COVID-19 and Lupus

Lupus raises your chances of catching any kind of infection. So if you have lupus, you may be more likely than other people to get COVID-19. And if you do, your symptoms are more likely to be serious. That’s both because of your condition itself and certain types of medicines you may take for it.

At the same time, researchers think some other types of lupus drugs might work to treat symptoms of COVID-19. But more studies are needed to know for sure.

Right now, experts don’t know a lot about how COVID-19 affects people with lupus or those who take drugs that slow down their immune systems. So don't change your treatment without talking to your doctor. Instead, keep taking your medicine, and try to avoid contact with the virus.

There are other things you can do every day to lower the chances you’ll get sick from the new coronavirus.

Lupus and Your Risk of COVID-19

Your immune system is your body's main defense against germs and illnesses. When you have lupus, you're more prone to infections because your immune system works differently than most people's. It becomes overactive and attacks your body itself.

Lupus affects many parts of your body. And people with lupus may have other health problems. Some can make it harder to fight an infection like COVID-19, including:

Lupus Drugs and COVID-19

You may take a type of drug for lupus that makes your immune system less active, called an immunosuppressant. While these drugs can make you more likely to catch an infection, they also help control your lupus. That's important because you’re more likely to get sick from an infection when your disease is active. You might hear that called a flare.

Immunosuppressant drugs for lupus include:

You may also take a nonsteroidal anti-inflammatory drug (NSAID), like ibuprofen, naproxen, or celecoxib (Celebrex), for lupus symptoms. You may have heard reports that these drugs can make COVID-19 symptoms worse. But the FDA says there’s no evidence right now that this is true.

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Can Lupus Drugs Treat COVID-19?

Some lupus drugs, like hydroxychloroquine (Plaquenil) and chloroquine (Aralen), change your immune system without raising the odds you’ll get an infection.

Researchers around the world have been studying hydroxychloroquine’s effects in people with COVID-19. Some found early evidence of an effect against the new coronavirus. But many of those trials were stopped when they found serious side effects or failed to show results.

After early studies showed promise, the FDA issued an emergency ruling that would allow doctors to use chloroquine and hydroxychloroquine (a less-toxic derivative of chloroquine) in people who were in the hospital with COVID-19. The agency later revoked the ruling amid concerns about the drugs’ safety and how well they work against the virus.

The sudden interest in these drugs is making it hard for some people with lupus to fill their prescriptions. But national health groups are asking state pharmacy boards to ensure they're available for people who depend on them. And they’re urging drugmakers to keep up with demand.

Some companies are donating hydroxychloroquine and chloroquine for COVID-19 use. And the FDA is working with them to make more. In the future, that should make it easier for you to get the drug from your pharmacy.

What if You Can’t Get Hydroxychloroquine or Chloroquine?

You may worry if you run out of medicine. But the drug can stay in your body for a while. You may not have a flare for at least a few weeks. But to be safe, you may want to:

  • Get your refill early
  • Call different pharmacies
  • Ask for a 90-day supply
  • Check with a compounding pharmacy

Make sure you say the medication is for your lupus. You may need to talk to your pharmacist, doctor, and insurance company about how to get more.

If you still can’t get your prescription, email the FDA at [email protected].

If you can’t get enough hydroxychloroquine or chloroquine, don’t start taking less. Instead, tell your doctor you may run out. They may want to:

  • Lower your dose
  • Temporarily take you off the drug
  • Change your medicine

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How to Stay Safe

The best way for people with lupus to avoid getting sick is to follow the safety steps recommended by public health officials:

  • Avoid others who may have been infected.
  • Wash your hands well and often.
  • Avoid touching your nose, mouth, and eyes.
  • Disinfect surfaces in your home that are touched a lot.

Also, try to avoid anything that triggers your lupus. That might include:

  • Physical or emotional stress
  • Sunlight
  • Certain drugs, like antibiotics or sulfa drugs

It’s a good idea to work with your doctor's office to come up with a lupus flare plan just in case.

What to Do if You Get Sick

Call your doctor if you don’t feel well or have any new symptoms. Most cases of COVID-19 are mild. That means you may be able to get better at home. But there are symptoms you should pay close attention to, including:

You may not have a fever, even if you’re sick, if you take drugs that suppress your immune system. Also, sometimes people with lupus have low fevers that come and go. A fever can also be a sign that you’re having a lupus flare.

Some symptoms are a sign of an emergency. Call your doctor or 911 right away if you have:

  • A really hard time breathing
  • Constant chest pain or pressure
  • A new sense of confusion
  • A blue tint to your lips and face

WebMD Medical Reference Reviewed by Brunilda Nazario, MD on August 18, 2020

Sources

SOURCES:

Michael Angarone, DO, assistant professor of infectious diseases and medical education, Northwestern University Feinberg School of Medicine.

Lupus Foundation of America: "Coronavirus (COVID-19) and lupus," "Lupus and your risk of infections," "Medications used to treat lupus," "FDA Issues Emergency Authorization of Hydroxychloroquine Amid Coronavirus Pandemic," "State Pharmacy Boards Urged to Ensure Availability of Critical Lupus Medicines," "Tips for refilling your hydroxychloroquine (Plaquenil) prescription," "Infection protection is in your hands," "Common triggers for lupus," "Frequently Asked Questions: Coronavirus (COVID-19) and Lupus," "Steps to help prevent coronavirus (COVID-19) for people with lupus," "Do vaccines cause flares?"

Lupus Research Alliance: "COVID-19 Frequently Asked Questions: What You Should Know."

American College of Rheumatology: "COVID-19 Frequently Asked Questions," "Advice from the American College of Rheumatology for Talking to Patients About Shortages of Hydroxychloroquine During the COVID-19 Pandemic."

Johns Hopkins Lupus Center: "How Lupus Affects the Body," "Treating Lupus with Anti-Malarial Drugs," "I’ve been diagnosed with the new coronavirus disease, what should I expect?" "Lupus Signs, Symptoms, and Co-occurring Conditions,"  "Treating Lupus With Immunosuppressive Drugs."

CDC: "Coronavirus Disease 2019 (COVID-19): People Who are At Higher Risk," "Symptoms of Coronavirus."  

PLoS One: "Increased Risk of Chronic Obstructive Pulmonary Disease in Patients with Systemic Lupus Erythematosus: A Population-Based Cohort Study."

Scientific Reports: "Impact of Diabetes Mellitus on the Risk of End-Stage Renal Disease in Patients with Systemic Lupus Erythematosus."

Frontiers in Immunology: "The Systemic Lupus Erythematosus Infection Predictive Index (LIPI): A Clinical-Immunological Tool to Predict Infections in Lupus Patients."

Hospital for Special Surgery: "Vaccinations and Lupus: What You Should Know."

FDA: "FDA advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19."

U.S. Department of Health & Human Services: "HHS accepts donations of medicine to Strategic National Stockpile as possible treatments for COVID-19."

Arthritis Foundation: "Hydroxychloroquine (Plaquenil) Shortage Causing Concern."

American Academy of Otolaryngology-Head and Neck Surgery: "AAO-HNS: Anosmia, Hyposmia, and Dysgeusia Symptoms of Coronavirus Disease."

Canadian Rheumatology Association: "CRA Updated Statement on COVID-19 -- March 17, 2020."

UpToDate: “Coronavirus disease 2019 (COVID-19): Management in hospitalized adults.”

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