Rheumatoid Arthritis & the Coronavirus
11 May 2020 • 2 comments
Rheumatoid arthritis (RA) affects about 1% of the population in the UK, or around 400,000 people. The disease affects the joints and causes the progressive destruction of cartilage and bone. The wrists and joints of the hands and feet, sometimes knees or elbows are stiff, painful and red with a sensation of heat, especially at night and in the morning when waking up.
Can I stop self-isolating? Are immunosuppressive treatments a risk factor for COVID-19 infection? How can I fight joint stiffness in self-isolation? We answer your questions!
I have rheumatoid arthritis, am I more at risk of being infected with COVID-19?
According to Dr. Patrick le Goux, rheumatologist at the Ambroise-Paré Hospital in Boulogne-Billancourt outside Paris, there is no evidence to suggest that a higher frequency of Covid-19 infection occurs in patients treated for rheumatoid arthritis, including those on immunosuppressants. However, care should be taken to respect the barrier measures.
How can I reduce joint stiffness upon waking which is exacerbated during the lockdown?
Exercise has a real anti-inflammatory role, and is indicated in patients who already have RA that has been well stabilised by treatment. There are some very simple morning exercises that take only about ten minutes to do. Dr. Patrick le Goux, who is also a specialist in sports medicine, has set up a specific programme in association with the rheumatology department of the Ambroise-Paré hospital: joint mobilisation exercises to do on the ground and exercises to do with a mini dumbbell weighing no more than 1 kg to make the joints more supple. This programme combining cardio-training, muscle strengthening, endurance-resistance, stretching postures and kinaesthetic exercises is available on the YouTube in French, Polyarthrite R-ACTION.
Be careful with any coaching videos and other relaxation exercises available on the Internet that are not adapted for RA patients. Patients with rheumatic problems should be treated by specialists (doctors, physiotherapists, etc.) and avoid training videos by fitness coaches intended for the general public.
I have rheumatoid arthritis, do I need to self-shield?
As the discussion on the end of the COVID-19 lockdown continues, RA patients may wonder if they should shield or continue their self-isolation as the UK starts to reopen schools, businesses and public places. According to Dr. le Goux, the French Society of Rheumatology does not advise that RA patients remain isolated beyond the official period. Arthritis Action references advice shared by the British Society for Rheumatology, which has divided people into three risk categories for complications of COVID-19:
- Group 1 - people in the lowest risk group, including those on HYDROXYCHLOROQUINE and SULFASALAZINE. These patients are not considered to be at much higher risk than the general population so do not need to shield themselves form others, though they should still maintain proper social distance and follow the barrier gestures.
- Group 2 - people in the next highest risk group, including those whose arthritis is stablised, have none of the related conditions listed below and who are on a regular dose of one disease-modifying drug (DMARD) (METHOTREXATE, etc.), with or without hydroxychloroquine or sulfasalazine and one biologic such as ETANERCEPT or ADALIMUMAB. Patients in this group should maintain increased social distancing.
- Group 3 - people at highest risk of complications with COVID-19, including those taking
- More than 20 mg prednisolone daily for over 4 weeks
- More than 5mg prednisolone daily plus one other DMARD, biologic or small molecule
- Any dose of cyclophosphamide within the past 6 months
- Any 2 immosuppressive drugs including biologics and DMARDs and any of the following conditions:
- 70+ years old
- Hypertension or ischaemic heart disease (angina, heart attacks, etc.)
- Renal Impairment
- Lung disease, including asthma
People in this group should continue to shield at home.
Should I stop taking my immunosuppressive medications?
Absolutely not, says Dr. le Goux. If your RA is stable with immunosuppressants and biologic treatments, then the inflammation is controlled and you are not at a higher risk of infection. So make sure you do not stop your immunosuppressive treatment or any other regimen! Continue to take your medications in the usual way, and consult your doctor regularly by telephone or by teleconsultation if possible.
I get my infusion treatment in hospital or clinic, I'm afraid of being exposed to COVID-19, are there any other options?
The hospital's dedicated COVID-19 services are highly secure. Patients can therefore safely come and continue their treatment. However, there are alternatives for some medications, including tocilizumab (ROACTEMRA) which, according to some ongoing studies, could be effective in severe cases of COVID-19. This may be injected subcutaneously in hospital. This may therefore be an alternative solution for patients who are very susceptible to inflammation. This is also the case for abatacept (ORENCIA). For more information, make sure to consult your doctor.
How to find support on Carenity?
Carenity currently has thousands of patients and relatives of patients affected by rheumatoid arthritis and other inflammatory diseases. On the platform, you can find support from other members of the community. It is important that we help one another especially in this difficult context of the COVID-19 pandemic. Feel free to join in on the discussions below!
- Rheumatoid arthritis - Are we at a higher risk for the coronavirus?
- Biotherapy and COVID-19: Has the virus had an impact on your treatment?
- COVID-19 Lockdown and Sleep: How are you sleeping lately?
- Coronavirus: What we know about the end of the lockdown!
Was this article helpful to you? Do you have any advice to share with the community? Feel free to share in the comments below!
Take care and stay home!