Guidance for immunosuppressant therapy for rheumatology patients from the rheumatology department

Guidance for immunosuppressant therapy for rheumatology patients from the rheumatology department

We are experiencing an unprecedented volume of calls on our advice line and via our secretarial staff relating to the issue of coronavirus. We have therefore produced this factsheet to help answer common questions that you may have about the current situation and how it relates to you.

The rheumatology department is keeping up to date with guidelines from the British Society for Rheumatology (BSR) and the Department of Health (DoH). This guidance is continually being revised and updated as new evidence becomes available but at the current time we are giving the following advice to our patients with rheumatic conditions on immunomodulatory therapy:

  • Continue with your DMARD (e.g. methotrexate, leflunomide, sulfasalazine, hydroxychloroquine etc) therapy and biologics unless you develop symptoms suggestive of the coronavirus or another infection which require antibiotics. In both of these situations DMARD therapy and immunomodulatory therapy including biologics should be stopped until the symptoms of any infection have resolved and/ or you have completed your antibiotic course.
  • If you are on a steroid medication like Prednisolone or Hydrocortisone, please do not suddenly stop that and ask for advice if not sure. This is particularly important if you have been taking this medication for four weeks or more.
  • It is advisable to avoid using anti-inflammatory medications (such as ibuprofen, naproxen etc.) to treat symptoms of possible coronavirus (e.g. fever/ muscle pain or aches/ sore throat/ headache.) If you have been taking these types of medications on a regular/ longterm basis for the treatment of your rheumatic condition then there is no need to stop them if you remain well.
  • The government has published advice on social distancing with a particular focus on those with underlying health conditions and we would advise that, irrespective of your age, you follow this advice and avoid large social gatherings and environments. Further detail regarding this advice can be found at:https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults
  • If you have a rheumatology follow up appointment already booked then we are offering you the option of having this appointment, at your existing allocated appointment date and time, via the telephone to avoid travel to hospital.
  • If you are a patient who is also a healthcare worker or frontline emergency worker who has face to face contact with patients then please contact your consultant’s secretary directly, via the hospital switchboard, to discuss your individual situation further.
  • If you are aware that you have tested positive for Covid-19 coronavirus and are being managed in either the community or hospital please could either you, or your GP, notify the rheumatology department via the rheumatology advice line. Anonymous details about your situation e.g. age, gender, underlying rheumatological diagnosis, current medication and other relevant health conditions (e.g. diabetes, high blood pressure etc) will be recorded for the purposes of helping to inform treatment decisions about patients in a similar situation in future. We thank you for your help with this. We would advise that you keep yourself up to date with the latest guidance directly by looking at the BSR, DoH and other allied national organisation’s websites on a daily basis using the weblinks below. British Society for Rheumatology website:  https://www.gov.uk/government/organisations/department-of-health-and-social-care NRAS (National Rheumatoid Arthritis Society) https://www.eular.org/eular_guidance_for_patients_covid19_outbreak.cfmVersus Arthritis (formerly Arthritis Research UK)

Best wishes

The Gloucestershire Rheumatology Team

We hope that this answers your queries in relation to Covid-19. In the event that you still have a query that you would like to speak to the advice line team about please bear with us and we will do our best to respond to your query as soon as we can. We wish you good health in this difficult and uncertain time.

https://www.versusarthritis.org/news/2020/march/coronovirus-covid-19-what-is-it-and-where-to-go-for-information/

EULAR (European League Against Rheumatism)

https://www.nras.org.uk/news/coronovius-what-we-know-so-far

Department of Health:

https://www.rheumatology.org.uk/News-Policy/Details/Covid19-Coronavirus-update-members