University of Nebraska Medical Center, Omaha, Nebraska and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska.
Toronto Western Hospital, Mount Sinai Hospital, and University of Toronto, Toronto, Ontario, Canada.
Arthritis Rheumatol. 2020 Aug;72(8):1241-1251. doi: 10.1002/art.41301. Epub 2020 Jun 5.
To provide guidance to rheumatology providers on the management of adult rheumatic disease in the context of the coronavirus disease 2019 (COVID-19) pandemic.
A task force, including 10 rheumatologists and 4 infectious disease specialists from North America, was convened. Clinical questions were collated, and an evidence report was rapidly generated and disseminated. Questions and drafted statements were reviewed and assessed using a modified Delphi process. This included 2 rounds of asynchronous anonymous voting by e-mail and 3 webinars with the entire panel. Task force members voted on agreement with draft statements using a 1-9-point numerical scoring system, and consensus was determined to be low, moderate, or high based on the dispersion of votes. For approval, median votes were required to meet predefined levels of agreement (median values of 7-9, 4-6, and 1-3 defined as agreement, uncertainty, or disagreement, respectively) with either moderate or high levels of consensus.
The task force approved 77 initial guidance statements: 36 with moderate and 41 with high consensus. These were combined, resulting in 25 final guidance statements.
These guidance statements are provided to promote optimal care during the current pandemic. However, given the low level of available evidence and the rapidly evolving literature, this guidance is presented as a "living document," and future updates are anticipated.
为风湿病医生在 2019 年冠状病毒病（COVID-19）大流行背景下管理成人风湿性疾病提供指导。
召集了一个由 10 名来自北美的风湿病专家和 4 名传染病专家组成的工作组。整理了临床问题，并迅速生成和发布了一份证据报告。通过修改后的德尔菲法对问题和起草的陈述进行了审查和评估。这包括两轮电子邮件异步匿名投票和与整个专家组的 3 次网络研讨会。工作组成员使用 1-9 分的数字评分系统对草案声明的一致性进行投票，根据投票的分散程度，共识被确定为低、中或高。为了获得批准，中位数投票需要达到预先设定的协议水平（中位数为 7-9、4-6 和 1-3 分别定义为协议、不确定性或不同意），且共识水平为中等或高。
工作组批准了 77 条初始指导声明：36 条为中等共识，41 条为高共识。这些声明被合并，最终产生了 25 条最终指导声明。
这些指导声明旨在促进当前大流行期间的最佳护理。然而，鉴于现有证据水平低且文献快速发展，该指南被视为“活文档”，预计未来会进行更新。
