COVID-19 and Rheumatoid Arthritis

If you have rheumatoid arthritis (RA), you’re more likely to get certain infections. That means you may have a higher chance of getting COVID-19. If you do get sick, your symptoms could be more serious than someone who doesn’t have RA. Some medicines you take might also make infections more likely.

On the flip side, researchers are looking into the benefits of some RA drugs for COVID-19, the infection caused by the new coronavirus. But more research is needed to know if and how they could prevent or treat COVID-19.

Experts aren’t sure how this coronavirus affects people with RA or those who take drugs that affect their immune systems. That means you shouldn’t change your treatment without talking to your doctor. For now, the best way to stay healthy is to keep taking your medicine. And try to avoid contact with the virus.

There are daily steps you can take to stay safe.

RA and Your Risk of COVID-19

RA raises your chances of getting any kind of infection. You’re also more likely to end up in the hospital when you get sick. Your illness is likely to be more serious when your RA is active. You may hear that called a flare.

You may also have other health problems along with RA. Some that can make it harder to fight off an infection like COVID-19 include:

There’s also some evidence that respiratory infections spread by viruses, like COVID-19, may raise the risk of getting RA. One study showed that women and older people who’d had other kinds of coronaviruses were more likely to get RA after they’d been sick. But more research is needed to know whether COVID-19 can actually trigger RA.

RA Drugs and COVID-19

When you control your disease, you’re less likely to get really sick. That’s why it’s important to take your medicine, even if some drugs slow down your immune system. Those are called immunosuppressants. Examples include some of the drugs in these categories:

  • Corticosteroids (prednisone)
  • Disease-modifying antirheumatic drugs (DMARDs)
  • Biologics, biosimilars

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You may also take a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen or naproxen. You may have seen news reports that NSAIDs could make COVID-19 symptoms worse. But the FDA says there’s no scientific evidence right now to back up that warning.

Talk to your doctor about your medicine. It may be safer for you to avoid a flare than to lower your chances of getting an infection. Your doctor will help you decide what’s right for you.

Can RA Drugs Treat COVID-19?

There’s no vaccine or treatment for the virus yet. But some researchers think that certain RA drugs might help. They include:

Researchers around the world are studying how these drugs, among others, could prevent or treat COVID-19. But there’s not much scientific information yet.

Based on early lab tests and word-of-mouth, some hospitals already give hydroxychloroquine to people who have COVID-19 .

You may notice a shortage if you order this medicine. That’s why experts are urging drugmakers to keep up with demand. And some states have new rules about who can get the drug. That may make it easier for people with RA to get it.

What if You Can’t Get Hydroxychloroquine?

You may worry if you can’t get your medicine. But if you miss a dose, you’ll probably be fine for at least several weeks. Experts think the drug should be back in supply by then. But to be safe, you may want to:

  • Get your refill now.
  • Ask for a 90-day supply.
  • Check with a compounding pharmacy.

Make sure you tell your pharmacist that the hydroxychloroquine is for your RA. You may need to talk to your pharmacist, doctor, and insurance company about how to get more.

If you still can’t get your medicine, let the FDA know. You can reach it at [email protected].

How to Stay Safe

You’ve probably heard this a lot. But wash your hands often. It’s one of the best ways to get rid of germs:

  • Scrub up for 20 seconds.
  • Keep count by singing the "Happy Birthday" song, twice.
  • Use regular soap and either cold or warm water.
  • If those aren’t around, an alcohol-based hand sanitizer with at least 60% alcohol is the next best thing.

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Make sure you clean every part of your hands. That includes under your fingernails, the back of your hands, and in between your fingers and thumbs.

If you have active RA or take an autoimmune drug, you should also:

  • Avoid travel.
  • Keep away from people, especially big groups (social distancing).
  • Stay home as much as possible.
  • Have someone else do your grocery runs.
  • Avoid close contact with others (stay 6 feet away).
  • Disinfect surfaces people touch a lot.
  • Try not to touch your eyes, nose, and mouth.
  • Get a 2- to 4-week supply of medicine, if possible.

You can help your immune system by preventing infections from other diseases. Talk to your doctor about vaccines for things like the flu, pneumonia, whooping cough, and shingles.

What to Do if You Get Sick

Most cases of COVID-19 are mild. So you may be able to get better at home. But there are certain symptoms to watch out for. The main ones are:

Some people also get:

You may not get a fever, even if you're sick, when you’re taking steroids, NSAIDs, or an immunosuppressant. Tell your doctor or rheumatologist if you have any of the above symptoms. They’ll decide if you need to make any changes to your medicine or go to the hospital.

Your doctor may delay or stop certain treatment while you’re sick. That includes biologics and DMARDs. If you’re on steroids, they may lower your dose.

Call your doctor or 911 right away if you have:

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

WebMD Medical Reference Reviewed by Arefa Cassoobhoy, MD, MPH on March 27, 2020

Sources

SOURCES:

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

Autoimmunity Reviews: "COVID-19 infection and rheumatoid arthritis: Faraway, so close!"

American College of Rheumatology: "ACR Updates: COVID-19."

Arthritis Research & Therapy: "Respiratory viral infections and the risk of rheumatoid arthritis."

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

Hospital for Special Surgery: "What to Know About Rheumatic Disease and the COVID-19 Coronavirus."

CDC: "Coronavirus Disease 2019 (COVID-19): Therapeutic Options for Patients with COVID-19, Symptoms," "Handwashing: Clean Hands Saves Lives."

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

Johns Hopkins Medicine: "Coronavirus, Social Distancing and Self-Quarantine."

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."

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