Following the recent licensing of the first two COVID vaccines, please find below some useful links about the vaccines, as well as general advice for clinicians and patients about COVID and rheumatological conditions:
BSR update (for clinicians): https://www.rheumatology.org.uk/practice-quality/covid-19-guidance
Versus Arthritis (for patients):https://www.versusarthritis.org/news/2020/april/coronavirus-covid-19-and-arthritis-where-to-go-for-information/
For further advice, GPs can contact the Rheumatology team via the Advice and Guidance portal and existing patients can continue to use our Patient Advice Line - 01962 824150 (Winchester) or 01256 313117 (Basingstoke).
The rheumatology service offers clinics from Basingstoke and North Hampshire Hospital and from Royal Hampshire County Hospital Winchester, with satellite clinics running in Andover and Alton.
We support patients with variety of rheumatological conditions including inflammatory arthritis, ankylosing spondylitis, connective tissue disorders, and other forms of arthritis.
This is a consultant led service running with a team of clinical nurse specialists who provide an advice line service
The clinical leads for this service are Dr Wendy Holden, consultant rheumatologist and Dr Emma Williams, consultant rheumatologist. The operational service manager for this service is Dan Parr.
The rheumatology team is further supported by therapy services including physiotherapy, occupational therapy and podiatry.
When you attend you will be asked questions about your problems, you will be examined by a doctor and may be sent for additional tests such as blood tests and scans.
COVID-19 - Frequently Asked Questions
Am I at increased risk of contracting the corona virus [COVID 19] due to my autoimmune condition and my immunosuppression treatment?
You are not at increased risk of contracting the corona virus – however, you may have an increased risk of suffering from complications of the virus if infected.
Should I stop my immunosuppression treatment? [for example methotrexate, sulfasalazine and or biological therapy – see below for additional information]
We do not advise stopping your usual immunosuppression treatment unless advised by our team. If immunosuppression treatment is stopped, you may suffer from a flare which could potentially increase risk of complications from COVID infection.
Should I stop my immunosuppression treatment if I am infected with COVID 19?
If you develop symptoms of a possible COVID infection [persistently high fever, persistent dry cough, muscle pains, general feeling of being unwell and increasing difficulty in breathing], we would advise you to stop your oral immunosuppression medication and biological injection [note exceptions as below]. You will need to stay off your treatment for at least 7 days.
Please contact the nurse helpline (01256 313117 or 01962 824150) in this situation so that we can provide advice on when to safely restart your medication.
Exceptions:
- If you are on oral prednisolone, the advice is to continue on your usual dose. You MUST NOT stop your prednisolone treatment as there is a significant risk of having withdrawal symptoms.
- If you are on hydroxycholoroquine, it is safe to continue this treatment.
- If you are on sulfasalazine, it is safe to continue this treatment.
- If you are on hydroxycholoroquine AND sulfasalazine, it is safe to continue this treatment.
Should I be self-isolating?
For patients identified from our rheumatology database as high risk, we are urgently contacting them directly to self-isolate for 12 weeks. British Society of Rheumatology has created a risk scoring guide in order to identify high risk patients [see below].
|
|
IF yes, score |
|
Have you had cyclophosphamide tablets and/or infusions in the last six months? |
3 |
|
Have you been taking prednisolone 20mg (or more) daily for more than four weeks? |
3 |
|
Do you regularly take prednisolone 5mg (or more) daily? |
2 |
|
Do you have any of the chronic medical conditions [listed below] OR even if you do not have these conditions, are you above 70 years of age? |
1 |
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Are you on just one immunosuppression tablet* and/or biological injection therapy** (other than sulfasalazine or hydroxychloroquine) |
1 |
|
Are you on two or more immunosuppression tablets* and/or biological injection therapy** (other than sulfasalazine or hydroxychloroquine)? |
2 |
|
Add up the numbers above, to make your total: |
|
Score of 3 or above:
You are in high risk group. We would advise you to self-isolate. You should stay at home at all times and avoid any face-to-face contact at all except with people who provide you with essential support for at least 12 weeks.
You will be eligible for help getting deliveries of essential supplies like food and medicine. You can register on the website link as below:
https://www.gov.uk/coronavirus-extremely-vulnerable
Score of 2:
You are in moderate risk group. We would advise you to practise social distancing.
Score of 0 or 1:
You are in low risk group. We would advise you to practise social distancing.
Social distancing:
*Immunosuppression medication: Azathioprine, Leflunomide, Methotrexate, Mycohphenolate Mofetil, Ciclosporin, tacrolimus, sirolimus, JAK inhibitors such as baracitinib, tofacitinib
**Biological therapy: Rituximab infusion in the past 12 months, all Anti TNF treatment [etanercept, adalimumab, infliximab, golimumab, certolizomuab and biosimilar variants of these medication], Tocilizumab, Abatacept, Belimumab, Anakinra, Secukinumab, Ixekinumab, Ustekinumab, Sarilumumab, Canakinumab
Chronic medical conditions:
- Diabetes Mellitus
- Any chronic lung condition [including asthma and COPD]
- Chronic renal disease [CKD 2 and above]
- Hypertension
- Ischaemic heart disease: angina, previous heart attacks
- Chronic liver disease [hepatitis, cirrhosis]
- Chronic neurological disease [Parkinson’s disease, Multiple sclerosis, Cerebral palsy]
- Pregnancy
- Sickle cell anaemia or problem[s] with spleen [including removal of spleen]
- High body weight [Body Mass Index >40]
Is it currently safe to be commencing ANY immunosuppression medication for my condition?
Decision to start any immunosuppression medication is dependent on the severity of your condition, carefully balancing benefits and risks of your specific treatment.
For active inflammatory joint disease [where there is a risk of significant joint damage and loss of function], we would consider starting the immunosuppression treatment with the lowest risk profile: hydroxychloroquine and or sulfasalazine.
If you had been counselled on biological treatment in the last 12 weeks, the decision to proceed with such treatment will lie with your consultant after appropriate risk assessment has been carried out. Our team will liaise with you regarding our decision.
If you are in the high or moderate risk patient groups, the commencement or switching of biological treatment may be delayed.
For life threatening autoimmune conditions such as vasculitis, a strong level of immunosuppression may be needed to control your symptoms and to prevent death. IN this case, we would expediently deliver the necessary treatment, followed by a period of patient self-isolation for 12 weeks.
I am experiencing a flare of my autoimmune condition. What do I do?
Please contact our nurse helpline on 01256 313117 or 01962 824150. If considered appropriate, we may then arrange to send you an outpatient prescription of oral prednisolone in the post.
Is it safe to take anti-inflammatory tablets or NSAIDs?
Current UK guidance advises that it is safe to continue NSAIDs/anti-inflammatory tablets. There is no evidence to suggest that taking NSAIDs lead to complications from the virus.
I am currently self-isolating. What is the advice for monitoring blood tests?
If you are on hydroxychloroquine, you do not need any monitoring blood tests
If you have been on a stable dose of ANY oral immunosuppression treatment for at least 3 months or longer with previously normal blood tests, we are happy for monitoring blood tests to be undertaken every 3 months
If you are on biological therapy [+/- ANY oral immunosuppression treatment] started in the last 3 months or longer with previously normal blood tests, we are happy for monitoring blood tests to be undertaken every 3 months
If you have had abnormal blood monitoring blood tests, we will contact you directly and guide you re: frequency of blood tests
If you are self-isolating, please do let us know so that we can review your previous blood tests and advise you on time frame to take the next blood test
Please note blood tests will now have to be booked via appointment from the Phlebotomy department [Basingstoke and Winchester sites: 01256 314751]
I am in the high risk category but receiving biological infusions which are necessary to keep my condition under control. Do I continue on my infusions?
It is important to ensure optimisation of your condition. Unless instructed otherwise by our team, your biological infusion therapy will continue as planned.
If you are identified as high risk patient by our team, we may provide you with a face mask to wear [on your journey to the hospital and during infusion treatment]. Infusions may be temporarily provided at a different site to the main hospital for your safety.
Please note that all of your future hospital appointments will be undertaken via telephone consultation. You will be receiving this via text and or letter.
Additional general information
Recommendations to reduce risk of contracting COVID 19:
- Avoiding travel abroad unless deemed essential [esp to high risk outbreak areas]
- Avoiding large gatherings if possible
- Avoiding contacts who are unwell with fever, cough and short of breath
- Undertaking regular hand hygiene with soap and water; hand sanitiser can be used if soap and water not available
- Routine wearing of face masks is NOT advised
- Avoid touching your eyes, nose or mouth if your hands are not clean
- Covering your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
- Putting used tissues in the bin immediately
Useful websites:
https://www.nhs.uk/conditions/coronavirus-covid-19/
https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public
https://publichealthmatters.blog.gov.uk/2020/01/23/wuhan-novel-coronavirus-what-you-need-to-know/
