COVID-19 - assessing your risk

We know that if you or a loved one are living with a long-term health condition such as arthritis, the information available can be confusing.

We’ve pulled together the latest content from the NHS and worked with the British Society for Rheumatology on guidance to help you assess your risk levels, and how best to protect yourself at this time.

Why is assessing your risk important for rheumatology patients?

Some people are more vulnerable to coronavirus, COVID-19 than others. If you have an autoimmune condition and/or if you're receiving treatment to control your immune system your risk from COVID-19 is higher.

People with autoimmune conditions and people receiving treatment to control their immune systems should practise social distancing. Some should also self-isolate as part of ‘shielding’.

We recommend you read the shielding guidance if you’re in one of the high-risk groups.

What is shielding?

Shielding is an extra measure to protect extremely vulnerable people from coming into contact with the coronavirus, COVID-19, by minimising all contact between them and others. This is to protect those who are at very high risk of severe illness from coronavirus.

Shielding gives a higher degree of protection than social distancing and is for your personal protection: it’s your choice whether to shield.

Most people who need to shield should now have received a letter. If you live in England, your rheumatology team may have told you, whereas in Scotland and Wales the process has been slightly different. If you have received a letter telling you to shield, you should do so.

If you haven’t been told to shield, please read through this information carefully. If you think you are in any of the groups listed here, but you haven’t been told to shield, you should contact your rheumatology team to ask their advice.

Some types of arthritis are caused by the immune system becoming overactive and attacking healthy parts of the body, such as the joints, by mistake. Treatments for these conditions work by dampening or suppressing the body’s immune system to prevent damage to healthy joints.

However, this also means that taking them can make you more vulnerable to picking up infections, such as COVID-19. We have listed the drugs that suppress your immune system in the table at the bottom. Some of these treatments have other names, so if you’re not sure if yours is listed, check the packet or check with your rheumatology team if you’re still unsure.

Hydroxychloroquine and sulfasalazine have less of an impact on your immune system, which is why they have not been included in the table.

I have an inflammatory condition, should I be shielding?

Most people with an inflammatory condition – for example rheumatoid arthritis – don’t need to shield.

However, we still don’t know for sure which people with inflammatory conditions are at highest risk from COVID-19. For this reason, people with reduced immunity or significant health problems should take extra care.

The British Society of Rheumatology (BSR) has worked with NHS England and national experts to identify which groups need to shield. They are listed below. If you belong to one of these groups, you may need to shield to stay safe from COVID-19. You could be vulnerable because of your medical condition or because of the medication you need to keep you well.

If any of the descriptions below sounds like you but you haven’t been told you need to shield, please contact your rheumatology team to ask their advice.

I have lung disease related to my inflammatory condition

If you have been diagnosed with pulmonary hypertension – a condition where the pressure of the blood flow in the lungs is too high – then you need to shield.

If you have been diagnosed with interstitial lung disease – a condition where there is inflammation and scarring of the lungs – then you may need to shield. Check with your rheumatology team.

I have been treated with cyclophosphamide in the last six months

Cyclophosphamide is a powerful immune-suppressing treatment. If you have had this through a drip in the last six months, or if you have been taking cyclophosphamide tablets, then you need to shield.

If you’re not sure, please check with your rheumatology team.

I take steroid tablets every day

Steroids can be used to suppress the immune system. The most common steroid tablet is called prednisolone. If you have been taking prednisolone every day for the last four weeks or more, and your daily dose of prednisolone is 20mg or more, then you need to shield.

If you are taking a different steroid tablet or if you’re not sure, please check with your rheumatology team.

I am on immune-suppressing drugs (other than sulfasalazine or hydroxychloroquine) as well as a daily steroid tablet

If you take 5mg prednisolone or more every day, then you may need to shield if you’re also taking another treatment to control the immune system.

If as well as your steroid tablets you’re also being treated with a tablet, injection or intravenous drip listed in the table below, then you need to shield.

If the only treatment you are taking alongside your steroids is sulfasalazine or hydroxychloroquine, then you don’t need to shield because of your treatment.

Many of the treatments listed can also have other names, so if you’re not sure, please check with your rheumatology team.

I am on two or more immune-suppressing drugs (other than sulfasalazine or hydroxychloroquine) and am aged 70 years or older

Being older increases your risk from COVID-19. If you’re over 70 and you’re being treated with two or more treatments from the tablets, injections or intravenous drip listed in the table below, then you need to shield. Many of the treatments listed can also have other names, so if you’re not sure, please check with your rheumatology team.

I am being treated with two or more immune-suppressing drugs (other than sulfasalazine or hydroxychloroquine) and I live with another long-term condition

Many long-term conditions increase your risk from COVID-19, whatever your age. This is particularly true if you have any of the following:

  • diabetes
  • lung disease, including asthma, emphysema or COPD
  • kidney disease, sometimes called ‘renal impairment’
  • heart disease
  • high blood pressure.

If you have a long-term condition and are also being treated with two or treatments from the tablets, injections or intravenous drip listed in the table below then you need to shield. Many of the treatments listed can also have other names, so if you’re not sure, please check with your rheumatology team.

If you’re not sure whether your long-term condition increases your risk from COVID-19, please check with your rheumatology team.

What do I need to do if I don’t need to shield?

If your inflammatory condition is well controlled and you’re not being treated with steroid tablets or any of the medicines listed below, then you should protect yourself by following social distancing guidelines

If you don’t need to shield but are taking regular steroids or one of the treatments listed below your risk of developing complications from COVID-19 isn’t as high as those who do need to shield, but may be higher than people not on these treatments. The guidance is to practise social distancing. There are ways you can practice more careful social distancing, such as asking family and friends to help you with tasks like shopping, so you don’t need to leave your home unnecessarily.

If you are in any doubt about whether or not you need to shield, then please check with your rheumatology team. 

Which treatments suppress my immune system?

Below is a list of immune-suppressing treatments that increase your risk from COVID-19. If you have other risk factors, then taking these treatments might mean that you have to shield. Please note that some of these treatments have multiple brand names.

If you know you're receiving treatment for an inflammatory condition but you don’t recognise the name of your treatment here, please check with your rheumatology team.

DMARDs

Azathioprine
Ciclosporin
Leflunomide
Methotrexate
Mycophenolate mofetil
Mycophenolic acid
Sirolimus
Tacrolimus

Biologics

Abatacept
Adalimumab
Anakinra
Belimumab
Certolizumab pegol
Etanercept
Golimumab
Infliximab
Ixekizumab
Rituximab (within the last 12 months)
Sarilumab
Secukinumab
Tocilizumab
Ustekinumab

JAK-inhibitors

Baricitinib
Tofacitinib
Upadacitinib

Stopping arthritis treatments during the COVID-19 pandemic

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. 

I'm in the 'extremely vulnerable' group, what help can I get?

If you are in the ‘extremely vulnerable’ group, you'll soon be able to ask for help getting deliveries of essential supplies like food and medicine. In England, you can register for this help on the gov.uk website.There's separate advice for Northern Ireland, Scotland and Wales.

If you’re not sure whether your medical condition makes you ‘extremely vulnerable’, register anyway.

Is there a risk calculator for children and young people?

The British Society of Rheumatology (BSR) and Great Ormond Street Hospital (GOSH) have produced a version relevant for children. This guide to shielding and social distancing for children and young people (PDF, 233 KB) has been designed to be useful to families and parents.

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