Risk stratification guide | Patients to shield | Patients to self-isolate or maintain social distance at their discretion | Patients to maintain social distance |
---|---|---|---|
Immunosuppressive medication |
|
|
|
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.