise that patients increase steroid dose if they become unwell.