Australian Rheumatology Association

12 August 2020

On 28 June 2020, the Australian Rheumatology Association published the following updated general information for people with rheumatoid and other inflammatory arthritis, systemic lupus erythematosus (SLE) and other autoimmune diseases in the COVID-19 (Coronavirus) pandemic.

This is GENERAL advice. If you have specific questions please contact your specialist.

Initial concerns from patients and rheumatologists related to the possible increased risk of getting COVID-19 and having a worse outcome if infected. Despite the Australian Department of Health identifying a large number of those with rheumatological disease as vulnerable, the current international peer-reviewed published data is reassuring.

  • Information about the outbreak in Wuhan has not found that immunosuppressive treatments prescribed in rheumatology patients result in a worse outcome.
  • Studies from Italy on rheumatology patients treated with immunosuppressive medications confirmed no increased risk of respiratory or life-threatening complications from COVID-19 compared with the general population.
  • An international registry reported on 600 patients with rheumatic disease:
  • Since January 2020 > 2 million COVID-19 tests have been conducted in Australia
    • 1 in 250 tests have been positive.
  • On 27 June 2020 7641 people were reported to have been infected with the virus in Australia.

(Editor’s note: For current COVID-19 statistics, see the latest health alerts on the Australian Government Department of Health Website.)

International studies continue to report a higher risk of worse outcomes in those who:

  • Are over 70 years of age
  • Have chronic lung, heart or kidney disease
  • Have poorly controlled diabetes or blood pressure

Many of the medications used to treat rheumatoid arthritis and other inflammatory immune diseases, such as hydroxychloroquine (Plaquenil), steroids (Dexamethasone) and tocilizumab (Actemra) have been highlighted in the media as possibly preventing or treating COVID-19 itself. However, there is no good evidence to date to support this in the well rheumatology population so ALL patients on these medications should take the same precautions as all members of the community.

Can I Help Prevent the Spread of Coronavirus?

  • Everyone in Australia can help by following the public health advice.
  • Exercise personal responsibility for physical distancing.
  • Ensure you adhere to excellent personal hygiene.

What if Australia Has a “Second Surge”?

  • While some Australian States may be entering a second surge as there is no evidence that patients who are well, without signs of infection, should change or stop any regular prescribed medications, please continue your treatment.
  • If you stop your medicine and have a flare you will need to restart and possibly take more intensive treatment with steroids.
  • If you are on a biological or targeted synthetic medication and someone close to you has a confirmed COVID-19 infection, talk to your GP or rheumatologist about delaying your next dose.
  • Do not stop steroids suddenly or you may become very unwell.
  • To date, there is no direct or clear evidence of harm or adverse events when anti-inflammatories are used in the setting of a COVID-19 infection.
  • If you use ibuprofen, naproxen or other anti-inflammatories you should not stop treatment.

I am Unwell: What Should I Do?

  • If you have fever (≥37.5°C), or history of fever (e.g. night sweats, chills) OR acute respiratory infection (e.g. cough, shortness of breath, sore throat) OR loss of taste or smell call your GP to discuss your circumstances.
    (Editor’s note: It is now advised that you get tested immediately if you show any symptoms that resemble those of COVID-19, regardless of how minor, and to self-isolate until you receive your results.)
  • You can call the National Coronavirus Health Information Line 1800 020 080 or your state or territory public health agency for advice.
  • If you are acutely unwell, please call an ambulance as you would do normally in an emergency situation.
  • If you do develop symptoms of any significant infection, you should contact your rheumatology team for specific advice, as decisions to pause treatment should be made on a case-by-case basis.
  • If you are on steroids (prednisolone), do not stop it suddenly; seek advice from your treating team. As usual, you should pause immunosuppressive medicines for the duration of the infection, in consultation with your rheumatology team.

I Work: What Should I Do?

  • With the low rate of infection adjusting the “work from home” model may be an option.
  • Each person has different circumstances so you may want to contact your rheumatologist if you are vulnerable and request a letter for your employer.

(Editor’s note: This advice depends on the level of COVID-19 cases and restrictions in your area.)

I am a Health Professional With a Rheumatic Condition: What Should I Do?

  • The low rate of infection may assist in a return to work, but each case should be reviewed individually.
  • Talk with your line manager/clinical lead, occupational health and treating rheumatologist to select the best approach for you.

(Editor’s note: This advice depends on the level of COVID-19 cases and restrictions in your area.)

Vaccinations: What Should I Do?

  • A flu vaccination is recommended for everyone with rheumatoid arthritis and other autoimmune diseases.
    • Whilst flu vaccination does not prevent against COVID-19, a flu vaccination is critical to protecting the general health of Australians from influenza.
    • The vaccination should continue to be offered as long as the influenza virus is circulating.
    •  So, if you haven’t already, it’s not too late to get vaccinated; call your GP or local pharmacy to check their availability of vaccines before attending in person.
  • The Medicare restrictions were modified for pneumococcal vaccination on 1 July 2020; please discuss this with your GP.

My Medications: Will I Be Able to Get Them?

  • While there were reports of supply issues with hydroxychloroquine (Plaquenil) and sulfasalazine (Salazopyrin), measures were put in place to ensure those needing the medications for approved indications can access them.
  • There should be no supply problems: if there are, talk to your rheumatologist as soon as possible.

My Appointments and Blood Tests: What’s Happening?

  • If you are on a biological or a targeted synthetic DMARD, due to the exceptional circumstances, you do not have to see your rheumatologist face to face for a repeat prescription; the review can be conducted by phone or video.
  • Some practices and outpatients are transitioning back to face to face appointments.
  • Make sure you keep in touch with your treating team so there is no interruption in prescriptions.
  • COVID-19 Medicare item numbers are currently in place until 30 September 2020.
  •  If you need blood tests, Medicare rebates may allow you to have these collected at home.

What Else Can I Do to Stay Healthy?

  • It is important to maintain healthy habits during this time to keep your immune system as strong as possible.
  • Emotional stress, lack of sleep and physical exhaustion can impact your immune system further, making you more susceptible to illness.
  •  Eat a healthy diet that includes plenty of fruit and vegetables.
  •  Ensure you exercise each day.
    • This is helpful for general physical and psychological health, but especially while physically isolated.
    • A number of Arthritis Australia affiliates run online options, details available here.
  • Get plenty of sleep—aim for eight hours every night.
  • Take steps to relieve stress—try yoga, meditation or light exercise you can do at home.
  • For more suggestions on how to stay healthy at home, take a look at the Healthier. Happier. website.

As your healthcare providers, all members of the Australian Rheumatology Association (ARA), (rheumatologists, nurses, physiotherapists, exercise physiologists and other allied health providers), are keen to provide you with information about the COVID-19 situation. We aim to provide an update next month.

For the latest advice, information and resources, please refer to the Department of Health at COVID19 resources. There are resources available in a number of languages.

The National Coronavirus Health Information Line, 1800 020 080, operates 24 hours, 7 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 State and Territory Health Departments.

Source: Australian Rheumatology Association Update for Patients: Edition 2, 28 June 2020.

Where Can I Get More Information?

CreakyJoints Australia has been publishing a comprehensive series of articles about COVID-19 and how it affects those with chronic illness over the last few months. New content is being added regularly.

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