How COVID-19 is changing rheumatology clinical practice


The emergence of COVID-19 in early 2020 led to unprecedented changes to rheumatology clinical practice worldwide, including the closure of research laboratories, the restructuring of hospitals and the rapid transition to virtual care. As governments sought to slow and contain the spread of the disease, rheumatologists were presented with the difficult task of managing risks, to their patients as well as to themselves, while learning and implementing new systems for remote health care. Consequently, the COVID-19 pandemic led to a transformation in health infrastructures and telemedicine that could become powerful tools for rheumatologists, despite having some limitations. In this Viewpoint, five experts from different regions discuss their experiences of the pandemic, including the most challenging aspects of this unexpected transition, the advantages and limitations of virtual visits, and potential opportunities going forward.

The contributors

Eloisa Bonfá is a full professor of rheumatology and the clinical director of the largest tertiary public hospital of Latin America. Her main clinical and research interests are systemic lupus erythematosus and autoimmunity, with relevant contributions in the fields of autoantibodies, vaccines and drug monitoring in autoimmune diseases. She graduated at the University of São Paulo Medical School, Brazil, and undertook specialist training in rheumatology in the same university followed by a 4-year rheumatology research fellowship at the Hospital for Special Surgery, New York.

Laure Gossec is a professor of rheumatology at Sorbonne Université and Pitié-Salpêtrière Hospital, Paris, France. She has a half-time clinical position where she mainly sees patients with inflammatory arthritis, and a half-time teaching and research position. Her main research interests are patient-reported outcomes and quality of life, as well as e-health and big data in psoriatic arthritis, spondyloarthritis and rheumatoid arthritis and she has authored more than 350 papers. She is a past-chair of the epidemiology standing committee of EULAR.

David Isenberg is the Academic Director of Rheumatology at University College London, UK. He has run both general and autoimmune rheumatic disease clinics for over 30 years. His major research interests are in the structure, function and origin of autoantibodies and improving the assessment of patients with autoimmune rheumatic diseases.

Zhanguo Li is a professor and head of the department of rheumatology and immunology at the Peking University People’s Hospital, China. He is the past president of APLAR, and the president of the Clinical Immunology Committee at the Chinese Society for Immunology. He is Editor-in-Chief of the Chinese Journal of Rheumatology. His research interests are the mechanisms and immune therapy of rheumatic diseases, including rheumatoid arthritis and systemic lupus erythematosus.

Soumya Raychaudhuri is a Professor at Harvard Medical School, and a practicing rheumatologist at the Brigham and Women’s Hospital Arthritis Center. He is also appointed at the Broad Institute, and the University of Manchester. He spends most of his time running a lab that is focused on defining mechanisms of disease in rheumatoid arthritis, and other immune-mediated diseases, using computational biology, genetics and functional genomics.


  1. 1.

    Stockman, F. & Barker, K. How a Premier U.S. Drug Company Became a Virus ‘Super Spreader’. The New York Times (2020).

  2. 2.

    Rothe, C. et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N. Engl. J. Med. 382, 970–971 (2020).

    Article  Google Scholar 

  3. 3.

    Miethke-Morais, A. et al. Overcoming barriers to providing comprehensive inpatient care during the COVID-19 pandemic. Clinics 75, 2100 (2020).

    Article  Google Scholar 

  4. 4.

    de Britto Ribeiro, M. L. Letter No.1756/2020, Federal Council of Medicine, Brasilia (Mauro Luiz de Britto Ribeiro to Luiz Henrique Mandetta). (2020).

  5. 5.

    Doria, J. Decree No. 64.959, Legislative Assembly of the State of São Paulo, São Paulo (2020).

  6. 6.

    Zhong, J. et al. COVID-19 in patients with rheumatic disease in Hubei province, China: a multicentre retrospective observational study. Lancet Rheumatol. 2, e557–e564 (2020).

    Article  Google Scholar 

Download references


E.B. has received grants from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (#305068/2014-8) and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (#2015/03756-4). Z.L. would like to thank all the rheumatologists in his group, at the Peking University People’s Hospital, for their contributions to patient care, and would also like to thank Dr. Fei Xiao and his colleagues for providing SSDM system support during the COVID-19 pandemic.

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Correspondence to Eloisa Bonfá or Laure Gossec or David A. Isenberg or Zhanguo Li or Soumya Raychaudhuri.

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Competing interests

L.G. receives research grants from Amgen, Galapagos, Janssen, Lilly, Pfizer, Sandoz and Sanofi, and receives consulting fees from AbbVie, Amgen, BMS, Celgene, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis and UCB, all unrelated to the present paper. S.R. is an employee of Brigham and Women’s Hospital, and has recently served as a consultant for AbbVie, Biogen, Gilead, Merck and Pfizer. He is a founder of Mestag. He currently receives research funding from Biogen. E.B., D.A.I. and Z.L. declare no competing interests.

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Bonfá, E., Gossec, L., Isenberg, D.A. et al. How COVID-19 is changing rheumatology clinical practice. Nat Rev Rheumatol (2020).

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