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). GP surgeries and hospitals are now booking blood tests with additional safety precautions being taken, so it is safe to have a blood test if you need one.
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.
People in this group are advised to maintain social distancing.
Group 2. People in the next highest risk group are considered to be clinically vulnerable and 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.
People in this group are advised to self-isolate or maintain social distancing at their discretion.
Group 3. These are people who are considered to be “clinically extremely vulnerable”
People in this group should still be shielding.
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.
- Patients with rheumatoid-arthritis-related lung disease or connective tissue-related lung disease (ILD).
National Restrictions apply to everyone in England from 5th November 2020 and in addition the UK government has produced advice for those living in England who are considered “clinically extremely vulnerable”. These include people in group 3 above plus people with other conditions including those who have received a solid organ transplant, people with lung cancer and others.
You can tell if you are considered to be one of these people because you have one of the listed conditions or because you have received a letter from your GP.
Please follow this guidance for further information.
Q: What should I do if I have a flare of my arthritis?
A: Please contact your rheumatology department as usual. Most departments are now offering a mixture of telephone, video, and face-to-face appointments, so please phone if you are in trouble. Your rheumatology department will still be able to help you even if you don’t want to come into the hospital and they will still see you if you have an emergency and you may be able to have a steroid injection to help settle things down.
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. Face masks can help stop an infected person from transmitting the virus but are not totally protective, so make sure that you still follow hand-washing advice and wear a mask that covers both your mouth and nose. A face mask with 3 layers such as a surgical mask will be more effective than masks made of single layers but remember to not touch your mask and then your face and to wash your mask frequently.
Q: Should I have the Covid-19 vaccination, and will it work if I am immunosuppressed?
A: Several very promising vaccinations will become available over the coming months. They have been shown to be effective in the over 65 age group and it is likely that they will also be effective in those on immunosuppressing medicines too. Certain medicines for example rituximab are known to reduce the efficacy of other vaccinations so many people on this medicine will have already switched to an alternative where possible. Existing vaccinations, for example the annual influenza vaccination is still very effective for people on methotrexate and other immunosuppressing medicines, so it is likely that the Covid-19 vaccination will also be effective.
People in the most vulnerable groups are likely to be offered the vaccination first, so if you are immunosuppressed, the advice is likely to be to accept the vaccination when it becomes available.
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 email@example.com.