COVID-19: What it means for patients living with osteoarthritis and autoimmune forms of arthritis

Some people living with arthritis are at greater risk of catching a cold or acquiring viruses, such as the common flu. This is also true in the context of the COVID-19 outbreak.

What you should know if you have OSTEOARTHRITIS:

People with osteoarthritis who have risk factors, such as being over 60 years of age or severe underlying co-morbidities, such as diabetes, cardiovascular disease or obesity, should follow the Health Canada guidance on taking extra measures to put distance between yourself and other people, including staying home as much as possible and avoiding crowds, especially in poorly ventilated spaces.

Health Canada recommends (see link below) many of the same practical measures that lower your risk of exposure to the coronavirus as they do the flu. These include:

Wash your hands often with soap and water for at least 20 seconds, especially after using the washroom and when preparing food
Use alcohol-based hand sanitizer if soap and water are not available
Avoid close contact with people who are sick and avoid touching your eyes, nose and mouth until you wash your hands.
Stay home when you’re sick
When coughing or sneezing:
- Cough or sneeze into a tissue or the bend of your arm, not your hand
- Dispose of any tissues you have used as soon as possible in a lined waste basket and wash your hands afterwards
Clean frequently touched objects and surfaces with a common household cleaning spray or wipe

What you should know if you have an AUTOIMMUNE/INFLAMMATORY ARTHRITIS:

People living with autoimmune forms of arthritis (e.g. rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis) may be at greater risk of developing infections and more severe infections. This is due to the diseases themselves where a patient’s immune system tends to focus on attacking their own body rather than outside threats like a virus and to the medicines used to treat these diseases, which may also suppress the immune system.

During the current COVID-19 outbreak, patients living with autoimmune arthritis are facing many concerns and questions particularly as it relates to the medicines they are taking like biologics (originator brand/biosimilar), targeted small molecule therapies such as JAK inhibitors, steroids and conventional disease modifying anti-rheumatic drugs (DMARDs), such as methotrexate.

These medicines are essential to prevent the worsening of a patient’s autoimmune arthritis. If you’re a patient, you know if you stop taking these medicines, you may experience a flare-up of your disease. With regard to the effect of these drugs on a possible coronavirus infection, our specialists and health authorities currently do not yet know enough to offer formal advice for patients. Arthritis research experts simply do not yet have specific data on COVID-19 in patients with autoimmune arthritis and currently do not know the rate and severity of infection in patients with one of these chronic diseases.

What we do know is you should speak to your rheumatologist or other health care provider if you are thinking about stopping or reducing your medication at this time. Only your health care team understands your specific disease and health history and current treatment regimen.

What patients should do:

In the event that you have a routine rheumatology appointment booked it would be wise to ask your rheumatologist if this is essential or can be safely delayed.
If you have symptoms, such as fever, persistent cough, shortness of breath, fatigue, aches and pains or complications like pneumonia, you may need to be tested for coronavirus. If these symptoms are present, you should follow Health Canada guidance for access to health care. Here is the link to the Health Canada website for the latest public health update on COVID-19: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html.
If you test positive for COVID-19, you should speak to your rheumatologist as soon as possible to discuss how to manage your disease and current medications. If you are on a biologic response modifier or “biologic” or another advanced therapy, it may be necessary to hold one or more doses if you are actively infected. Again, this is a decision to take with your rheumatologist or health care provider who oversees your arthritis treatment.
If you take medications for other chronic diseases or conditions and have COVID-19 related questions about those, talk to the member of your healthcare team who prescribed them, such as your dentist, family doctor or other specialist physician.

Staying home? Stay active.

If you are staying home and avoiding crowds as a means of prevention, patients living with osteoarthritis or autoimmune arthritis should still try exercise and be physically active as part of their treatment plan to manage disease symptoms and feel better.

ACE has great information and ideas for exercise that you can do comfortably on your own at home, including range of motion exercises that can help keep joints mobile by helping reduce stiffness and pain:

Mental Health

People living with autoimmune arthritis are twice as likely as the rest of the population to experience depression. The stress and anxiety and self-isolation that is caused by the risk of COVID-19 could certainly trigger depression in a patient.

There are helpful strategies to reframe what’s going on externally with the COVID-19 outbreak.

Look for ways to focus on activities that make you feel emotionally better or calm. Try to find activities you like to do but haven’t because you’ve lacked time; maybe a new hobby you had once thought of doing, picking up a bestseller you wanted to read, or learning how to FaceTime with a family member or long lost friend. Try to practice mindfulness; trying to keep your thoughts “in the moment” rather than thinking the worst about the current situation. That does not diminish the need to be prepared, but does help keep one’s mind “quiet” from moment to moment.

To learn more about the current status of COVID-19, here are links to get more evidence-based information about the virus: