Rheumatic Disease and the COVID-19 Coronavirus

As the number of cases of COVID-19 increases in the US and the world, people with rheumatic diseases are wondering if their immunosuppressants put them at greater risk of acquiring the virus. At this time, experts believe that it is too early to know how these drugs may affect a COVID-19 infection.

Therefore, rheumatic disease experts agree that for right now, people should continue taking their immune-suppressing medications as prescribed.¹ We explain this complicated issue and provide resources below, but here are the take-home messages:

• Patients with rheumatic conditions should not stop taking their drugs
• Talk to your doctor now to come up with a plan if you do get COVID-19 symptoms
• Talk to your doctor before stopping any medications

Are there increased risks for people with rheumatic conditions?

We do not know yet if people with lupus, rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis are at higher risk for COVID-19.²

For people with these conditions, the immune system may already be stressed by chronic lung disease, age, or diabetes.³ But what most people wonder about are the risks posed by their medicines. Many drugs that treat inflammation work so by suppressing the body’s autoimmune response. Drugs like corticosteroids or disease-modifying antirheumatic drugs (DMARDs) like biologics and JAK inhibitors all impact the immune system in different ways.

In normal times, these drugs can make people more prone to infections. These drugs can also make it harder to recover from an infection. However, we do not yet know that this may happen with COVID-19. Currently, there is no scientific data that shows immune-suppressing medications put people at an increased risk.⁴

Should I stop taking immune-suppressing medications?

Doctors agree that people should continue taking their medications. If you feel sick, you should talk to your doctor before stopping any drugs that you normally take. Stopping medications without consulting your doctor could cause increased chances of developing a flare. Uncontrolled inflammation may then result in increased risk of infection.^4,5

Not all people with rheumatic diseases are the same, and not all medications are the same. So whether you should stop a drug is based on your doctor’s understanding of your individual situation, and what you decide together after discussing it.

For example, weekly medicines (such as the DMARD, methotrexate) are easier to stop taking than monthly infusions. This is because monthly infusions remain in the body much longer. But, there are many complicating factors, and no one should make the decision to go on a “drug holiday” alone.

The issue can get even more complex. For example, some DMARDs are actually under very early consideration for treatment for COVID-19 infection.^6–8 That means doctors think some of these drugs may help improve symptoms of COVID-19. For example, there are encouraging early results from small trials with Plaquenil, Actemra, and Kevzara.^9–11

However, the World Health Organization (WHO) says that it is far too early to know if these drugs are effective. But, it shows how much we simply don’t know many things about COVID-19 right now, and no one should change drug routines without talking with their doctor first.

What can I do now? What should I do if I feel sick?

Even now, you can talk to your doctor to come up with a plan in case you show symptoms. This conversation can happen over the phone. Some of the questions you may want to ask are:

• How do my medications affect my risk of infection?
• What steps can I take to protect myself now?
• Should I stop taking any of my drugs if I show symptoms?
• If I stopped taking any drugs, would I need to start taking antibiotics?
• What should I do to treat any symptoms if I get sick?
• What should I do if someone in my home is sick?

If you show symptoms of COVID-19 infection, tell your doctor or urgent care center right away. Let them know that you are currently taking immunosuppressant drugs. This is especially important for older people, pregnant women, and people with underlying lung and heart disease.²

Call ahead to make sure your doctor can see you in person or wants you to go to another facility.

Where can I go for more information?

Providing more specific recommendations is hard because not much is known and the outbreak is changing rapidly. Your doctor is the best person to go to with questions about your specific case. You can find more up-to-date information about COVID-19 on the CDC website.¹²