To screen or not to screen – that is the Covid question for rheumatologists

Experts have advised against screening rheumatology patients for SARS-CoV-2 because not enough is known about current screening tests and the practice could lead to false reassurance and unnecessary anxiety.

Writing in the Annals of the Rheumatic Diseases Professor Robert B Landewé of the Amsterdam Rheumatology Center in The Netherlands and Professor Hendrik Schulze-Koops from Ludwig-Maximilians-Universitat Munchen, Germany, were responding to a letter in the same journal that questioned whether rheumatologists should screen their patients who start biologics for SARS-CoV-2.

As is the case so often in medicine, the question is easily asked but is more difficult to answer, the Professors wrote.

They noted that widely available and reliable antibody tests were currently lacking and not enough was known about the performance of the tests or the consequences of a positive test for the patient.

“Does a positive test mean that you cannot start a biologic? Does it harm such a patient? Does a positive test indicate temporal or persistent immunity for SARS-CoV-2? What about cross-reaction with other coronaviruses?,” they asked.

The Professors concluded that more needed to be learned before screening patients with rheumatological diseases could be considered.

“Screening may seem simple and straightforward, but it is awfully complicated and will lead both to false reassurance and unnecessary anxiety

For now, we strongly discourage screening for SARS-CoV-2 to be applied in patients with rheumatic and musculoskeletal diseases, whether or not they will start a biologic,” they concluded.

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