Arthritis and COVID-19 - what are the risks?

Last updated: 2 December 2020

Am I 'clinically extremely vulnerable'?

Clinically extremely vulnerable is the most commonly used term being used to describe people whose health condition means they may be more at risk of severe COVID-19 illness.

For each nation, there's separate guidance on shielding and how you can help to protect yourself and others. Read more by accessing the Government's information below, you'll also find details of advice during the Christmas period:

Those who were originally contacted and told to shield are automatically classed as clinically extremely vulnerable. If there are further restrictions for your area, you will receive a letter explaining what they are and what you need to do. 

If your doctor thinks that you may not need to follow these strict guidelines, they should contact you to discuss whether or not you remain on the clinically extremely vulnerable list.

If you are extremely clinically vulnerable or clinically vulnerable it is important to continue to be particularly careful in following the advice on limiting household contacts, keeping social distance, hand washing and wearing a face covering.

Individuals who are not categorised as not extremely clinically vulnerable but are considered to be at higher risk of severe illness from coronavirus, because they are over 60 years old or are clinically vulnerable, have been advised to:

  • Be especially careful in following the restrictions relating to meeting other people and social distancing
  • Wash your hands and clean touched areas of the home and workspace more frequently

Why is my risk higher?

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. 

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've listed the drugs that suppress your immune system at the bottom of this page. 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.

What does it mean to take extra care and practice strict social distancing?

If you are in the clinically extremely vulnerable group you may want to take extra care to minimise contact with others by maintaining strict social distancing. This includes:

      • Staying at home as much as possible, except to go outdoors for exercise or to attend essential health appointments.
      • Working from home, if you can. If you cannot work from home, you should not attend work for this period of restrictions. If you cannot work for this reason, you may be eligible for benefits.
      • You may also be eligible for the Coronavirus Job Retention Scheme (on furlough). Speak to your employer if you think you are eligible.
      • You may wish to meet up with one other person from outside your household or support bubble, for example, to exercise in an outdoor public place. Always try to do so as safely as possible. For help with social distancing, check out the please give me space website.
      • Keeping two metres away from people not in your household or support bubble and avoid face to face contact
      • Avoiding crowded spaces
      • Wearing face coverings on public transport, in shops, for hospital appointments and in enclosed public places
      • Washing your hands regularly and use hand sanitiser outside your home if you’ve touched other surfaces

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 should take extra care and practice strict social distancing to protect yourself.

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 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 should take extra care and practice strict social distancing to protect yourself.

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 should take extra care and practice strict social distancing to protect yourself.

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 should take extra care and practice strict social distancing to protect yourself.

If the only treatment you are taking alongside your steroids is sulfasalazine or hydroxychloroquine, then it’s not thought that your treatment puts you at the highest risk of COVID-19.

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 below, then you should take extra care and practice strict social distancing to protect yourself. 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 below then you should take extra care and practice strict social distancing to protect yourself. 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.

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 should take extra care and practice strict social distancing to protect yourself. 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

Should I stop taking my arthritis medication 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. 

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