What to know about COVID-19 and arthritis

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Neither researchers nor doctors know the exact effects of COVID-19 on people with arthritis. The World Health Organization (WHO) and other expert bodies are still learning about the impact of the virus on people with preexisting health conditions.

According to the Arthritis Foundation, people with autoimmune or inflammatory arthritis with high disease activity generally have a higher risk of infections due to reduced immune function.

Regarding children with arthritis, the Arthritis Foundation suggest that factors such as arthritis type, disease activity, the involvement of organs, and the level to which their immune system is suppressed may all play a role in the risk of coronavirus infection.

Some research suggests that people with rheumatoid arthritis (RA) have an increased risk of infection because their immune system is impaired. This is typical in autoimmune conditions such as RA.

Furthermore, these people may take medications — such as corticosteroids and immunosuppressive drugs — that also affect immune function. This may increase their risk of contracting the virus.

The presence of other underlying conditions, such as diabetes or heart disease, can further increase risk.

There is not yet enough evidence to confirm this, but it seems that people with autoimmune or inflammatory arthritis may be at higher risk of infection or severe COVID-19 symptoms.

The Centers for Disease Control and Prevention (CDC) report that conditions or medications that weaken the immune system increase the risk of severe illness with COVID-19.

Experts suggest that the main concerns for those with autoimmune conditions who develop COVID-19 include secondary bacterial infections and other complications that may result from the initial viral infection.

In general, those who take immunosuppressive medications, such as biologics or corticosteroids, are at higher risk of a severe viral infection. People who take immunosuppressive medications and who develop flu-like symptoms should call their doctor immediately.

Healthcare professionals typically do not recommend immunosuppressive treatments in those with active infections, but the risk of disease flares is also worth consideration. A person can determine whether to discontinue, taper, or maintain their medication by consulting their doctor.

Those who take immunosuppressive drugs and who do not have symptoms of COVID-19 should discuss their options with their doctor. In some cases, the risk of arthritis flares may outweigh the potential benefits of stopping treatment.

In either case, it is important that people do not adjust their dosage or stop taking their medication without first seeking medical advice.

Common COVID-19 symptoms, according to the WHO, include:

• a dry cough
• fatigue
• a fever

Other symptoms may include:

• aches and pains
• breathing difficulties
• gastrointestinal symptoms, such as diarrhea
• a stuffy or runny nose
• shortness of breath
• a sore throat
• red or watery eyes
• severe headaches

In most cases, the symptoms will begin within 2–14 days of exposure to the virus. Most people will experience only mild symptoms, though some will have more severe ones.

Some individuals may be asymptomatic. This means that they have the illness but do not display any symptoms. It is important to note that those who are asymptomatic can still transmit the virus to others.

The CDC explain that the virus SARS-CoV-2 which causes COVID-19 spreads very easily and efficiently between people. To reduce the risk of contracting the virus, people should:

• Wash the hands regularly with soap and water, for at least 20 seconds.
• Use an alcohol-based hand sanitizer containing at least 60% alcohol when soap and water are not available.
• Maintain a physical distance of 6 feet (2 meters) from other people, especially those who are unwell.
• Limit the time outside of the home, including in grocery stores and on the streets. When it is necessary to leave the home, try to wear a face mask.
• Stock up on food, medications, and other essential items to reduce the number of trips outside of the home.
• Disinfect surfaces and everyday household items frequently. Examples include faucets, door handles, toilet handles, keys, and remote controls.
• Avoid sharing utensils, towels, and other personal items with other people.
• Isolate sick members of the household in a separate bedroom and bathroom (if possible) until their symptoms resolve. These people should wear a face covering such as a mask when using shared spaces.
• Avoid all nonessential air and sea travel and other forms of public transport.
• Discuss the use of arthritis medications with a doctor to see if it is advisable to continue with the treatment.

Anyone who believes that they have had contact with someone with COVID-9 should:

• monitor their symptoms closely and check their temperature daily
• call their doctor immediately if any symptoms develop
• seek immediate medical attention if severe symptoms, such as breathing difficulties, occur
• call ahead before going to any healthcare facility

There is currently no specific treatment for COVID-19. Treatment aims to relieve symptoms in those who contract the virus. Options include:

• cough medicines
• fluids
• pain-relieving medications
• rest

Clinical trials and vaccine development studies are in progress at many medical centers around the world.

People who get severely ill typically require hospitalization. In the hospital, medical staff may use oxygen therapy or ventilators, or they may use other specialist treatments to alleviate the symptoms and prevent or manage complications.

Those with arthritis who contract COVID-19 should discuss their arthritis treatment with their doctor. The doctor, most often a rheumatologist, may suggest continuing with the treatment, tapering it off, or temporarily stopping use.

Medical professionals will advise their patients on a case-by-case basis.

What to do if the test is positive

A doctor will provide individual instructions to those who test positive for SARS-CoV-2. Typically, those who have mild symptoms can isolate and recover at home. Self-isolating prevents the spread of the virus to others.

Those with severe symptoms require urgent medical attention and perhaps a hospital stay. People with underlying conditions and those who take immunosuppressive drugs may also require additional medical care.

The outlook for people who contract COVID-19 varies greatly. It depends on several factors, including:

• the severity of the disease
• the person’s age, sex, and ethnicity
• the presence of any underlying conditions
• the use of any immunosuppressive treatments

Current research indicates that around 80% of individuals experience mild-to-moderate symptoms, 13.8% develop severe disease, and 6.1% become critical and require intensive care.

Prompt medical treatment may improve the outlook and reduce the risk of complications. In severe cases of COVID-19, complications include pneumonia, organ failure, and death.

At present, experts are still unsure of the exact effects of COVID-19 on individuals with arthritis.

It appears that people with autoimmune or inflammatory arthritis and those taking immunosuppressive drugs may be more at risk of contracting the virus and experiencing more severe illness.

Those who have arthritis and develop flu-like symptoms should contact a doctor immediately, even if their symptoms seem mild. They will advise on the person’s arthritis treatment options and the next steps in COVID-19 diagnosis and treatment.