COVID-19 and Spondyloarthritis
In light of the COVID-19 pandemic outbreak, we are providing additional recommendations based on what we know about Coronavirus and Spondyloarthritis (SpA).
What we know about COVID-19 and how it acts in people with SpA is changing rapidly and these recommendations may change. We will do update these recommendations as new evidence emerges and will inform Canadians with SpA of changes through our mailing list, social media, and other channels. We also suggest you visit our website regularly for any updates.
Please note that these recommendations should supplement, but not replace the recommendations made by your doctor or your local public health authority. Please speak to your healthcare provider if you have any further questions and before making any changes to your medication regime.
WHAT IS COVID-19?
COVID-19 is a type of coronavirus that is infecting people around the world. Coronaviruses are very common, and typically cause coughs and colds. This form of coronavirus emerged in late 2019. In 80% of people infected, symptoms include mild cold or flu-like symptoms (fever, cough). In 20% of people infected, more serious respiratory symptoms (pneumonia) develop which might require hospitalization, the need for mechanical ventilation or might even result in death. Approximately 2-3% of cases with COVID-19 die, but the risk is highest in vulnerable people (see below). More information is available from the Centers for Disease Controls (CDC)
On March 11, 2020, the World Health Organization (WHO) assessed COVID-19 as a pandemic. This means it is infecting people around the world in a way that is difficult to control.
HOW DOES COVID-19 AFFECT PEOPLE WITH INFLAMMATORY AUTOIMMUNE DISEASE?
People with SpA who have risk factors, such as being over 70 years of age or having underlying medical conditions, (such as diabetes, cardiovascular disease) should follow the Health Canada guidance on taking extra measures to put distance between yourself and other people, including staying home as much as possible and avoiding crowds.
People with SpA who are not using immunosuppressive medications are currently believed to be at the same risk of infection and complications from COVID-19 as the general population.
Immunosuppressive and biologic medications include: Corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate, anti-TNF biologics, anti-IL17 biologics, anti-leukocyte migration biologics, and JAK inhibitor small molecules
If you are not taking immunosuppressive medications your risk of COVID-19 should be the same as the general population. We recommend following the guidance of the Public Health Agency of Canada (PHAC).
If you are on immunosuppressive medications, you may be at increased risk for infection and complications of COVID-19. People at higher risk also include older adults, people with an underlying medical condition (e.g., heart disease, hypertension, diabetes). Having a compromised immune system from a medical condition or treatment (immunosuppressive medications) may also be a risk factor.
The below guidance are for people in this group. More information on vulnerable populations are available on the PHAC website.
FOR SPA PATIENTS ON IMMUNOSUPPRESSIVE MEDICATIONS WE RECOMMEND:
Do not travel outside of Canada. Do not travel unless it’s essential. In addition, please see the travel advice provided by PHAC.
Practice “social distancing” to reduce the risk of transmission and large-scale population spread. This includes:
- Self-isolate as much as possible
- Avoid group settings, particularly larger groups >25 people.
- Keep a distance of 2 meters from the nearest person
- Avoid personal contact with others who are sick or not feeling well
- Do not shake hands, hug, or engage in physical contact with other people
- Practice good hand hygiene. Frequent and effective hand washing. Wash your hands with soap and water regularly after social contact, before meals, and often in between, or use hand sanitizer that contains at least 60% alcohol when soap and water is not available. Avoid touching your face. Cough into your sleeve.
- Continue your exercise regime at home or outdoors. Consider a walk or hike outside in the fresh air, away from others. Stay active with stretching, cardio, or yoga exercises at home. There are several great apps you can download.
- The routine wearing of masks by uninfected individuals is not encouraged. The use of masks may give patients a false sense of security and lessen other protective measures.
DO NOT CHANGE YOUR MEDICATIONS WITHOUT CONSULTING YOUR DOCTOR FIRST
People with SpA may be at greater risk of developing infections. This can result when the immune system focuses on attacking you own body (an autoimmune disease) rather than an outside threat like a virus. Further, our defences can be altered by medications for SpA which may also suppress the immune system. Do not discontinue taking medications unless recommended to do so by your medical health care practitioner. If you develop an infection of any kind, promptly discuss with your doctor whether to stop or hold your medications
Most people are taking medications that may include biologics (originator brand/biosimilar), targeted small molecule therapies such as JAK inhibitors, steroids and conventional disease modifying anti-rheumatic drugs (DMARDs), such as methotrexate. These medications are essential for controlling SpA. Stopping these medicines may result in a flare-up of your disease so first discuss with your doctor any change in your treatments.
If your biologic infusion or injection must be delayed because you have an infection or because you are on isolation precautions related to COVID-19, contact your physician to reschedule your treatments.
CLINIC VISITS AND TESTS
If you have a scheduled visit with your physician, contact the office to discuss their current practice. Some physicians are conducting patient assessments by phone or by video-telemedicine.
TESTING FOR COVID-19
If you are worried you may have COVID-19 speak to your healthcare provider or local public health authority for advice. Be sure to tell your local public health authority if you are on immunosuppressant medications.
ARE THERE ANY MEDICATIONS TO TREAT COVID-19?
There are currently no medications beyond supportive care recommended for Coronavirus. Testing of potential therapies is underway in the U.S., Japan, and China, and work to develop a vaccine is also moving forward rapidly. However, it is not known when these will be available.
Our colleagues at the Arthritis Consumer Experts have developed an information Facts and Myths article. Check it out here:https://jointhealth.org/programs-jhexpress-view.cfm?id=2224&locale=en-CA
WHERE TO FIND ADDITIONAL EVIDENCE BASED INFORMATION ON COVID-19
· Health Canada: Coronavirus (COVID-19)
· World Health Organization: Coronavirus disease (COVID-19) outbreak
· European League Against Rheumatism (EULAR): EULAR Guidance for patients COVID-19 outbreak
· The College of Family Physicians of Canada: COVID-19 Information and Resources
· Canadian Pharmacists Association: COVID-19 – Information for Pharmacists
We will continue to provide updates as necessary and available. If you have additional questions, email them to [email protected] and we will do our best to find the answers. Please note that our medical advisors are not able to response to questions specific to your condition. Only your physician would know the best advice to give you.