FAQs FOR PATIENTS DURING COVID-19

I AM FEELING FINE AND NO INFECTION BUT I’M NERVOUS TO LEAVE THE HOUSE. DO I KEEP MY RHEUMATOLOGY APPOINTMENT?

If you are not sick with infection (ex. cough, fever, difficulty breathing, or nausea/diarrhea), we recommend you come to your visit as scheduled. We also encourage you to stay on track with any in-office treatments (injections/infusions). Do not stop medications as precautions or skip necessary labs. Keeping your autoimmune condition well-controlled is even more important during a pandemic and stressful circumstances. Please wear a mask to your appointment.

WHAT NEW CHANGES CAN I EXPECT COMING TO CLINIC AT RCC?

RCC has updated the flow and uses universal precautions to keep you safer. Here are just a few changes:

  • WEAR A MASK TO YOUR APPOINTMENTS.
  • Check in and copayments may occur from the car. We also may permit a lower volume and safe distance in the waiting room due to the summer heat.
  • We have more private rooms and bigger spaces to spread out and reduce contacts at your visit.
  • Enhanced mask/gloves by doctors and staff. It is still very difficult to get PPE and hand sanitizer so WEAR your mask and carry hand sanitizer to your appointment.
  • Multiple, separate entrances for clinics, labs, and infusion visits.
  • Drivers and visitors need to wait in the car unless necessary for the visit. Don’t hesitate to explain if a visitor needs to accompany the patient.
  • Smaller volume of patients, visitors, or staff in the office with distanced work spaces.
  • The office and private rooms are disinfected frequently.

We are expecting social distancing and precautions to continue for months ahead, and RCC will continue to adjust to meet your rheumatologic needs and keep you safe at your visits.

ARE YOU OFFERING TELEMEDICINE INSTEAD OF CLINIC VISITS?

In some cases, a telemedicine visit (done by phone or video) is appropriate. If you are feeling well, don’t need labs or in office treatments, and have kept previous appointments, telemedicine may be a good option. We are expanding telemedicine to the patients who are unable to travel. Telemedicine appointments will be offered to these patients and may be requested where appropriate.

WITH COVID-19 RISKS AND MY IMMUNE SYSTEM, SHOULD I STOP/HOLD MY RHEUMATOLOGY MEDS?

  1. In general, stopping/holding your rheumatology medications without infection issues during this pandemic is not a good idea. Rheumatology patients face vulnerability to infections of all kinds throughout the year and need to consult with their Rheumatologist when they get sick or worry about the safety of their medications. Of note, these issues are not ending soon and require ongoing conversation at the visits. Discontinuing immune therapies may result in flare of your autoimmune disease.
  2. Keep in mind: all rheumatology patients and rheumatology meds are not the same! The rheumatology medications each have different risks to your health and are not the same in how they affect the immune system or the ability to fight infection.

The DMARDs (disease modifying antirheumatic drugs) such as methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine do not increase your risk for more severe infection or complicated infections. You are able to fight infection as well as before you started them. In fact, by staying consistent with your treatment, controlling your disease, and lowering the hectic immune disease activity, you are actually in better health (less inflammation, lower cardiovascular disease, better mobility, reduced pain/fatigue, healthier systemic effects on other organs, etc.).

The biologics/JAKs* for your arthritis are a higher risk than the traditional DMARDs for more severe infection or complications. While biologic/JAK patients may have a harder time recovering from infections, they do not necessarily get infections more often. In higher risk patients with underlying lung conditions, diabetes, cardiovascular disease, or who already struggled with infections prior to treatment, your risk could be even higher for serious complications. So why do we advise you to stay on your treatment if you are currently healthy?

The truth is that your odds of fighting infection are still in your favor. Most patients will recover and be able to fight off an infection. However, if you are sick, we recommend stopping your biologic/JAK to help your body heal faster and prevent complications. During infections, DMARDs can be safely continued.

*Biologics-Humira, Enbrel, Cimzia, Simponi, Simponi Aria, Cosentyx, Taltz, Tremfya, Skyrizi, Orencia, Actemra, Kevzara, Rituxan, Remicade, Stelara. JAKs-Xeljanz, Olumiant, Rinvoq

CAN YOU HELP ME PICK A SAFER ALTERNATIVE THAT DOES NOT LOWER MY IMMUNE SYSTEM DURING THIS TIME?

DMARDs and biologic/JAK therapies are the best treatment options for our rheumatologic patients. These medications are necessary to control your disease and have been carefully chosen at your visit. We will continue to evaluate the risks and benefits of your treatments during this pandemic. This is a shared decision by you and your rheumatologist to find the safest and most effective medication.

IMPORTANT FACT: Did you know prednisone 20mg and higher doses of steroids suppress the immune system and increase your risk for infection? Steroids, while we use them during flares and when other medications are not working, have many side-effects that may outweigh the benefits of staying on safer DMARDs/biologics/JAKs.

SINCE I MAY BE AT A HIGHER RISK FOR COMPLICATIONS FROM COVID-19 AND MY IMMUNE SYSTEM IS COMPROMISED, SHOULD I START/RESTART HYDROXYCHLOROQUINE?

Research is ongoing but hydroxychloroquine has not been proven to prevent or protect patients with COVID-19. Additional research is needed on hydroxychloroquine and our other rheumatic treatments and whether they could be helpful in COVID-19 treatment. To be very clear, however, there is no evidence that hydroxychloroquine reduces infection, complications, or prevents COVID-19. Hydroxychloroquine is not proven to change the outcomes for patients who are asymptomatic, experiencing mild disease or hospitalized with COVID-19.

It is well-established and proven that hydroxychloroquine is a life-saving and essential  treatment for Rheumatology patients. The shortage has led to a change in pharmacy dispensing but please call us if you have difficulty accessing your medication.

We are closely following the clinical trials for many of our medications being evaluated during the pandemic so we will be able to provide you with scientific answers. Also, we are keeping track of the emerging studies and registries specific to rheumatology patients.  For example, there is an international rheumatology patient registry collecting and sharing information with us through the  COVID-19 Global Rheumatology Alliance. Our hope is that there will be new discoveries, adequate research, and better access to rheumatic treatments accelerated by this viral crisis.

SHOULD I TAKE THE VACCINE IF I HAVE AN AUTOIMMUNE/RHEUMATIC CONDITION/IMMUNE SUPPRESSED?

The short answer is yes. Unless you have experienced serious allergic reactions to vaccines in the past, we recommend this vaccination for our patients. We also want you to know about its effectiveness, safety, and awareness from your trusted rheumatologist who knows your medical history so, whether it is a televisit or visit in person, please talk to us for the details. Be informed by your doctors.

As you know, on December 11 and 17th, the FDA granted emergency use for the Pfizer and Moderna vaccines. The vaccine is already being given here in the U.S. to highest risk groups, U.K., Canada, Saudi Arabia, and Mexico. Basically, U.S. medical experts determined the benefits for protecting people outweigh the risks and found the clinical trials showed a good balance of safety and effectiveness. We found the results of these clinical trials encouraging, reviewed the FDA’s comments, and we are getting to see real world experience as they are being given now. There is still more to learn but want you to feel comfortable taking the vaccine when it is available to you.

I DON’T WANT TO BE A GUINEA PIG FOR A RUSHED VACCINE

Even though this vaccine was approved in lightning fast time, this advanced vaccine technology comes after many years of research and development in SARs, mRNA, and lipids. For nearly a decade, scientists and doctors have been preparing for related viral vaccines and the components of this vaccine have been in the works due to worldwide infection control concerns. Collaboration of scientists, doctors, and big funding made it come together quickly.

The mRNA vaccination is NOT live and will not give you COVID-19. The mRNA coding teaches the body to recognize the virus spike protein without causing the disease. It tells your immune system how to mount a response that protects you from coronavirus infection. In order to get the best protection, you will need to take two shots three weeks apart. Whether you get the Pfizer or Moderna vaccine will have more to do with logistics and refrigerators but don’t worry, they are both safe and effective.

When you take the COVID-19 vaccine, there are signs your body is firing up an immune response. Common side effects include pain/stiffness at the injection site, fatigue, headache, muscle aches, and joint pain. These symptoms generally last a day or two.

COVID-19 risk, infection and its complications are far worse than any potential, rare vaccine side-effect. With the evidence we have to date, we feel confident recommending it as a safe and effective vaccine for our patients.

I’M NOT GOING TO TAKE THE VACCINE SINCE MY IMMUNE SYSTEM IS WEAKER

Like most vaccines, they first study them in healthy people and there are no definitive answers, yet, about patients with inflammatory diseases or taking immune therapies. It might take years to properly study rheumatologic conditions but that does not mean you should not take the vaccine.

Even though there needs to be more research, we have been making educated guesses about high risk groups for decades. For example, we have no reason to believe that these vaccines will be less safe and we know in vaccines like flu, pneumonia, and shingles, that our patients are better off taking these vaccines to prevent infection. Viruses and bacteria can be triggers for immune problems and flares in our patients. That’s why it’s even more important to Rheumatologists to prevent infections with vaccines. We worry that weaker immune systems, underlying medical conditions like high blood pressure, kidney disease, and obesity may actually make our patients a higher risk for complications from COVID infection. Right now, we believe where the threats of COVID may be higher to our patients, we want our patients to get vaccinated.

I’M READY TO TAKE IT BUT DON’T KNOW WHERE/WHEN TO GET THE VACCINE

Right now, healthcare workers who are at higher risk are getting the vaccines in Alabama, along with nursing home residents and workers.

Stay tuned to the local news on phasing, staging, and where to get the vaccine when Alabama gets more doses. We don’t know where to get it, yet.

RCC staff and physicians plan to take the vaccine when it is available to us but do not have allocation or designation to give it out. As soon as we know when and where our patients may take the vaccine, we will let you know.

Common side effects include pain/stiffness at the injection site, fatigue, headache, muscle aches, and joint pain. These symptoms generally last a day or two.

I’M SO TIRED OF ALL OF THIS AND READY TO GET BACK TO NORMAL LIFE AGAIN

It’s going to take some time to spread the word on the safety of vaccination, to get enough supplies out to everyone, and to protect one another so remember to wear your masks, wash your hands, and watch your distances/gatherings.