People with autoimmune disorders, such as rheumatoid arthritis (RA), may be more likely to experience infections. Therefore, those with RA who develop COVID-19 may be at higher risk for developing severe symptoms and additional complications.
The FDA have removed the Emergency Use Authorization (EUA) for hydroxychloroquine and chloroquine for the treatment of COVID-19. Based on a review of the latest research, the FDA determined that these drugs are not likely to be an effective treatment for COVID-19 and that the risks of using them for this purpose might outweigh any benefits.
Treatment options for RA may also affect the immune system, increasing the risk further. However, in most cases, doctors do not recommend abruptly stopping any treatments for RA, as this may lead to a flare.
The best way to reduce the risk of developing COVID-19 is by staying home (shelter-in-place), and maintaining consistent infection prevention habits to inhibit the transmission of SARS-CoV-2, the virus that causes the disease.
Keep reading to learn more about how COVID-19 may affect a person with RA, including what current research says, the risks, and the precautions people should take.
Rheumatoid arthritis is an autoimmune condition in which the immune system attacks the lining of the joints. Autoimmune conditions, such as RA, compromise the immune system, in varying degrees of severity.
The World Health Organization (WHO) and other expert bodies are still investigating the impact of the novel coronavirus on people with preexisting conditions.
Some research published in Autoimmunity Reviews suggests that people with RA have an increased risk of contracting the virus due to their impaired immune system. Factors that can affect the vulnerability of someone with RA include medication, age, and other health conditions.
Treatments for RA, including corticosteroids and drugs that modify or suppress the immune system, may increase the risk of infection.
The British Society for Rheumatology created a risk scoring guide chart to clarify the potential level of risk that someone with RA may be at.
According to the COVID-19 Global Rheumatology Alliance Global Registry, which supplies live-time information regarding rheumatic diseases and COVID-19, people with RA may be at higher risk for infection and developing severe symptoms.
This may be truer for people with very high disease activity, people who have trouble controlling their symptoms, or those with other health conditions.
A person with RA who also has other risk factors, such as being over 65, living in a long-term care facility, or having another medical condition, may be at a higher risk for severe illness.
Additionally, people with RA who take certain drugs, such as immunosuppressant drugs, to control symptoms may be more at risk for infections or complications from those infections.
However, people should not stop, change the dosage of, or take a new medication or supplement without contacting their doctor.
Currently, there is not much formal evidence connecting COVID-19 and RA.
The Centers for Disease Control and Prevention (CDC) state that the most common symptoms of COVID-19 include a fever, a dry cough, and shortness of breath. These symptoms may appear 2-14 days after infection.
A report from the WHO also notes that other symptoms may include:
- extra mucus production
- a sore throat
- severe headache
- nausea or vomiting
- nasal congestion
The CDC also include the loss of taste and smell as a symptom of COVID-19
In some cases, a COVID-19 infection can cause aches and pains in the joints. This pain may mimic the pain of RA or make RA seem worse.
Additionally, people who are at risk should pay especially close attention to the emergency warning signs of a COVID-19 infection.
According to the CDC, emergency warning signs include:
- difficulty breathing
- constant pressure or pain in the chest
- New sensations of confusion or an inability to arouse
- A bluish hue in the skin of the face or lips
Anyone experiencing the emergency signs of COVID-19 infection should seek medical attention immediately.
People with RA should take extra care to prevent their exposure to SARS-CoV-2.
In general, the CDC recommend that people who are at higher risk of severe illness should stay home and avoid close contact with others.
Several general practices can also help to reduce the spread of the virus. General prevention tips include:
- staying home whenever possible
- washing the hands regularly with warm water and soap, lathering for at least 20 seconds
- coating the hands in an alcohol-based sanitizer when soap is not available
- regularly disinfecting frequently used surfaces, such as countertops, keyboards, and phones
- practicing physical distancing if a person needs to go out, staying at least 6 feet away from others while in public, and wearing a mask
- avoiding contact with people who are sick in any way
- keeping supplies of food and medication to hand so the person has access to them if they need to quarantine
- avoiding public areas, such as public restrooms and public transportation
- avoiding all non-essential travel
Additionally, the CDC now recommend that people wear cloth masks while in public as an additional step to slow the spread of the virus.
People with RA should take steps to ensure they have access to their medicines.
Anyone who relies on drugs, such as hydroxychloroquine, to treat RA should talk to their doctor or pharmacist about ensuring their access to treatment.
People with RA should not slow or stop any treatments they are taking without their doctor’s permission. This includes medication s that may suppress the immune system, such as biologics or DMARDs.
Stopping taking a medication may cause a flare-up, which can put more stress on the body. However, sometimes a doctor may recommend that a person takes reduced doses of immunosuppressant medication and lengthens the intervals between infusions.
Some people have voiced concerns over the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to control symptoms.
However, the Arthritis Foundation note that there is no clear evidence that using NSAIDs will increase a person’s risk of developing COVID-19 or that they will experience more significant adverse effects from the disease should they contract it.
People who rely on any of these medications to manage RA should talk to their doctor to asses their specific risks.
There is currently no direct treatment for COVID-19. Treatment will largely vary on the severity of the illness and the symptoms a person has.
People who only experience mild to moderate symptoms may be able to manage the illness in their homes. However, people must work closely with their doctors to monitor symptoms and potential treatments.
People with severe symptoms may require hospitalization to treat symptoms and complications. Treatments will vary in each case based on the complications.
Some people with severe complications may require oxygen supplementation to help them get enough oxygen into their lungs. Others may require mechanical respiration if their lungs begin to fail.
Anyone who tests positive for SARS-Cov2 should work closely with their doctor to discuss and implement any treatments necessary to manage symptoms.
A public health professional may also assist in tracing others they have been in contact with. This is known as contact-tracing.
A person who tests positive for the novel coronavirus should self-isolate. This means staying at home.
Ideally, a person with COVID-19 should self-isolate in a room away from other family members, using a separate bathroom if possible.
A person can leave the house to collect medicines if no one else can do it for them. Wear a mask, especially when leaving home.
A large report from the WHO notes that approximately 80% of confirmed COVID-19 cases experience mild to moderate symptoms.
These infections may clear up at home, using over-the-counter or prescription drugs to manage symptoms.
People who experience moderate to severe infections may require hospitalization. Treatments may include oxygen supplementation to keep enough oxygen in the lungs.
In critically severe cases, the person may need mechanical ventilation to keep oxygen in the lungs.
In the most severe cases, a person may experience organ failure and shock that could be life-threatening.
Experts are not entirely certain how COVID-19 affects people with RA. There is not enough evidence to confirm a link between the two at this point.
In general, people with autoimmune conditions, such as RA, are at a higher risk of contracting infections, including SARS-CoV-2.
People with RA should take extra steps to avoid contracting and spreading the virus.
Doctors may recommend a person with RA have at least a 90-day supply of their medications on hand, to ensure they have access to their medication if they need to stay in quarantine. Do not stop taking any medication unless directed to do so by a doctor.
General preventive practices are important for all and can help reduce the spread of the infection.
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