Arthritis and COVID19 – a conversation with rheumatologist Dr. Janet Pope

In this video, CAPA Steering Committee member, Michael Kuluva (@MichaelKuluva), has a conversation with #rheumatologist Dr. Janet Pope (@janetbirdope) about living with #arthritis during #COVID19.

CAPA and COVID-19

All CAPA Board members live with different types of rheumatic disease and we know the COVID-19 pandemic is causing a lot of stress and anxiety for our community. To help, we have developed a list of evidence-based resources so you can stay up to date on the latest news and find answers to your questions. We will be updating this information regularly as the situation changes. If you have any questions about your personal health situation, please contact your rheumatologist or other healthcare provider.

Content has been reviewed by: Dr. Carter Thorne, senior rheumatology consultant

What is COVID-19?

The World Health Organization has developed a video that explains COVID-19, how it is transmitted and signs and symptoms of the disease.

How can I protect myself?

We have recently developed a video with Dr. Janet Pope about living with arthritis during COVID-19. It includes information on medications, going outside, what to do if you have a flare, and taking care of yourself.

Physical distancing is important especially to people with compromised immune systems. As many of you know, many people living with inflammatory arthritis (e.g. Rheumatoid Arthritis, Psoriatic Arthritis) take medications that suppress their immune systems. Physical distancing means reducing close contact with people including:

  • avoiding non-essential gatherings
  • avoiding common greetings, such as handshakes
  • keeping a distance of at least 2 arms lengths (approximately 2 metres) from others

In some provinces, such as New Brunswick and Newfoundland and Labrador, the guidelines for physical distancing have been updated as the number of COVID-19 cases drops. For more information, visit the website for your province or territory of residence.

Medications

I lost my job and access to my health benefits. How will I pay for my medications?

If you have lost your job and access to private insurance that reimburses the cost of prescription medications, you might be eligible for the public drug program in your province. To help you navigate these programs, we have developed a resource that provides basic information on public drug plans including who qualifies for the program, what is the deductible, premium and co payment, and where to find additional information.

Can I refill my medications?

Insurance often limits how often medications can be reimbursed. In addition to these usual restrictions, many provinces are only allowing pharmacists to dispense a thirty day of supply of medications following recommendations from the Canadian Pharmacists Association The restrictions are being slowly reduced in some provinces (e.g. New Brunswick, Saskatchewan) but it is up to each province to make this decision. Talk to your pharmacist if you wish to request additional medication.

I’m worried about getting enough of my medications to get through the pandemic. Have there been any changes to how public drug plans manage medication renewals to make it easier for me?

Controlled substances, such as opioids used for treating chronic pain, are typically only allowed to be refilled once a minimum time has elapsed. To allow people to self-isolate safely while keeping access to pain medications, Health Canada has allowed pharmacists to extend prescriptions of these controlled substances as well as issue verbal orders (i.e. over the phone) to extend or refill a prescription. Pharmacists can also transfer prescriptions of controlled substances to other pharmacists and pharmacy employees can deliver prescriptions of controlled substances to a patient’s home or other location where they may be.

Several changes have also been made to public drug plans in response to the COVID-19 pandemic. The Canadian Skin Patient Alliance has compiled a list of changes to federal and provincial drug programs. This resource can help you determine whether there are any changes in processes such as special approval extensions, drug dispensing limits, co-payments, emergency drug refills, and more.

Can I continue taking Non-Steroidal Anti-Inflammatory Drugs (NSAID’s)?

Based on currently available information, the World Health Organization and Health Canada say that there is not enough scientific evidence that Ibuprofen worsens COVID-19 symptoms. Health Canada has recently stated that there is no scientific evidence that establishes a link between ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDS), and the worsening of COVID-19 symptoms.

According to the Canadian Paediatric Society, Ibuprofen can also continue to be taken by children to treat children with COVID-19 infection.

I take Hydroxychloroquine (Plaquenil) for Systemic Lupus Erythematosus or Rheumatoid Arthritis. Are Hydroxychloroquine and Chloroquine the same medication? Is it safe to keep taking Hydroxychloroquine?

The media and government officials across the world have been reporting that Hydroxychloroquine (Plaquenil) may be a possible treatment for COVID-19. Hydroxychloroquine is used to treat Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) and is prescribed at 200 mg once per day or 200 mg twice per day. At these doses, Hydroxychloroquine is generally well tolerated by patients. Chloroquine is a different medication and is not typically used for treating SLE and RA.

I’m worried about accessing Hydroxychloroquine (Plaquenil) since it could be used to treat COVID-19. What should I do?

Since Hydroxychloroquine is showing potential to treat people with COVID-19, there could be an increased demand for the medication. The government and healthcare professional associations in certain provinces, such as Ontario and Nova Scotia, recognize that people with SLE and RA need access to Hydroxychloroquine and are taking steps to ensure there is enough supply. Currently, most government and health care professional organizations support the use of Hydroxychloroquine only for clinical trials as there is not enough evidence to recommend its routine use for COVID-19.

Read a joint letter to the Minister of Health regarding access to hydroxychloroquine (Plaquenil) sent on April 5, 2020.

As a precaution, you can take several steps to manage medication supply:

  • Contact your pharmacy for refills well before you run out of medication. Try to request your refill as early as possible to give more time for your pharmacist.
  • Be sure to tell your pharmacist the reason you are taking the medication. Some places give pharmacists the discretion to decide which prescriptions to prioritize.
  • If the drug is not available at the pharmacy, ask the pharmacist for help in finding other nearby pharmacies who may have some of the medication on hand. If you can’t find any at nearby pharmacies, contact your doctor.
  • If your pharmacy can’t fill your prescription due to limited supply, ask if you be contacted as soon as new medication comes in.

I live in Quebec and the pharmacy would not dispense Hydroxychloroquine. Why is that?

The Institut national d’excellence en santé et en services sociaux (INESS) has now cancelled the a directive to limit the distribution of Hydroxychloroquine. Pharmacies should now be dispensing this medication to people living with all forms of rheumatic diseases Please contact us directly should you have any difficult in refilling medications.

I can’t access my medications at the pharmacy. What should I do?

Work closely with your pharmacist and try taking these steps:

  • ask for help in finding other nearby pharmacies who may have some of the medication on hand. If you can’t find any at nearby pharmacies, contact your doctor.
  • If your pharmacy can’t fill your prescription due to limited supply, ask if you be contacted as soon as new medication comes in.

Together with the Canadian Spondylitis Association, we are teaming up to better understand any issues Canadians living with inflammatory arthritis conditions are experiencing accessing medications and services. Please complete this short survey that will help us share your lived experiences with Health Canada and health ministers.

Work

I work in an essential services job and I’m worried about exposure to the virus. Since I’m taking medications that suppress my immune system, what can I do?

The decision to advise an employer of the risk of severe outcomes if you contract coronavirus is personal and considers a number of factors like trust and the existing relationship (for more specific advice on disclosing information about arthritis, refer to page 3 of our “Knowing your Workplace Rights” resource). If you feel comfortable speaking with your manager, advise them of the higher risk and discuss what steps can be taken to protect your health. Some options include taking extra precautions in the workplace such as reducing social contact and/or using an alternative work arrangement like teleworking. You may find our workplace resource on “Adapting your Work Environment” helpful.

Access to healthcare

I have an appointment with my rheumatologist coming up soon. Do I need to go physically into the office?

We understand that some doctors are offering telephone or video-based visits to patients. In addition, some provinces are offering reimbursement of telephone visits or waiving the costs of video-based medical appointments. Please speak with your rheumatologist for more information.

Will my infusion appointment go ahead as scheduled?

We have heard some situations where regularly scheduled infusions may not go ahead as scheduled. In some cases, there may be an alternative like moving to a self-injectable medication, if one is available. Contact the patient support program or your rheumatologist to confirm the infusion appointment is going ahead as planned and see if alternative arrangements need to be made.

Parenting

The schools and daycares are closed. How can I keep my children busy?

Many schools, daycares and outings have been cancelled during the pandemic. Join the Mamas Facing Forward Facebook group to share tips on how to entertain children at home. There is a list of quiet activities to do with children on the Mamas Facing Forward website, including:

Staying healthy

How can I manage stress and anxiety?

The WHO has developed an infographic that provides tips on managing stress during the pandemic. Advice includes:

  • Talking with someone you trust
  • Maintaining a healthy lifestyle as much as possible
  • Getting the facts
  • Lessen time watching or listening to media coverage

How can I stay active when I cannot follow my usual exercise routine?

Some organizations are offering gentle exercise programs through webinars or videos that you can enjoy at home. Pain BC is offering Gentle Movement @ Home, a training course that was developed by physiotherapist Neil Pearson who is one of Canada’s leading experts on movement and chronic pain. You can sign up for the sessions on the Pain BC website. In addition, Arthritis Consumer Experts has developed the Arthritis at Home program which provides 10-15 minute videos from various arthritis clinical, research and patient experts from across Canada.

Advocacy

How can I get involved?

Advocate from the comfort of your living room by signing this open letter from Creaky Joints. It highlights the challenges Coronavirus among the immunocompromised, chronically ill and/or disabled.

There is a lot discussion on social media and follow these hashtags to stay up to date:

#COVID19highrisk
#flattenthecurve
#physicaldistancing
#StayHomeSaveLives
#coronavirus

We are also contributing to an international research effort to create a COVID-19 global rheumatology registry – we will keep our community updated and there may be opportunities to contribute soon!

Want to learn more?

Additional information is available from rheumatology associations, patient groups, health charities and public health organizations – please see below for a compilation of resources.

Guidance from rheumatology associations

Guidance from patient groups and health charities

Federal and global public health information

 

SOURCE: Canadian Arthritis Patient Alliance (www.arthritispatient.ca)

Updated: May 24, 2020