Many rheumatology patients are worried above and beyond the background level of worry and anxiety about COVID19. Please be reassured that this is genuinely a mild illness in the vast majority of those who contract it. There are no specific data yet on rheumatology patients who have COVID19. There is an evolving database which is being added to daily from rheumatologists around the world but it may be some time before we know what the outcomes from that data are.
For Now Please Note The Following
- If you are on medication for a rheumatic condition, continue to take it as normal. The COVID19 pandemic will likely last several months so taking a break from your treatment means you are at risk of a flare of your arthritis. Having a flare of arthritis means you are by definition at higher risk of infection as your immune system is disturbed. Also, having a flare of arthritis often means needing to take a course of steroids which will increase your risk of infection in addition to the increased risk of infection of the active arthritis.
- If you have a cough, shortness of breath and fever or are strongly suspicious that you have an infection of any form we would always advise you to skip your arthritis treatment, seek appropriate medical help and then to restart your arthritis medication once you are well again. In the case of COVID19, you should either contact your GP or the national ambulance service by phone if you think you have symptoms and follow their protocols. If you test positive then stay off your medication until you are well again. If you test negative, then stay off your medication until you feel well again. Do NOT stop your medication if you are well.
- Rheumatology patients do NOT need to take extra precautions in excess of what is recommended by the HSE. You should observe strict handwashing practices, social distancing and remember that transmission can occur at home so ensure you wash your hands often at home and ensure your loved ones do also. If possible to work from home then do so. Don’t let your children have playdates as they could bring this into your home without you knowing it.
- Do not take ‘immune boosters’ of any sort. If your arthritis is under control then your immune system is working well and is fit for purpose. Vitamin tablets or boosters will NOT protect you from COVID19. Good quality sleep, regular proper exercise and a healthy diet of minimally processed food are the fundamentals of health and apply as much now as they always do. Avoid sugary foods, avoid excessive use of the internet, turn off blue screens and devices in a timely fashion in the evening so that your body is ready for refreshing sleep.
Many patients have contacted us around a couple of specific issues as follows.
Anti-inflammatory medications: The advice here is that there is not sufficient data to recommend that they need to be avoided per se but if you are in need of something for fever or minor ailments then try paracetamol as a first-line treatment. If you are on regular anti-inflammatories then you can continue to take them.
Plaquenil: The role of Plaquenil in COVID19 is purely experimental. It is being used in Italy and Belgium (and possibly other countries) for patients with relatively severe symptoms in the inpatient hospital setting. There is no established role for Plaquenil in preventing COVID19 but if you are on it, keep taking it as usual.
Tocilizumab (RoActemra/Actemra): There have been some very promising results on this drug but from very small numbers of patients and this drug has only been looked at in patients who are extremely unwell with COVID19. The data is from both China and Italy and by no means is this drug a sure thing for COVID19. If you are on this drug for your arthritis, stay on it. There is no evidence that this will prevent COVID19. Switching to this drug from your established medication is a terrible idea as you are leaving a strategy which is working for you to move to a strategy which may not work for you and may in fact worsen your arthritis and leave you vulnerable to infection.
Unless you have symptoms of COVID19 or have been in contact with someone who has symptoms there is no reason for you not to attend your appointment. You will be able to maintain social distance and wash your hands here without difficulty.
We have changed the way we run our clinics. You will be seen from a distance in a room with the door open and physical contact will only be made if absolutely necessary. The seat and furniture used during your assessment will be wiped down with disinfectant after you leave the room. Appointments are scheduled such that the waiting room will be close to empty so please stay away from other patients if you are not alone. Ideally, leave your coat, bag and any non-essential paraphernalia in the car to minimise the amount of contact you have in the building. Wash your hands with alcohol before entering and on leaving the building. Please be prepared with loose clothing so we can examine you. Please have all uptodate bloods on you before you come or contact us to ensure we actually have it before you come. Bring a list of medications with you. Don’t assume we know them. All this will ensure we can provide your arthritis care as quickly as possible and minimize the risk to you and to us.
Please come to the clinic (including the waiting room) alone. This is very important as it reduces the number of people who can potentially transmit or receive COVID19.