COVID-19 Frequently Asked Questions
Arthritis Action’s Medical Advisor, Consultant Rheumatologist Dr Wendy Holden, addresses the most frequently received questions about COVID-19 (also known as coronavirus), in relation to arthritis.
Q: I have arthritis. Am I at increased risk of catching COVID-19?
A: Just having arthritis doesn’t mean that you are at increased risk of catching COVID-19, but if you have other medical conditions such as diabetes, heart or lung disease, kidney disease or are very overweight, you may be at increased risk of complications if you catch the virus. People taking immunosuppressive drugs, including methotrexate or steroid tablets by mouth, are also at risk of developing COVID-19-related complications and should follow British Society for Rheumatology guidelines on social isolation or complete shielding discussed below.
Q: I need to have blood tests regularly because I take methotrexate. What should I do?
A: If your arthritis is stable, you can continue with 3-monthly blood tests as usual (except if you are in the highest risk self-shielding group below where your blood test monitoring period may have to be longer than usual, perhaps 4 or 6 monthly). If you have only just started methotrexate, you may need to switch to a safer medication such as sulfasalazine which will need less frequent blood tests.
Q: Should I stop taking my immunosuppressive medicines?
A: No. It is safe to continue your medicines and if you stop suddenly, your arthritis may flare. You must never stop steroid tablets by mouth suddenly. If you catch coronavirus, you should stop your immunosuppressing medicines (apart from prednisolone) and seek advice from your rheumatology team.
Q: Should I stop taking NSAIDs such as ibuprofen?
A; Anti-inflammatory medicines such as ibuprofen have been reported in very few people to possibly increase the complications of coronavirus, but this has not been confirmed in clinical trials. If you need NSAIDS for your arthritis, it is not recommended that you stop them, however it may be reasonable to see if you can manage on a reduced dose or try paracetamol instead.
Q: I have rheumatoid arthritis and take several medicines. Do I need to completely isolate myself?
A; The British Society for Rheumatology has divided people into 3 risk categories for complications of COVID-19 and gives helpful advice on how they should protect themselves.
Group 1. People in the lowest risk group include those on hydroxychloroquine and sulfasalazine. These people are not considered to be at much higher risk than the general population so do not need to completely shield themselves from others, just to maintain self-distancing and follow hand washing advice.
Group 2. People in the next highest risk group include those whose arthritis is stable, have none of the associated conditions below and who are on a stable dose of one disease-modifying drug, for example methotrexate, with or without hydroxychloroquine or sulfasalazine and one biologic medication such as etanercept or adalimumab. People in this group should maintain increased social distancing.
Group 3. Those at highest risk of COVID-19 complications include those taking:
– More that 20mg prednisolone daily for more than 4 weeks
– More than 5mg prednisolone daily plus one other disease-modifying drug, biologic or small molecule such as baricitinib.
– Any dose of cyclophosphamide within the last 6 months
– Any 2 immunosuppressive drugs including biologics and disease-modifying drugs and one or more of the following conditions:
- Age over 70
- Lung disease including asthma
- Renal impairment
- Hypertension or ischaemic heart disease such as angina or heart attacks.
People in this highest risk group must protect themselves by self-shielding as follows.
The government has advised that from 1st June, those who are shielding can take initial steps to safely spend time outdoors. Please follow this guidance if you are in one of the high-risk groups.
Regularly wash hands with soap and water for 20 seconds and do not touch your face with hands that are not clean.
The rest of your household should minimise contact with you including minimising time spent together in shared spaces, keeping 2 metres part, sleeping in separate bedrooms where possible and using separate towels. You should eat meals in your room where possible.
Visitors including carers should wash their hands for 20 seconds on arrival and often.
Emergency medical care will of course still be provided if you need it but you should not have routine GP or face-to face hospital appointments. If you need to speak to your rheumatology team, most departments will offer consultations by telephone and your GP may agree to prescribe longer than usual prescriptions of your medicines.
Q: What should I do if I have a flare of my arthritis?
A: Contact your rheumatology department as usual. They may still see you if you have an emergency if it is safe for you to come to the hospital, or they may suggest a course of steroid tablets by mouth for a while, rather than your usual steroid injection.
Hand-washing and general hygiene advice
Soap and water are more effective than hand sanitiser, so wash your hands with soap and water for 20 seconds more often than usual. Use hand sanitiser only if soap and water are not available. Do not touch your face if your hands are not clean and if you are outside your house, assume that all surfaces are dirty. Cough or sneeze into a tissue than put it in the bin immediately – Catch it, bin it, kill it.
For Frequently Asked Questions concerning medication, you can find more in the FAQs for Pharmacy and medicines, by the Royal Pharmaceutical Society (opens pdf).
For media enquiries, and expert comment by our Medical Advisor, please contact us by email at firstname.lastname@example.org.