Rheumatology (COVID-19)


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NHS Highland Rheumatology Department follows the guidance of the British Society of Rheumatology, which is subject to frequent updates. Patients are advised to check this as we will continue to follow any changes in advice that are issued at a national level.

In summary
Patients who are established on biologic therapy or disease modifying therapy should continue treatment in order to keep their disease under control. It is felt that stopping treatment is NOT in a patient's best interest and is unlikely to reduce chances of catching COVID-19 or reduce the effects of it if they do catch it.
Being admitted to hospital with a flare-up of disease, due to withholding treatment, would be counter-productive.

We will be cautious starting new treatment at present and will discuss the individual patient's pros and cons of doing so at the time of clinic appointment.

If a rheumatology patient tests positive for COVID-19, in keeping with current advice, ALL DMARDs should be withheld for the duration of the illness.

This includes but is not limited to:

  • Conventional synthetic DMARDs: Methotrexate, Leflunomide, Sulfasalazine and Hydroxychloroquine.
  • Protein Kinase Inhibitors: Tofacitinib (Xeljanz), Baricitinib (Olumiant), Upadacitinib (Rinvoq).
  • Anti-TNF treatments: Adalimumab (Amgevita, Humira), Certolizumab (Cimzia), Etanercept (Enbrel, Benepali, Erelzi), Golimumab (Simponi), Infliximab (Inflectra, Remicade, Remsima, Zessly)
  • Rituximab (Mabthera, Rixathon, Truxima, Ruxience).
  • other biologic DMARDs: Abatacept (Orencia), Anakinra (Kineret), Ixekizumab (Taltz), Sarilumab (Kevzara), Secukinumab (Cosentyx), Tocilizumab (Roacterma), Ustekinumab (Stelara), Guselkumab (Tremfya).
  • Immunosuppressants: Cyclophosphamide, Mycophenolate Mofetil, Azathioprine, Ciclosporin.

NOTE: For leflunomide, Consultant Rheumatologist opinion should be sought as to whether a leflunomide washout is indicated.

Glucocorticoid treatment should not be stopped abruptly. In COVID-19, the standard advice to double the prednisolone dose in the event of significant intercurrent illness may not be sufficient. This can be applied to rheumatology patients as follows:

  • Patients on 5 to 15 mg prednisolone daily: take 10 mg prednisolone every 12 hours
  • Patients on oral prednisolone more than 15 mg: continue usual dose but split into two equal doses (of at least 10 mg) every 12 hours
  • NOTE: Patients with COVID-19 may have large insensible water losses, and should be advised to drink plenty of fluids, especially if they may have adrenal insufficiency

There is NO evidence that NSAIDs are contraindicated for controlling initial symptoms of COVID-19, but caution should be given to renal function and potential dehydration.

DMARD monitoring during COVID-19

Information for patients

All patients on immunomodulating drugs and those with inflammatory joint disease are advised to follow the guidance on social distancing as advertised nationally and in the British Society of Rheumatology Website.
We cannot give individual advice on suitability for continuing in the workplace. This needs to be discussed with your own line manager and occupational health department. National guidance will be advertised in the press and we advise all line managers to follow this advice when it is available.

Elderly patients, patients with heart disease and other chronic conditions, including those on immunosuppressive therapy are considered high risk - please see Public Health England guidance on social distancing.

Patients may decide that they do not need to follow this advice and would not need to inform us if they decide to stop treatment. However, if they receive medication via Homecare, they should notify their provider so deliveries can be stopped and expensive waste minimised.

DMARD monitoring during COVID-19

Last reviewed: 08 March 2021

Next review: 08 September 2021

Author(s): Alex Morrison (Pharmacist) and Dr Jan Sznajd (Consultant Rheumatologist)

Approved By: NHS Highland Clinical Response Group

Document Id: COVID019