key: cord-280917-j2a77fw3 authors: Kim, Hyun-Sook; Lee, Myeung-Su; Kim, HyungJin; Sung, Yoon-Kyoung; Lee, Jisoo; Shim, Seung-Cheol; Park, Sung-Hwan; Baek, Han Joo title: Self-care recommendations for patients with rheumatic diseases during the COVID-19 pandemic date: 2020-06-02 journal: Rheumatol Int DOI: 10.1007/s00296-020-04614-4 sha: doc_id: 280917 cord_uid: j2a77fw3 nan Since the first novel coronavirus disease 2019 (COVID-19) patient was diagnosed in the Republic of Korea on January 20, 2020, 10,780 patients have been diagnosed as of May 2, 2020. In the middle of the COVID-19 pandemic, it is important to protect patients against infection and inaccurate information [1] [2] [3] [4] . Adherence to strict personal hygiene rules and proper treatment are important for respiratory virus protection in patients with rheumatic diseases. A task force of the Korean College of Rheumatology (KCR) examined 15 items to help their patients using a theoretical framework. Selfcare against COVID-19 for Koreans with rheumatic diseases includes conduct during infectious disease outbreaks, washing hands, precautions against airborne particles or droplets, universal facial mask use, avoiding people with a fever or symptoms and public places, being physically active inside, sun exposure, a regular diet, mental health, no smoking, treatment adherence, and caution regarding health supplement advertising. The validity of the items was evaluated in a survey conducted on the Google web service. Opinions were collected from 18 experts on the KCR committee. Ultimately, 14 items were developed with over 90% agreement and officially endorsed by the KCR April 23, 2020. They were announced by both the Korean Academy of Internal Medicine under the title "A Wise COVID-19 Life" and the KCR. Table 1 lists the final 14 items and their agreement rates. Eleven focus exclusively on general dress guidelines, hygiene, and physical and mental activity. The recommendation concerning indoor exercise will preserve joint function and prevent muscle weakness that might result from a long stay indoors due to social distancing because of COVID-19. The recommendation regarding sunbathing in a well-lit indoor space will help produce vitamin D, which is necessary to maintain immunity and body function [3, 5] . However, patients with lupus are advised to consult a rheumatologist, as sunlight can make their disease worse. Although the long-term effects of the pandemic on rheumatic diseases are not known, stress [6, 7] . With a prolonged indoor life, it is necessary to reduce fear, illness, social isolation, and depression as much as possible. Smoking not only exacerbates rheumatic diseases but is also a risk factor for respiratory disease, so no smoking is especially important in the COVID-19 crisis [8] [9] [10] . Patients with rheumatic diseases use a variety of immunomodulators and anti-inflammatory drugs administered under the supervision of a rheumatologist. A sudden discontinuation or change of dosage without consulting a rheumatologist can lead to a deterioration in condition and disease exacerbation [3, 4] . In East Asia, including Korea, many health supplements are promoted as being good for nonspecific immune function. The effectiveness of most commercial products at preventing and treating rheumatic diseases or infectious diseases, such as COVID-19, has not been sufficiently proven. Therefore, the KCR does not recommend taking health supplements for COVID-19 in patients with rheumatic diseases. We do not know how the COVID-19 pandemic will affect people with systemic autoimmune rheumatic diseases in the long term. However, rigorous patient self-care guidelines based on hygiene and expert recommendations are the minimum for caring for those with rheumatic diseases in this crisis. Author contributions HS, HJ: data collection, writing and original draft. MS, HJ, YK: data collection, methodology. JS, SC: review and editing. SH, HS: supervision, writing, review and editing. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Wash your hands thoroughly with soap for at least 30 s and strictly follow abide by the cough etiquette 100 3. Avoid touching your face, eyes, nose, and mouth with your hands 94 4. Avoid direct contact with people who have a fever or respiratory symptoms 100 5. Avoid visiting places where people gather, especially the poorly ventilated spaces 100 6. Wear a mask when going outside or visiting a medical institution 100 7. Maintain regular stretching or light exercise indoors 100 8. Spend at least 15 min for a day in a sunny spot or a sun porch in a well-lit indoor space to get vitamin D from sunlight 100 9. Ensure that rooms are well ventilated 100 10. Avoid stress and depression as much as possible 94 11. Refrain from smoking and avoid exposure to passive smoking 100 12. Do not arbitrarily stop taking or adjust the dose of any drug currently being taken without consulting a rheumatologist 100 13. In case of suspected COVID-19 infection or fever, consult a rheumatologist as adjustment of the medication may be needed 100 14. Exercise caution when taking supplements The novel coronavirus (SARS-CoV-2) infections in China: prevention, control and challenges Application of refined management in the prevention and control of coronavirus disease 2019 epidemic in non-isolated areas of a general hospital Rheumatologists' perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets What does the COVID-19 pandemic mean for rheumatology patients? Optimisation of vitamin D status for enhanced immuno-protection against Covid-19 Association between depression and rheumatoid arthritis: two longitudinal follow-up studies using a national sample cohort Dealing with sleep problems during home confinement due to the COVID-19 outbreak: practical recommendations from a task force of the European CBT-I Academy COVID-19 and smoking Sex difference and smoking predisposition in patients with COVID-19 Smoking upregulates angiotensin-converting enzyme-2 receptor: a potential adhesion site for novel coronavirus SARS-CoV-2 (Covid-19) Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations Conflict of interest No potential conflict of interest relevant to this article was reported.