Updated: Apr 19, 2020
COVID 19 (Coronavirus disease-19) is a novel viral infection that has affected over a million people worldwide and killed over a hundred thousand people. This is a scary time for everyone, especially for patients who have chronic rheumatologic diseases. There are many answered questions. I hope the information below helps guide rheumatology patients.
Does my medical(rheumatologic) condition increase my risk of having severe disease if I were to get infected with Coronavirus?
COVID 19 is a new disease, so humans do not have immunity to this virus. Everyone is at risk of contracting the virus. Patients over the age of 65, those living in nursing homes and those with poorly controlled medical conditions such as diabetes, chronic lung disease, asthma, heart disease and immunocompromised are likely to get sicker if they were to contract the disease. Similarly patients with poorly controlled arthritis or lupus tend to have a higher risk for infection overall. With all the information we have so far, there does not appear to be an increased risk in patients with rheumatic diseases. For more information on who is at higher risk, please click on the link below for information from the CDC.
I have been told that my arthritis medicines compromise my immune system. What should I do about my medication?
It is important that you speak with your rheumatologist about your medication. Patients are concerned that their medications can compromise their immune system and tend to discontinue their medications.
The following are general recommendations based on the clinical guidance provided by the American College of Rheumatology.
If you are not infected with or have known exposure to COVID -19 and have well controlled arthritis or Lupus.
There is no need to discontinue medications such as Plaquenil, Sulfasalazine or anti-inflammatory medication such as Naproxen or Motrin.
If you have been on chronic prednisone therapy for your arthritis please do not abruptly discontinue this medication.
In patients whose arthritis is well controlled, there is no recommendation to stop medications such as Methotrexate, Leflunomide and biologic medications - injectable or infusions.
Depending upon a patient's individual risk your rheumatologist may recommend changing the dose or extend the time period between your biologic treatments.
I hear arthritis medications are being used to treat COVID-19. Plaquenil and Chloroquine are medications used to treat rheumatoid arthritis and Lupus are now being studied to treat COVID-19. It is important to remember that there is no conclusive evidence that these medications are effective. Taking Plaquenil does not make you immune to Coronavirus.
COVID-19 is a fatal illness because the immune system instead of just trying to contain the virus, mounts a chaotic,unruly response to the virus and floods the lung with immune cells and starts attacking healthy lung tissue and makes the blood vessels leaky, this eventually leads to multiorgan failure. This is also described as a cytokine storm. Cytokines are chemicals that control the activity of the immune system. One such cytokine is IL-6 that drives immune cells to attack healthy tissue, in the case of Rheumatoid arthritis- it attacks the joints. At this time two rheumatoid arthritis medications, Actemra and Kevzara( both of these medications block IL-6) are being used to treat patients with COVID-19 with symptoms of cytokine storm.
I just got diagnosed with arthritis/ have very active joint disease. Should I hold off on seeing my rheumatologist? I don’t want to start any treatment now!
It is vital that you keep in touch with your rheumatologist. Please find out if your rheumatologist is offering telemedicine visits. Even if you are unable to see your rheumatologist in person, discussing your current condition over the phone or video to come up with a treatment plan is a good idea. If your doctor feels that you need to be seen in person, they will arrange for you to be seen in the office. Arthritis can be aggressive and cause severe damage fairly quickly and relying on emergency rooms or urgent cares during flares may increase your risk of being exposed to Coronavirus.
Other rheumatic diseases such as lupus or vasculitis can cause damage to vital organs such as your kidneys or lungs. Time is of the essence, early treatment is vital.
What if I have a rheumatologic disease and I am exposed to COVID -19? I don’t have any symptoms, can I continue my medication?
Symptoms of Coronavirus can develop anywhere from 2 to 14 days after exposure. Some medications such as Plaquenil, Sulfasalazine and Naproxen or Motrin may be continued however medication such as Methotrexate, Leflunomide and biologic medications may need to be discontinued at least for a two week period or until you have conclusively tested negative for COVID 19.
I have heard that Ibuprofen should not be taken during this pandemic. Is this really true?
There is no conclusive evidence that taking Ibuprofen can make COVID symptoms worse. Early misinformation left a lot of people confused. The WHO has now changed its stance regarding Ibuprofen. https://www.sciencealert.com/who-recommends-to-avoid-taking-ibuprofen-for-covid-19-symptoms
What if I have COVID-19/ symptoms of COVID-19?
Make sure to contact your rheumatologist. Your rheumatologist may recommend that you continue your Plaquenil. If you are on Actemra or Kevzara for your rheumatoid arthritis, be sure to discuss with your rheumatologist and your medical team. As discussed above, some patients may benefit from these medications if they develop COViD-19 related complications. Everyone should make a list of all medications that they take including infusion medications and make sure your close family members have easy access to this information as well.
As a patient with autoimmune disease, how do I protect myself?
The best thing for everyone to do is to avoid getting infected with the virus. You can do this by following the social distancing guidelines, washing your hands often, cleaning and disinfecting surfaces and avoiding close contact with people who are sick.
Please click on the link below for the most updated CDC guidelines.