Coronavirus (COVID-19): Frequently asked questions - for our Rheumatology patients
This information is for patients who have a diagnosis of an Inflammatory Rheumatology conditions and particularly where the condition requires treatments with specialist level medications such as "DMARDs", "biologics" or steroids.
There is now an excellent FAQ webpage available from one of the national charities (versus arthritis) via the link:
Which Rheumatology conditions?
Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Connective Tissue Diseases, Lupus, Scleroderma, Polymyositis, Dermatomyositis, Vasculitis, GCA, PMR. This is not an exhaustive list.
Which specialist drugs?
DMARDs (Disease Modifying Anti-Rheumatic Drugs) include Methotrexate (tablets and injections), Sulfasalazine, Hydroxychloroquine, Leflunomide, Azathioprine, Mycophenolate, Cyclophosphamide.
Biologic drugs include injections and intravenous infusions such as Etanercept (Enbrel), Benepali, Adalimumab (Humira), Imraldi, Golimumab (Simponi), Tocilizumab (Roactemra), Abatacept (Orencia), Rituximab, plus Baricitnib (Olumiant) and Tofacitinib (Xeljanz) as tablets.
Who is this advice NOT aimed at?
This advice is NOT likely to be particularly helpful for patients with spinal problems (neck pain, back pain, sciatica, spinal stenosis), fibromyalgia, osteoarthritis or osteoporosis, unless they also suffer from one of the inflammatory conditions listed above.
Where can I go for general advice about Coronavirus? How can I reduce the risk?
It is important to carefully read and follow the advice provided by Public Health England and this Hospital Trust. Please see the end of this document for links. You should continue to revisit, refresh and read those web pages to keep up to date. The advice may change quickly depending on the national situation.
Will my Rheumatology condition make it more likely that I will catch the virus? How can I reduce the risk?
COVID-19 can spread very easily, even amongst healthy individuals. Inflammatory conditions in themselves can raise the risk of infection and this risk is likely to be even higher if the inflammatory condition is untreated or poorly controlled. See below for more information about your treatment. Follow the advice from the links at the bottom of the page for the best ways to reduce your risk of catching an infection.
Will my Rheumatology medication treatment make it more likely that I will catch the virus? How can I reduce the risk?
The best way to reduce your risk is to follow the advice from the links at the bottom of this page which will lead you to the most update advice from the Government and Public Health England.
In general, the specialist treatments for inflammatory conditions may increase your overall risk of developing any infection. This is however always balanced against the improvements in disease control, overall health, pain and mobility that specialist Rheumatology medication treatments can provide. If your inflammatory condition is well controlled, you are likely to be in a better position to deal with infections you may develop or come into contact with. Make sure that you follow the general advice from the links at the end of this document.
Will COVID-19 make my Rheumatology condition worse if I am unlucky enough to catch the infection?
Patients with inflammatory Rheumatology conditions frequently report that their symptoms can be exacerbated by viral infections but so far the experience suggests that this is not any greater problem with COVID-19 than any other virus and any worsening of inflammatory arthritis symptoms will usually be temporary.
What should I do with my Rheumatology medication during this pandemic, if I am otherwise well?
You should continue to take your medication at the prescribed doses as per the letter you received after your last Rheumatology out-patient clinic visit or consultation. Continue with monitoring blood tests as previously advised. Do not stop any medication unless you are advised to do this by the Rheumatology team, your GP or another hospital doctor advising on your care. Stopping your medication without advice could lead to reactivation of your inflammatory symptoms and this might actually increase your risk of infections as well as worsening your overall health, increasing pain and impairing your mobility.
What should I do with my Rheumatology "DMARDs" and "biologic" medication if I catch an infection?
We advise that you should temporarily stop taking DMARDs and biologics during the period of any active infection. In practice we would expect that this would only apply for about one or two weeks at the most and the Rheumatology treatment should be restarted immediately afterwards when the infection has subsided and any other medication course has been completed. This advice will also apply if you develop Covid–19 infection and you are staying at home and being treated in the community.
The advice is different for steroid treatment. See next question.
What should I do with my Rheumatology steroid medication during this pandemic, if I catch an infection?
In most cases, steroid tablets like Prednisolone which have been taken on a regular basis for more than a month should not be stopped abruptly, even during a period of infection, as this can be dangerous.
I've heard that Ibuprofen might increase the risk of COVID-19 infection or make it worse?
This has been mentioned in the media but the original report was based on just a handful of cases. We don't know if this is significant at this stage. For the time being, if you feel you can manage without ibuprofen, maybe using paracetamol on a regular basis, then this is reasonable.
Should I avoid public places?
You should follow the advice of Public Health England. Follow the links at the bottom of this page.
Should I avoid contact with children during this pandemic COVID – 19 period?
Healthy children do not seem to be affected very much by this virus, but they could act as carriers and spread the disease. The government will be providing advice to schools and colleges and this may change frequently. If you are a parent or guardian, you will want to continue to care for your children even if you are on specialist treatment for an inflammatory Rheumatology condition, and this is appropriate. You should still continue to follow the advice of Public Health England. If you provide occasional care for a child and you are on specialist treatment for an inflammatory Rheumatology condition, this is a more difficult question and there are no easy answers. It would be best to discuss this with the child's normal carers. More information on this may become available and you should continue to check the advice given via the link below.
What can I do about holidays and travel?
You should follow the Foreign Office advice as this depends on your destination and the advice may change frequently. You may also be able to get advice from your travel insurers, airlines and transportation companies. Unfortunately we are not able to provide specific individual advice to our patients about travel during the COVID-19 pandemic and we cannot provide letters to support travel or advise cancellation. Follow the link below for more information.
Christchurch Hospital Rheumatology Department
26th March 2020
UK government main page which provides links on to Coronavirus / COVID-19 information
Royal Bournemouth and Christchurch Hospitals NHS Trust Coronavirus / COVID-19 information
