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People with Rheumatological diseases requiring immunosuppressants are understandably concerned and may wish to seek advice from their clinical teams in light of the current coronavirus pandemic.

The volume of calls to the department is currently such that we may be unable to offer personalised advice for patients who are otherwise well but want to clarify the situation regarding self-isolating.

How do I avoid catching COVID-19?

The situation in the UK is changing rapidly with advice being updated daily and we therefore recommend that you follow the advice being provided by the NHS and the British Society for Rheumatology (BSR) , which are being reviewed and updated regularly.

As has been recommended by the Government, the best course of action is to reduce the risk of contracting COVID-19 is by hand washing and social distancing for those individuals in high risk groups.

Am I in a high-risk group?

We regard all patients with rheumatic diseases that need treatment with steroids (prednisolone) and immunosuppressants as being high-risk.

This does not include patients using colchicine, allopurinol, febuxostat, hydroxycholoquine, sulfasalazine or moderate doses of methotrexate (equal to or less than 15mg/week) or occasional use of steroids (such as "depo injections") unless you are over 70 or have another risk factor. It is possible that future recommendations will suggest self-isolation.

Immunosuppressants that do fall within this group include:

  • long-term steroids
  • methotrexate (at doses greater than 15mg/week)
  • azathioprine
  • mycophenolate
  • ciclosporin
  • tacrolimus
  • leflunomide
  • Jak inhibitors (tofacitinib or baracitinib)
  • >"biologic" medicines which are given by injection or infusion.

We are unable to provide any additional information if you contact the department directly as we need to prioritise advising patients who have become unwell with their rheumatological condition.

Should I stop taking my immunosuppressant medication?

Our general advice is to continue your immunosuppressant medications because the health risk associated with a flare of your disease is likely to be greater than the risks associated with COVID-19. This is because:

  • of the symptoms of your disease itself
  • infection risk can be higher if your disease is not well controlled
  • if you had a flare, the treatments needed to control the flare could be risky.

If you develop a viral infection, immunosuppressants will need to be paused until you feel completely well, as with any infection.

What about steroids?

Steroids should not be stopped suddenly if you have taken more than 5mg for more than four weeks. The dose may need to be increased for those taking low doses of prednisolone who become moderately or severely unwell. Please make sure you tell the doctors treating you that you are taking steroids.

Should I attend my appointment?

We are moving to telephone consultations to reduce the need for patients to travel and attend hospital. If your clinic appointment is changed to a phone consultation, you should receive notification of this in advance.

If you need blood tests, we will arrange this at the time. We are able to post medication for patients that require it and are self-isolating.

We appreciate that this is a significant change in how the NHS operates, but it is necessary to protect you and your family.

Please do not attend the hospital or your GP surgery if you have a continuous cough and/or a fever. Please follow NHS advice, which is regularly updated.