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 the CAPA Medical Advisory Committee

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 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.

COVID-19 vaccine

What COVID-19 vaccines are available?

There are two currently approved COVID-19 vaccines approved for use in Canada at this time. There is the Moderna COVID-19 vaccine and the Pfizer-BioNTech COVID-19. Other vaccines are currently being studied in clinical trials or are under review by Health Canada to authorize their use in Canada. For more information on the COVID-19 vaccine in people with rheumatic diseases, you can refer to the CRA Position Statement on COVID-19 vaccination. The Society of Obstetricians and Gynecologists of Canada also provide guidance on the vaccination in pregnancy.

When will be able to get vaccinated?

In Canada, the roll out of the COVID-19 vaccine is being managed differently depending on what province or territory you live in. In addition, the National Advisory Committee on Immunization (NACI) issued recommendations on the currently approved COVID-19 vaccines that impact people taking immunosuppressing medications. We were concerned that this recommendation negatively affects our community and did not support patient decision making (please note the recommendations were updated on January 12). As a result, we wrote a letter to NACI and public health officials across Canada to express our concerns. We will continue to work with stakeholders to create resources for people living with rheumatic diseases, and to support research on vaccine safety.

Is the COVID-19 vaccine safe in people with rheumatic diseases?

Clinical trial results show that the COVID-19 vaccine is safe and effective. However, people with autoimmune rheumatic conditions were not included in the clinical trials so we don’t know how well these vaccines work in people with autoimmune rheumatic conditions. The Canadian Rheumatology Association (CRA), with input from the Canadian Arthritis Patient Alliance (CAPA) has developed a Decision Aid for the COVID-19 Vaccine in Patients with Autoimmune Rheumatic Diseases. It is designed to help you to decide with your healthcare provider which option works best for you. This Decision Aid is for an adult of age more than 18 years living with the following autoimmune diseases, including (but is not limited to):

– Juvenile Idiopathic Arthritis
– Ankylosing Spondylitis/spondyloarthritis
– Behcet’s disease
– Myositis
– Polymyalgia rheumatica
– Psoriatic arthritis
– Reactive arthritis
– Relapsing polychondritis
– Rheumatoid arthritis
– Scleroderma
– Sjogren’s syndrome
– Still’s disease
– Systemic lupus erythemathosus, and
– Vasculitis

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.

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?

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 similar but medication and has not typically used for treating SLE and RA for nearly 40 years. Recent research has shown that Hydroxychloroquine is not an effective treatment for COVID-19.

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

We are actively monitoring drug shortages experienced by people living with arthritis in Canada so please contact us directly or complete this short survey to let us know. We can ensure that Health Canada is aware of these issues and work to resolve them. Many arthritis medications are being tested to treat severe Covid-19.

To address your medication access issue, work closely with your pharmacist and take 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.

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. 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:

Indigenous communities

Are there any specific support or resources for Indigenous peoples?

Indigenous Services Canada has created a website with information specific to Indigenous communities. It includes information on confirmed COVID-19 cases in First Nations reserves, COVID-19 vaccine access in Indigenous communities, new financial support and changes and improvements to services for Indigenous peoples. You may find some additional helpful information with the following organizations:

This is not an exhaustive list and if you wish to add your organization’s resources to the list, please feel free to contact us.

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.

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: February 24, 2021