African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic.
Identifieur interne : 000D12 ( Main/Corpus ); précédent : 000D11; suivant : 000D13African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic.
Auteurs : Richard Oluyinka Akintayo ; Rachid Bahiri ; Yasser El Miedany ; Hakeem Olaosebikan ; Asgar Ali Kalla ; Adewale Olukayode Adebajo ; Angela Nyangore Migowa ; Samy Slimani ; Ouma Devi Koussougbo ; Ben Abdelghani Kawther ; Akpabio Akanimo Akpabio ; Imad Ghozlani ; Dzifa Dey ; Waleed A. Hassan ; Nimmisha Govind ; Kavita Makan ; Abdelgaffar Mohamed ; Eugene Kalman Genga ; Mohamed Khattry Ahmed Ghassem ; Mohamed Mortada ; Wafa Hamdi ; Moudjib O. Wabi ; Mohammed Tikly ; Madeleine Ngandeu-Singwe ; Christian ScottSource :
- Clinical rheumatology [ 1434-9949 ] ; 2020.
Abstract
OBJECTIVES
To develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic.
METHOD
A task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a hub-and-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1-3, 4-6 and 7-9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a 'low' level of agreement.
RESULTS
A total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting.
CONCLUSIONS
The preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges. Key Points • AFLAR has developed preliminary recommendations for the management of RMDs in the face of the COVID-19 pandemic. • COVID-19 is an unprecedented experience which has brought new concerns regarding the use of some disease-modifying anti-rheumatic drugs (DMARDs), and these recommendations seek to provide guidelines to the African rheumatologists. • Hydroxychloroquine shortage has become rampart across Africa as the drug is being used as prophylaxis against COVID-19 and this may necessitate a review of treatment plan for some patients with RMDs. • Breastfeeding should continue for as long as possible if a woman is positive for SARS-CoV-2 as there is currently no evidence that the infection can be transmitted through breast milk.
DOI: 10.1007/s10067-020-05355-2
PubMed: 32876786
PubMed Central: PMC7465880
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic.</title><author><name sortKey="Akintayo, Richard Oluyinka" sort="Akintayo, Richard Oluyinka" uniqKey="Akintayo R" first="Richard Oluyinka" last="Akintayo">Richard Oluyinka Akintayo</name><affiliation><nlm:affiliation>Rheumatology Department, Dumfries and Galloway Royal Infirmary, Cargenbridge, Dumfries, UK. r.akintayo@nhs.net.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow,, G4 0BA, UK. r.akintayo@nhs.net.</nlm:affiliation></affiliation></author><author><name sortKey="Bahiri, Rachid" sort="Bahiri, Rachid" uniqKey="Bahiri R" first="Rachid" last="Bahiri">Rachid Bahiri</name><affiliation><nlm:affiliation>Department of Rheumatology, El Ayachi Hospital, Medical University, Rabat, Morocco.</nlm:affiliation></affiliation></author><author><name sortKey="El Miedany, Yasser" sort="El Miedany, Yasser" uniqKey="El Miedany Y" first="Yasser" last="El Miedany">Yasser El Miedany</name><affiliation><nlm:affiliation>Rheumatology and Rehabilitation Department, Ain Shams University, Cairo, Egypt.</nlm:affiliation></affiliation></author><author><name sortKey="Olaosebikan, Hakeem" sort="Olaosebikan, Hakeem" uniqKey="Olaosebikan H" first="Hakeem" last="Olaosebikan">Hakeem Olaosebikan</name><affiliation><nlm:affiliation>Lagos State University College of Medicine and Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.</nlm:affiliation></affiliation></author><author><name sortKey="Kalla, Asgar Ali" sort="Kalla, Asgar Ali" uniqKey="Kalla A" first="Asgar Ali" last="Kalla">Asgar Ali Kalla</name><affiliation><nlm:affiliation>Department of Medicine, University of Cape Town, Cape Town, South Africa.</nlm:affiliation></affiliation></author><author><name sortKey="Adebajo, Adewale Olukayode" sort="Adebajo, Adewale Olukayode" uniqKey="Adebajo A" first="Adewale Olukayode" last="Adebajo">Adewale Olukayode Adebajo</name><affiliation><nlm:affiliation>Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Migowa, Angela Nyangore" sort="Migowa, Angela Nyangore" uniqKey="Migowa A" first="Angela Nyangore" last="Migowa">Angela Nyangore Migowa</name><affiliation><nlm:affiliation>Aga Khan University Hospital Nairobi Kenya, Nairobi, Kenya.</nlm:affiliation></affiliation></author><author><name sortKey="Slimani, Samy" sort="Slimani, Samy" uniqKey="Slimani S" first="Samy" last="Slimani">Samy Slimani</name><affiliation><nlm:affiliation>Atlas Clinic of Rheumatology, 05000, Batna, Algeria.</nlm:affiliation></affiliation></author><author><name sortKey="Koussougbo, Ouma Devi" sort="Koussougbo, Ouma Devi" uniqKey="Koussougbo O" first="Ouma Devi" last="Koussougbo">Ouma Devi Koussougbo</name><affiliation><nlm:affiliation>Victoria Hospital, Republic of Mauritius, Quatre Bornes, Mauritius.</nlm:affiliation></affiliation></author><author><name sortKey="Kawther, Ben Abdelghani" sort="Kawther, Ben Abdelghani" uniqKey="Kawther B" first="Ben Abdelghani" last="Kawther">Ben Abdelghani Kawther</name><affiliation><nlm:affiliation>Rheumatology Department, Mongi Slim Hospital, Tunis faculty of Medicine, Tunis EL Manar University, Tunis, Tunisia.</nlm:affiliation></affiliation></author><author><name sortKey="Akpabio, Akpabio Akanimo" sort="Akpabio, Akpabio Akanimo" uniqKey="Akpabio A" first="Akpabio Akanimo" last="Akpabio">Akpabio Akanimo Akpabio</name><affiliation><nlm:affiliation>University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria.</nlm:affiliation></affiliation></author><author><name sortKey="Ghozlani, Imad" sort="Ghozlani, Imad" uniqKey="Ghozlani I" first="Imad" last="Ghozlani">Imad Ghozlani</name><affiliation><nlm:affiliation>Department of Rheumatology, Military Hospital, University Ibn Zohr, Agadir, Morocco.</nlm:affiliation></affiliation></author><author><name sortKey="Dey, Dzifa" sort="Dey, Dzifa" uniqKey="Dey D" first="Dzifa" last="Dey">Dzifa Dey</name><affiliation><nlm:affiliation>University of Ghana Medical School, Korlebu Teaching Hospital, Accra, Ghana.</nlm:affiliation></affiliation></author><author><name sortKey="Hassan, Waleed A" sort="Hassan, Waleed A" uniqKey="Hassan W" first="Waleed A" last="Hassan">Waleed A. Hassan</name><affiliation><nlm:affiliation>Rheumatology and Rehabilitation, Benha University, Banha, Egypt.</nlm:affiliation></affiliation></author><author><name sortKey="Govind, Nimmisha" sort="Govind, Nimmisha" uniqKey="Govind N" first="Nimmisha" last="Govind">Nimmisha Govind</name><affiliation><nlm:affiliation>Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.</nlm:affiliation></affiliation></author><author><name sortKey="Makan, Kavita" sort="Makan, Kavita" uniqKey="Makan K" first="Kavita" last="Makan">Kavita Makan</name><affiliation><nlm:affiliation>Chris Hani Baragwanath Academic Hospital University of the Witwatersrand, Johannesburg, South Africa.</nlm:affiliation></affiliation></author><author><name sortKey="Mohamed, Abdelgaffar" sort="Mohamed, Abdelgaffar" uniqKey="Mohamed A" first="Abdelgaffar" last="Mohamed">Abdelgaffar Mohamed</name><affiliation><nlm:affiliation>Rheumatology, King Abdulla Hospital, Bisha, Kingdom of Saudi Arabia, Bisha, Saudi Arabia.</nlm:affiliation></affiliation></author><author><name sortKey="Genga, Eugene Kalman" sort="Genga, Eugene Kalman" uniqKey="Genga E" first="Eugene Kalman" last="Genga">Eugene Kalman Genga</name><affiliation><nlm:affiliation>University of Nairobi, Nairobi, Kenya.</nlm:affiliation></affiliation></author><author><name sortKey="Ghassem, Mohamed Khattry Ahmed" sort="Ghassem, Mohamed Khattry Ahmed" uniqKey="Ghassem M" first="Mohamed Khattry Ahmed" last="Ghassem">Mohamed Khattry Ahmed Ghassem</name><affiliation><nlm:affiliation>Rheumatology Department, Military Hospital Mohammed V, Rabat, Morocco.</nlm:affiliation></affiliation></author><author><name sortKey="Mortada, Mohamed" sort="Mortada, Mohamed" uniqKey="Mortada M" first="Mohamed" last="Mortada">Mohamed Mortada</name><affiliation><nlm:affiliation>Rheumatology and Rehabilitation Faculty of Medicine, Zagazig University, Zagazig, Egypt.</nlm:affiliation></affiliation></author><author><name sortKey="Hamdi, Wafa" sort="Hamdi, Wafa" uniqKey="Hamdi W" first="Wafa" last="Hamdi">Wafa Hamdi</name><affiliation><nlm:affiliation>Department of rheumatology, Kassab Institute UR17SP04 Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.</nlm:affiliation></affiliation></author><author><name sortKey="Wabi, Moudjib O" sort="Wabi, Moudjib O" uniqKey="Wabi M" first="Moudjib O" last="Wabi">Moudjib O. Wabi</name><affiliation><nlm:affiliation>Rhumatologie, Doctorant Épidémiologie Clinique et Sciences Médico - Chirurgicales, Polyclinique Apkapka, Cotonou, Bénin.</nlm:affiliation></affiliation></author><author><name sortKey="Tikly, Mohammed" sort="Tikly, Mohammed" uniqKey="Tikly M" first="Mohammed" last="Tikly">Mohammed Tikly</name><affiliation><nlm:affiliation>Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.</nlm:affiliation></affiliation></author><author><name sortKey="Ngandeu Singwe, Madeleine" sort="Ngandeu Singwe, Madeleine" uniqKey="Ngandeu Singwe M" first="Madeleine" last="Ngandeu-Singwe">Madeleine Ngandeu-Singwe</name><affiliation><nlm:affiliation>Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon.</nlm:affiliation></affiliation></author><author><name sortKey="Scott, Christian" sort="Scott, Christian" uniqKey="Scott C" first="Christian" last="Scott">Christian Scott</name><affiliation><nlm:affiliation>University of Cape Town, Cape Town, South Africa.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32876786</idno><idno type="pmid">32876786</idno><idno type="doi">10.1007/s10067-020-05355-2</idno><idno type="pmc">PMC7465880</idno><idno type="wicri:Area/Main/Corpus">000D12</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000D12</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic.</title><author><name sortKey="Akintayo, Richard Oluyinka" sort="Akintayo, Richard Oluyinka" uniqKey="Akintayo R" first="Richard Oluyinka" last="Akintayo">Richard Oluyinka Akintayo</name><affiliation><nlm:affiliation>Rheumatology Department, Dumfries and Galloway Royal Infirmary, Cargenbridge, Dumfries, UK. r.akintayo@nhs.net.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow,, G4 0BA, UK. r.akintayo@nhs.net.</nlm:affiliation></affiliation></author><author><name sortKey="Bahiri, Rachid" sort="Bahiri, Rachid" uniqKey="Bahiri R" first="Rachid" last="Bahiri">Rachid Bahiri</name><affiliation><nlm:affiliation>Department of Rheumatology, El Ayachi Hospital, Medical University, Rabat, Morocco.</nlm:affiliation></affiliation></author><author><name sortKey="El Miedany, Yasser" sort="El Miedany, Yasser" uniqKey="El Miedany Y" first="Yasser" last="El Miedany">Yasser El Miedany</name><affiliation><nlm:affiliation>Rheumatology and Rehabilitation Department, Ain Shams University, Cairo, Egypt.</nlm:affiliation></affiliation></author><author><name sortKey="Olaosebikan, Hakeem" sort="Olaosebikan, Hakeem" uniqKey="Olaosebikan H" first="Hakeem" last="Olaosebikan">Hakeem Olaosebikan</name><affiliation><nlm:affiliation>Lagos State University College of Medicine and Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.</nlm:affiliation></affiliation></author><author><name sortKey="Kalla, Asgar Ali" sort="Kalla, Asgar Ali" uniqKey="Kalla A" first="Asgar Ali" last="Kalla">Asgar Ali Kalla</name><affiliation><nlm:affiliation>Department of Medicine, University of Cape Town, Cape Town, South Africa.</nlm:affiliation></affiliation></author><author><name sortKey="Adebajo, Adewale Olukayode" sort="Adebajo, Adewale Olukayode" uniqKey="Adebajo A" first="Adewale Olukayode" last="Adebajo">Adewale Olukayode Adebajo</name><affiliation><nlm:affiliation>Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Migowa, Angela Nyangore" sort="Migowa, Angela Nyangore" uniqKey="Migowa A" first="Angela Nyangore" last="Migowa">Angela Nyangore Migowa</name><affiliation><nlm:affiliation>Aga Khan University Hospital Nairobi Kenya, Nairobi, Kenya.</nlm:affiliation></affiliation></author><author><name sortKey="Slimani, Samy" sort="Slimani, Samy" uniqKey="Slimani S" first="Samy" last="Slimani">Samy Slimani</name><affiliation><nlm:affiliation>Atlas Clinic of Rheumatology, 05000, Batna, Algeria.</nlm:affiliation></affiliation></author><author><name sortKey="Koussougbo, Ouma Devi" sort="Koussougbo, Ouma Devi" uniqKey="Koussougbo O" first="Ouma Devi" last="Koussougbo">Ouma Devi Koussougbo</name><affiliation><nlm:affiliation>Victoria Hospital, Republic of Mauritius, Quatre Bornes, Mauritius.</nlm:affiliation></affiliation></author><author><name sortKey="Kawther, Ben Abdelghani" sort="Kawther, Ben Abdelghani" uniqKey="Kawther B" first="Ben Abdelghani" last="Kawther">Ben Abdelghani Kawther</name><affiliation><nlm:affiliation>Rheumatology Department, Mongi Slim Hospital, Tunis faculty of Medicine, Tunis EL Manar University, Tunis, Tunisia.</nlm:affiliation></affiliation></author><author><name sortKey="Akpabio, Akpabio Akanimo" sort="Akpabio, Akpabio Akanimo" uniqKey="Akpabio A" first="Akpabio Akanimo" last="Akpabio">Akpabio Akanimo Akpabio</name><affiliation><nlm:affiliation>University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria.</nlm:affiliation></affiliation></author><author><name sortKey="Ghozlani, Imad" sort="Ghozlani, Imad" uniqKey="Ghozlani I" first="Imad" last="Ghozlani">Imad Ghozlani</name><affiliation><nlm:affiliation>Department of Rheumatology, Military Hospital, University Ibn Zohr, Agadir, Morocco.</nlm:affiliation></affiliation></author><author><name sortKey="Dey, Dzifa" sort="Dey, Dzifa" uniqKey="Dey D" first="Dzifa" last="Dey">Dzifa Dey</name><affiliation><nlm:affiliation>University of Ghana Medical School, Korlebu Teaching Hospital, Accra, Ghana.</nlm:affiliation></affiliation></author><author><name sortKey="Hassan, Waleed A" sort="Hassan, Waleed A" uniqKey="Hassan W" first="Waleed A" last="Hassan">Waleed A. Hassan</name><affiliation><nlm:affiliation>Rheumatology and Rehabilitation, Benha University, Banha, Egypt.</nlm:affiliation></affiliation></author><author><name sortKey="Govind, Nimmisha" sort="Govind, Nimmisha" uniqKey="Govind N" first="Nimmisha" last="Govind">Nimmisha Govind</name><affiliation><nlm:affiliation>Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.</nlm:affiliation></affiliation></author><author><name sortKey="Makan, Kavita" sort="Makan, Kavita" uniqKey="Makan K" first="Kavita" last="Makan">Kavita Makan</name><affiliation><nlm:affiliation>Chris Hani Baragwanath Academic Hospital University of the Witwatersrand, Johannesburg, South Africa.</nlm:affiliation></affiliation></author><author><name sortKey="Mohamed, Abdelgaffar" sort="Mohamed, Abdelgaffar" uniqKey="Mohamed A" first="Abdelgaffar" last="Mohamed">Abdelgaffar Mohamed</name><affiliation><nlm:affiliation>Rheumatology, King Abdulla Hospital, Bisha, Kingdom of Saudi Arabia, Bisha, Saudi Arabia.</nlm:affiliation></affiliation></author><author><name sortKey="Genga, Eugene Kalman" sort="Genga, Eugene Kalman" uniqKey="Genga E" first="Eugene Kalman" last="Genga">Eugene Kalman Genga</name><affiliation><nlm:affiliation>University of Nairobi, Nairobi, Kenya.</nlm:affiliation></affiliation></author><author><name sortKey="Ghassem, Mohamed Khattry Ahmed" sort="Ghassem, Mohamed Khattry Ahmed" uniqKey="Ghassem M" first="Mohamed Khattry Ahmed" last="Ghassem">Mohamed Khattry Ahmed Ghassem</name><affiliation><nlm:affiliation>Rheumatology Department, Military Hospital Mohammed V, Rabat, Morocco.</nlm:affiliation></affiliation></author><author><name sortKey="Mortada, Mohamed" sort="Mortada, Mohamed" uniqKey="Mortada M" first="Mohamed" last="Mortada">Mohamed Mortada</name><affiliation><nlm:affiliation>Rheumatology and Rehabilitation Faculty of Medicine, Zagazig University, Zagazig, Egypt.</nlm:affiliation></affiliation></author><author><name sortKey="Hamdi, Wafa" sort="Hamdi, Wafa" uniqKey="Hamdi W" first="Wafa" last="Hamdi">Wafa Hamdi</name><affiliation><nlm:affiliation>Department of rheumatology, Kassab Institute UR17SP04 Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.</nlm:affiliation></affiliation></author><author><name sortKey="Wabi, Moudjib O" sort="Wabi, Moudjib O" uniqKey="Wabi M" first="Moudjib O" last="Wabi">Moudjib O. Wabi</name><affiliation><nlm:affiliation>Rhumatologie, Doctorant Épidémiologie Clinique et Sciences Médico - Chirurgicales, Polyclinique Apkapka, Cotonou, Bénin.</nlm:affiliation></affiliation></author><author><name sortKey="Tikly, Mohammed" sort="Tikly, Mohammed" uniqKey="Tikly M" first="Mohammed" last="Tikly">Mohammed Tikly</name><affiliation><nlm:affiliation>Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.</nlm:affiliation></affiliation></author><author><name sortKey="Ngandeu Singwe, Madeleine" sort="Ngandeu Singwe, Madeleine" uniqKey="Ngandeu Singwe M" first="Madeleine" last="Ngandeu-Singwe">Madeleine Ngandeu-Singwe</name><affiliation><nlm:affiliation>Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon.</nlm:affiliation></affiliation></author><author><name sortKey="Scott, Christian" sort="Scott, Christian" uniqKey="Scott C" first="Christian" last="Scott">Christian Scott</name><affiliation><nlm:affiliation>University of Cape Town, Cape Town, South Africa.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Clinical rheumatology</title><idno type="eISSN">1434-9949</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b></p><p>To develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic.</p></div><div type="abstract" xml:lang="en"><p><b>METHOD</b></p><p>A task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a hub-and-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1-3, 4-6 and 7-9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a 'low' level of agreement.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>A total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>The preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges. Key Points • AFLAR has developed preliminary recommendations for the management of RMDs in the face of the COVID-19 pandemic. • COVID-19 is an unprecedented experience which has brought new concerns regarding the use of some disease-modifying anti-rheumatic drugs (DMARDs), and these recommendations seek to provide guidelines to the African rheumatologists. • Hydroxychloroquine shortage has become rampart across Africa as the drug is being used as prophylaxis against COVID-19 and this may necessitate a review of treatment plan for some patients with RMDs. • Breastfeeding should continue for as long as possible if a woman is positive for SARS-CoV-2 as there is currently no evidence that the infection can be transmitted through breast milk.</p></div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">32876786</PMID><DateRevised><Year>2021</Year><Month>02</Month><Day>09</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1434-9949</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Sep</Month><Day>02</Day></PubDate></JournalIssue><Title>Clinical rheumatology</Title><ISOAbbreviation>Clin Rheumatol</ISOAbbreviation></Journal><ArticleTitle>African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic.</ArticleTitle><ELocationID EIdType="doi" ValidYN="Y">10.1007/s10067-020-05355-2</ELocationID><Abstract><AbstractText Label="OBJECTIVES" NlmCategory="OBJECTIVE">To develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic.</AbstractText><AbstractText Label="METHOD" NlmCategory="METHODS">A task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a hub-and-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1-3, 4-6 and 7-9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a 'low' level of agreement.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">A total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">The preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges. Key Points • AFLAR has developed preliminary recommendations for the management of RMDs in the face of the COVID-19 pandemic. • COVID-19 is an unprecedented experience which has brought new concerns regarding the use of some disease-modifying anti-rheumatic drugs (DMARDs), and these recommendations seek to provide guidelines to the African rheumatologists. • Hydroxychloroquine shortage has become rampart across Africa as the drug is being used as prophylaxis against COVID-19 and this may necessitate a review of treatment plan for some patients with RMDs. • Breastfeeding should continue for as long as possible if a woman is positive for SARS-CoV-2 as there is currently no evidence that the infection can be transmitted through breast milk.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Akintayo</LastName><ForeName>Richard Oluyinka</ForeName><Initials>RO</Initials><Identifier Source="ORCID">http://orcid.org/0000-0002-4177-8981</Identifier><AffiliationInfo><Affiliation>Rheumatology Department, Dumfries and Galloway Royal Infirmary, Cargenbridge, Dumfries, UK. r.akintayo@nhs.net.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow,, G4 0BA, UK. r.akintayo@nhs.net.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bahiri</LastName><ForeName>Rachid</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Rheumatology, El Ayachi Hospital, Medical University, Rabat, Morocco.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>El Miedany</LastName><ForeName>Yasser</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Rheumatology and Rehabilitation Department, Ain Shams University, Cairo, Egypt.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Olaosebikan</LastName><ForeName>Hakeem</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Lagos State University College of Medicine and Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kalla</LastName><ForeName>Asgar Ali</ForeName><Initials>AA</Initials><AffiliationInfo><Affiliation>Department of Medicine, University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Adebajo</LastName><ForeName>Adewale Olukayode</ForeName><Initials>AO</Initials><AffiliationInfo><Affiliation>Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Migowa</LastName><ForeName>Angela Nyangore</ForeName><Initials>AN</Initials><AffiliationInfo><Affiliation>Aga Khan University Hospital Nairobi Kenya, Nairobi, Kenya.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Slimani</LastName><ForeName>Samy</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Atlas Clinic of Rheumatology, 05000, Batna, Algeria.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Koussougbo</LastName><ForeName>Ouma Devi</ForeName><Initials>OD</Initials><AffiliationInfo><Affiliation>Victoria Hospital, Republic of Mauritius, Quatre Bornes, Mauritius.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kawther</LastName><ForeName>Ben Abdelghani</ForeName><Initials>BA</Initials><AffiliationInfo><Affiliation>Rheumatology Department, Mongi Slim Hospital, Tunis faculty of Medicine, Tunis EL Manar University, Tunis, Tunisia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Akpabio</LastName><ForeName>Akpabio Akanimo</ForeName><Initials>AA</Initials><AffiliationInfo><Affiliation>University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ghozlani</LastName><ForeName>Imad</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>Department of Rheumatology, Military Hospital, University Ibn Zohr, Agadir, Morocco.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dey</LastName><ForeName>Dzifa</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>University of Ghana Medical School, Korlebu Teaching Hospital, Accra, Ghana.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hassan</LastName><ForeName>Waleed A</ForeName><Initials>WA</Initials><AffiliationInfo><Affiliation>Rheumatology and Rehabilitation, Benha University, Banha, Egypt.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Govind</LastName><ForeName>Nimmisha</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Makan</LastName><ForeName>Kavita</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Chris Hani Baragwanath Academic Hospital University of the Witwatersrand, Johannesburg, South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mohamed</LastName><ForeName>Abdelgaffar</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Rheumatology, King Abdulla Hospital, Bisha, Kingdom of Saudi Arabia, Bisha, Saudi Arabia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Genga</LastName><ForeName>Eugene Kalman</ForeName><Initials>EK</Initials><AffiliationInfo><Affiliation>University of Nairobi, Nairobi, Kenya.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ghassem</LastName><ForeName>Mohamed Khattry Ahmed</ForeName><Initials>MKA</Initials><AffiliationInfo><Affiliation>Rheumatology Department, Military Hospital Mohammed V, Rabat, Morocco.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mortada</LastName><ForeName>Mohamed</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Rheumatology and Rehabilitation Faculty of Medicine, Zagazig University, Zagazig, Egypt.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hamdi</LastName><ForeName>Wafa</ForeName><Initials>W</Initials><AffiliationInfo><Affiliation>Department of rheumatology, Kassab Institute UR17SP04 Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wabi</LastName><ForeName>Moudjib O</ForeName><Initials>MO</Initials><AffiliationInfo><Affiliation>Rhumatologie, Doctorant Épidémiologie Clinique et Sciences Médico - Chirurgicales, Polyclinique Apkapka, Cotonou, Bénin.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tikly</LastName><ForeName>Mohammed</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ngandeu-Singwe</LastName><ForeName>Madeleine</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Scott</LastName><ForeName>Christian</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>University of Cape Town, Cape Town, South Africa.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>09</Month><Day>02</Day></ArticleDate></Article><MedlineJournalInfo><Country>Germany</Country><MedlineTA>Clin Rheumatol</MedlineTA><NlmUniqueID>8211469</NlmUniqueID><ISSNLinking>0770-3198</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Pan Afr Med J. 2020 Nov 16;37:240</RefSource><PMID Version="1">33552358</PMID></CommentsCorrections></CommentsCorrectionsList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">African rheumatology</Keyword><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">DMARD</Keyword><Keyword MajorTopicYN="N">Rheumatic and musculoskeletal diseases</Keyword><Keyword MajorTopicYN="N">Rheumatology</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>07</Month><Day>08</Day></PubMedPubDate><PubMedPubDate 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