Flow chart for identifying rheumatology patients extremely vulnerable

Flow chart for identifying rheumatology patients “extremely vulnerable” to Covid-19. Adapted from BSR guidance 23/03/20 Have you been taking prednisolone at a dose of 20 mg or higher for 4 weeks or more? Yes No Have you been treated with cyclophosphamide either through a drip or by tablet in the last 6 months? No Yes Have you been taking prednisolone at a dose of 5 mg or higher for the last 4 weeks AND are you taking one or more of the medications in box 1? No Yes Are you taking TWO or more medications from box 1 AND do you have any of the conditions in box 2? Yes No Definite High Risk Not Definite High Risk Government advise complete selfisolation for at least 12 weeks: Complete isolation not mandatory but many patients still at higher risk than general population. Strict social distancing guidance strongly recommended: https: //www. gov. uk/government/publications/guid ance-on-shielding-and-protecting-extremelyvulnerable-persons-from-covid-19/guidance-onshielding-and-protecting-extremely-vulnerablepersons-from-covid-19 Box 1 Azathioprine, Leflunomide, Methotrexate, Mycophenolate, Ciclosporin, Tacrolimus, Sirolimus, 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, all JAK inhibitors – Baracitinib, Tofacitinib, Upadacitinib https: //www. versusarthritis. org/news/2020/march/coron avirus-covid-19 -what-is-it-and-where-to-go-forinformation/ Box 2 Age more than 70 Diabetes Mellitus “diabetes” Any pre-existing lung disease (including asthma, COPD, interstitial lung disease) Renal impairment “kidney impairment” Any history of ischaemic heart disease (including history of angina or “heart attack” or “stents” to heart vessels) Any history of high blood pressure (hypertension)