Arthritis - does it increase your risks?!

[Sarahspeaksloud]

Does anyone know if having inflammatory arthritis increases your risks of a poorer outcome with Covid?

I’m 34 and had my first baby this year.

I was med free during pregnancy and on the advice from my rheumatologist I’m still med free.

I’m starting with a mild flare but it’s something I can manage with painkillers.

I know that the immune suppressing meds puts people at risk, but what about the arthritis itself?

I have psoriatic arthritis & psoriasis.

The consultant told me that because the meds reduce inflammation, a person on RA drugs is less likely to have problems with Covid. It’s because the really nasty lung issues are caused by inflammation

Presumably if your not on meds at all the opposite would be true You’d be more likely to be quite unwell as you’ve already got inflammation in the body

Same chance of catching tho. Apparently

@Heatherjayne1972

The consultant told me that because the meds reduce inflammation, a person on RA drugs is less likely to have problems with Covid. It’s because the really nasty lung issues are caused by inflammation

Presumably if your not on meds at all the opposite would be true You’d be more likely to be quite unwell as you’ve already got inflammation in the body

Same chance of catching tho. Apparently

@Heatherjayne1972

I wonder why then, they told people on meds to shield, but not people without meds?

My mum has RA and she’s over 60 and she wasn’t told to shield. She’s a nurse (not in a hospital though) so she can’t anyway. She was told the same thing - the drugs she’s in for her RA are quite protective for Covid.

I wondered about this too, so I checked. This is the NHS advice.

www.versusarthritis.org/covid-19-updates/covid-19-assessing-your-risk/

I’ve just recovered and immune suppressed. Without a crystal ball- you’ll be fine.

The guidance states that people should not stop taking their treatments for arthritis. Although it may raise your risk slightly of developing complications, not taking your medication would mean you are at risk of having a flare-up. This would put you into a higher risk group than those on treatments.

Will call my rheumatologist then!

@Sakesman

I’ve just recovered and immune suppressed. Without a crystal ball- you’ll be fine.

@Sakesman

Are you on medication? Im not.

Yeah I’m on immune suppression but you don’t take it if you get symptoms of any illness. The level of inflammation you’ve got doesn’t sound like increased risk. I’m not a medic. And you’re young. All the covid risk assessments don’t flag you up as a particular problem.

OP I have arthritis.. As I understand it is the immuno-suppressant drugs that are the issue where covid is concerned. Unless you are taking those you are fine,

I have inflammatory arthritis and take methotrexate, as well as other meds, for it.

I currently have Covid. I teach but have tried to be super careful. I have been told all along that I was vulnerable (not shielded.)

It's not pleasant currently. Was in hospital initially having tests as they thought I had a potential blood clot on my lung or pneumonia. Turns out it was Covid. I'm home now and seem to have it stable - it's no worse these past couple of days anyway. The cough (which started the afternoon after I got a positive result) is similar to pneumonia but not as frequent. The chest tightness and breathing issues are similar to when I was in hospital with pneumonia several years back. My heart rate and blood pressure are both affected but I've been given medication for them, which have stabilised things. Chest x ray was clear and all bloods were normal. Ecg was normal too.

Hopefully recovery will be quicker than when I had pneumonia though.

My discharge advice is to not take my methotrexate for at least 2 weeks now, longer if still ill at end of it.

I don't know if the arthritis or the meds has had any bearing obviously.

www.rheumatology.org.uk/practice-quality/covid-19-guidance

Go to the how should I assess my patients risk.

I have Ankylosing spondylitis and my dept used this to decide risk.

Flaring does put you at some risk though yes. But th main issue is it you take steroids or not , rather than the immunosuppressants

That’s a good resource, thanks OpheliasCrayon

I'm sure we've crossed paths before and I have asked why you aren't medicated?

Medication isn't just to help with your current pain but it is to protect your joints from further damage. Arthritis is progressive and the earlier you intervene, the better the prognosis.

I too have PsA, have been in a period of remission for quite some time but am medicated. I take Methotrexate and as I understand that makes me slightly more vulnerable but I've never needed to shield.

FWIW, I started on Sulfaslazine, which was breastfeeding friendly and moved to MTX when DC stopped with breastmilk.

My arthritis is psoriatic too. I started on sulfasalazine and now take that and methotrexate. My scalp psoriasis cleared up with the medication.

@Heatherjayne1972

The consultant told me that because the meds reduce inflammation, a person on RA drugs is less likely to have problems with Covid. It’s because the really nasty lung issues are caused by inflammation

Presumably if your not on meds at all the opposite would be true You’d be more likely to be quite unwell as you’ve already got inflammation in the body

Same chance of catching tho. Apparently

This is dangerous advice and I can’t believe a consultant said it. Pls report them.

Whilst they are using similar meds to the ones we are on to reduce inflammation in serious cases of covid, taking them makes you more at risk, not less.

An inflammatory response is how your body deals with infection. If you can’t produce one, you cannot kill the virus.

Covid seems to be producing an overactive inflammatory response in some people, which is what causes issues in the lungs. And if you have this cytokine storm, then the meds used to inhibit immune responses Can be helpful in controlling it. But it’s a matter of degree and timing.

Those with the dodgy immune systems that lead to inflammatory disease (whether arthritis/IBD/fibromyalgia etc) may suffer more, but it’s only those on strong immunosuppressant drugs (high dose prednisolone is one) or combinations of them and active disease that were categorised as Clinically extremely vulnerable www.versusarthritis.org/covid-19-updates/covid-19-assessing-your-risk/

I am interested in getting more information on this. I have ankylosing spondylitis, psoriasis and psoriatic arthritis and was on methotrexate and adalimumab. I stopped my drugs in February as only my skin had responded and my judgment was that severely depressed immunity was a high price to pay for clear skin in the circumstances. I was told to shield based on being on the drugs. I’ve recently read that adalimumab is being trialled as a treatment for COVID, and also that there is some evidence that people on the drug have been les likely to be hospitalised. If this is the case I would go back on the drugs.

MrsMcGarry

I agree. Unless this advice is actually verified and reported properly it is dangerous advice to have on here, left unchallenged especially.

It goes against everything my own consultant has said, plus the other medics I know and have seen during this time.

@MyPersona

I am interested in getting more information on this. I have ankylosing spondylitis, psoriasis and psoriatic arthritis and was on methotrexate and adalimumab. I stopped my drugs in February as only my skin had responded and my judgment was that severely depressed immunity was a high price to pay for clear skin in the circumstances. I was told to shield based on being on the drugs. I’ve recently read that adalimumab is being trialled as a treatment for COVID, and also that there is some evidence that people on the drug have been les likely to be hospitalised. If this is the case I would go back on the drugs.

I was told NOT to shield for one of the same conditions and both those drugs. But the fact I'm flaring means I was supposed to shield but I haven't bothered.

@OpheliasCrayon

I was told NOT to shield for one of the same conditions and both those drugs. But the fact I'm flaring means I was supposed to shield but I haven't bothered.

So it was the condition itself and not the meds why you were told to shield?

I was told NOT to shield for one of the same conditions and both those drugs. But the fact I'm flaring means I was supposed to shield but I haven't bothered

My shielding letter referred to the drugs rather than the condition. No one has mentioned flaring to me, although I am now having quite a severe skin flare up. FFS, I just want sensible collaboration and decent information.

@MyPersona

I was told NOT to shield for one of the same conditions and both those drugs. But the fact I'm flaring means I was supposed to shield but I haven't bothered

My shielding letter referred to the drugs rather than the condition. No one has mentioned flaring to me, although I am now having quite a severe skin flare up. FFS, I just want sensible collaboration and decent information.

The letter refered to the drugs but if you look at the link that I and someone else have posted, you will be able to see the way in which the risk is calculated for arthritis.
www.rheumatology.org.uk/practice-quality/covid-19-guidance

And go to this section

How should I determine the level of risk to my patients of COVID-19 and advise them on what precautions to take?

This links to the table to explain all the catalogues of risk.