As it is known, we, together with the whole world, are struggling against the coronavirus (covid-19) epidemic. Chronic patients are particularly at risk for this disease. These patient groups are chronic cardiovascular patients, severe hypertension, diabetes, chronic lung patients, cancer patients receiving chemotherapy, and rheumatology patients receiving immunosuppressants.
Rheumatological diseases are of course very diverse, and the drugs and drug combinations taken by the patients depend on the severity of the disease. It can be very different. Those who suffer from vasculitis and take chemotherapy drugs such as cyclophosphamide, which suppress the immune system, and high doses of cortisone, or those who take biological agents and have another concomitant disease constitute the highest risk group. These patients constitute a very small portion of rheumatological patients. Most of the patients with rheumatoid arthritis and ankylosing spondylitis, which we encounter most frequently, generally do not need this type of medication or use low doses. Since Covid 19 is a new disease, there is not yet enough information about drug use strategies in rheumatological patients. I am stating the recommendations of the British Association of Rheumatology and the European Association of Rheumatology in the following lines.
It is emphasized that rheumatology patients, like all individuals, should strictly comply with all necessary measures to protect themselves from Covid 19. For this purpose, routine doctor checks, which are generally every 3 months, should be spaced out. Instead of going to the hospital, which is a potential source of disease, a doctor can be contacted by phone from home. Except for critically ill patients, blood checks may be delayed. If necessary, blood can be taken at home without leaving the patient. Particular attention should be paid to those taking chemotherapy drugs such as cyclophosphamide, biological agents, and high doses of cortisone. Currently, there is no common opinion on stopping or reducing medications. However, in case of disease or suspicion of disease, cortisone should be gradually reduced and discontinued, and biological agents and other immunosuppressive drugs should also be discontinued. Patients using hydroxychloroquine (plaquenil), one of the drugs we call DMARDs, do not need to stop the drug if they are Covid +. Because this drug is already used in the treatment of this disease (conduct the treatment here The doctor's opinion is also important). Likewise, in case of illness, the patient can continue to use salazopryn. Methotrexate and leflunamide should be discontinued in case of illness.
What I can say as an extra suggestion is that although there is no recommendation to reduce the dose of medication used in Covid 19 negative patients, I think it would be beneficial for patients under control to reduce the dosage of the medication they take by consulting with their doctor. Those who use biological agents can space out the periods of use of the drug (by talking to their doctor). As a result, even if medications are stopped completely, except for very active patients, it may take several months for the disease to appear. Since the pandemic will subside in a few months, patients can get through this period more safely. In patients using more than one medication, one of the medications can be discontinued. However, interfering with this treatment is not something that the rheumatology patient can decide on his own; he must consult his doctor.
I wish a speedy recovery to everyone, I hope that we, as a country and as a world, will emerge from this epidemic with the least damage.
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