Important information for people with Rheumatoid and other Inflammatory Arthritis, SLE and other autoimmune diseases in the COVID-19 (Coronavirus) pandemic
From the Australian rheumatology Association
As at 25th March 2020
This is GENERAL advice. If you have specific questions, please contact your specialist.
We understand that many of you are feeling particularly vulnerable and anxious because you have chronic illnesses and take medications that may affect the immune system, so we hope that this information will help.
So far, studies of the outbreak in Wuhan have NOT found that immunosuppressive treatments prescribed for rheumatology patients are a risk factor for higher mortality. However up-to-date information is being continuously monitored.
Risks to date have been identified as people with the following:
- Over 70 years of age
- Chronic heart or lung disease
- Diabetes
- High blood pressure
What should I do if I am well?
Do NOT stop your medications. There is no evidence to suggest that WELL patients, without fever or signs of infection should change or stop any of their regular prescribed medications including:
- DMARDs: methotrexate (including Trexject injections), hydroxychloroquine (Plaquenil), leflunomide (Arava), sulfasalazine (Salazopyrin), azathioprine (Imuran), mycophenolate (CellCept, Myfortic)
- Biologics (bDMARDs): adalimumab (Humira), etanercept (Enbrel, Brenzys), golimumab (Simponi), abatacept (Orencia), certolizumab (Cimzia), tocilizumab (Actemra), infliximab (Remicade, Inflectra) or targeted DMARDs (tsDMARDs) e.g. baricitinib (Olumiant), tofacitinib (Xeljanz)
- Anti-inflammatories: celecoxib (Celebrex), ibuprofen (Brufen), meloxicam (Mobic), naproxen (Naprosyn)
- Steroids: prednisone or prednisolone
The COVID-19 pandemic may last months, so if you stop your medicine you may have a flare and need to restart or have to take more intensive treatment with steroids. We do not recommend stopping your rheumatology medication. Do not stop steroids suddenly or you may become very unwell.
If you are on these medicines and have risk factors for COVID-19 noted above, or have had a history of recurrent infections while on these medicines, it is especially important to take actions to reduce your risk of exposure and you should socially isolate to protect yourself.
If you are on a biological medication and someone close to you has a confirmed COVID-19 infection, talk to your GP or Rheumatologist about delaying your next dose.
What should I do if I get sick?
If you think you have been exposed or have developed symptoms, seek medical advice from your general practitioner. If you have fever, sore throat, shortness of breath or cough, CALL FIRST and tell them you are on immunosuppressive medications. You can also call the National Coronavirus Health Information Line 1800 020 080 or your state or territory public health agency and they will be able to advise you.
If you are acutely unwell, please call an ambulance as you would do normally in an emergency situation.
If you develop symptoms of any significant infection, established practice is to pause immunosuppressive medicines for the duration of the infection in consultation with your rheumatology team. It you are on steroids (prednisone) do not stop abruptly. Seek advice from your treating team.
If you have questions about your immune suppressing medications, contact your Rheumatologist/Immunologist or other prescribing specialist for advice.
What if I am a health professional but also have a rheumatic condition?
You should ensure your line manager/clinical lead, occupational health and treating Rheumatologist are all aware of your medication and scope of practice.
What can I do to help prevent the spread of coronavirus?
IT IS VITAL THAT EVERYONE IN AUSTRALIA FOLLOWS THE GENERAL PUBLIC HEALTH ADVICE
Avoidance of all non-essential contact with people is recommended. This includes:
- exercise personal responsibility for social distancing
- working from home if possible
- avoiding public spaces
- avoiding unnecessary travel
- using telehealth/phone to communicate with doctors where possible (see below)
Excellent personal hygiene is needed including the following:
- Wash your hands frequently with soap and water, before and after eating, after going to the toilet, after being out in general community areas (schools, shops, after touching lifts, escalators, shopping trolleys etc)
- 20 seconds with soap and water is needed; use hand sanitiser if water is not available
- wash the backs of your hands, tips of your fingers, thumbs and wrists
- sneeze/cough into a disposable tissue or your elbow and then wash your hands, please dispose of tissues and use alcohol-based hand sanitiser
- limit touching your face
- sanitise your phone, computer and work surfaces regularly.
There is no evidence to suggest that you should wear a mask unless you are advised by a health care professional to do so. Gloves do not replace the need to wash your hands as above.
What about vaccinations?
- It is really important your vaccines are kept up to date.
- Flu vaccination when available and appropriate (early April 2020)
- Consider pneumococcal vaccination– please discuss this with your GP
What about supply of medications?
Australian medications are sourced widely. There have been reports of supply issues with some medications such as hydroxychloroquine (Plaquenil) and sulfasalazine (Salazopyrin). There are now measures in place to ensure adequate provision for those needing the medications for approved indications. Some pharmacies may ask for a letter to confirm you are taking the medication for an approved indication. Your Rheumatologist can supply that if needed. Please do not stockpile.
What about appointments and blood tests?
If you are on a b/tsDMARD, due to the exceptional circumstances, you do not have to see your Rheumatologist face to face for a repeat prescription. Seek a review via the phone or telehealth. COVID-19 bulk billed Medicare items numbers have been created; please contact your Rheumatologist as soon as possible if you are under financial stress.
If you need blood tests, there are now Medicare rebates which may allow you to have these collected at home.
As your health care providers all members of the Australian rheumatology Association, (Rheumatologists, nurses, physiotherapists, exercise physiologists and other allied health providers), are keen to provide you with information about the COVID-19 (Coronavirus) situation. As more information becomes available, this document will be updated.
For the latest advice, information and resources, please refer to Department of Health.
https://www.health.gov.au/resources/collections/novel-coronavirus-2019-ncov-resources
There are resources available for both health professionals and public. There are also resources available in Farsi, Italian, Arabic, Vietnamese, Korean, Simplified and Traditional Chinese.
National Coronavirus Health Information Line 1800 020 080 – operates 24 hours, seven days a week. If translation or interpreting services needed, call 131 450.
The phone number of your state or territory public health agency is available at
https://www.health.gov.au/about-us/contact-us/local-state-and-territory-health-departments
Download a PDF version of this advice from the Australian rheumatology Association here.
Version 3, 25th March 2020
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