This text was written to clarify the potential relationship between Chronic Rheumatism patients and Coronavirus COVID-19, and especially to inform about the use of rheumatism medications in this case.
Since the first Coronavirus started in our country, one of the most frequently asked questions to our Rheumatology Clinic is the question "Should medications be stopped or reduced as a precaution?".
As it is known, the inflammatory rheumatism of many of our patients has been defined as a "Chronic Disease". In addition, most of these patients use "immunosuppressive" drugs that suppress the immune system. Generally speaking, patients with this type of chronic rheumatism, especially those using cortisone and/or immunosuppressive drugs, are considered at risk for infection and are exposed to many possible infections. However, during this Corona Virus epidemic, it is not right to consider all rheumatism medications as risky and stop taking them without consulting your doctor. The doctor knows which rheumatism medication to stop or not, and this decision may differ from person to person. In general, the Rheumatologist makes a "personalized" decision, taking into account all the risk factors of each patient.
Frankly, whether or not to stop rheumatism medications during this “Corona Virus Pandemic” is like a double-edged sword. Both sides can be dangerous. This decision is made by the Rheumatologist by performing a risk analysis of the patient. Not every rheumatism drug is an "immunosuppressive" drug that suppresses the immune system, and not every patient is considered at risk. For example, since drugs containing the active ingredient Hydroxychloroquine, Salicylazosulfapyridine and Colchicine do not suppress the immune system, it is not necessary to stop or reduce the dose. Some rheumatism patients may be at higher risk than other rheumatism patients. Even if they have the same diagnosis, the risk of a patient with inflammatory rheumatism for more than 10 years cannot be the same as the risk of a patient with rheumatism for 6 months. Because it is necessary to calculate the cumulative damage of the disease and chronic drug use.
The presence of a chronic autoimmune disease/inflammatory joint rheumatism and the use of chronic immunosuppressive drug (or drugs) are considered risky in themselves. Separate Other risk factors that increase the chance of contracting Corona Virus COVID-19 have also been noted. The most important of these is being over the age of 65. In addition, concurrent diseases such as Chronic Kidney Failure, COPD and similar Chronic Lung Disease, Diabetes, Chronic Heart Diseases or Chronic High Blood Pressure (hypertension) are comorbidities that increase the risk of contracting Coronavirus. Active smoking is also considered a significant risk.
Therefore, one of the risk factors mentioned above and the presence of chronic rheumatic disease, especially patients using chronic cortisone and/or chronic immune-suppressing rheumatism drugs, are considered the highest risk group. It is important to identify this group of patients because a risk assessment can be made for this group of patients and a risk-reducing intervention such as medication reduction/cessation can be performed. If the chronic rheumatism of these patients is under control in "silent mode" (especially if they have not experienced a rheumatism attack for more than 6 months), this patient is considered "in remission". If a Rheumatism patient in the High Risk patient group is in Remission, his/her medications can be adjusted to less suppress the patient's immune system. For example, it may be possible to reduce the dose of drugs containing the active ingredients cortisone, methotrexate, leflunomide and azathioprine or even discontinue them completely for up to 6 weeks. The doctor can determine its suitability. Of course, if the patient has been using cortisone for a long time, he should not stop it suddenly. However, other medications may be interrupted suddenly.
Looking at the other side of the coin, since some patients' chronic rheumatism is known to be more severe or resistant to treatment, they use stronger (and more effective) drugs (or injections/serum), which we call Biological Agents, and these drugs are more dangerous if they are stopped. A pattern may also emerge. If chronic rheumatism patients stop taking effective Biological Agents or similar "new generation" drugs, their disease may recur, arouse rheumatism, and cause internal organ damage. Such a recurrence (or recurrence) can put a strain on the immune system, increase the body's level of inflammation and inflammation, and may also expose the immune system to infections. Therefore, at this stage, the Chorus During the coronavirus epidemic, Turkish, American and European Rheumatology Associations do not recommend stopping such "Biological" drugs because there is no information yet that the Coronavirus COVID-19 infection is more severe in patients taking these drugs. We should not forget that these types of drugs, especially Biological Agent drugs such as anti-TNF, have been used with viral carriers such as HIV and Hepatitis C.
As a matter of fact, our Rheumatism patients should generally not give up their Biological Agents. However, when there are signs of infection, we stop the Biological Agent and some other rheumatism medications during active infection, as in every infection. In case of suspected or proven COVID-19 infection, when there is fever and/or severe shortness of breath, immunosuppressive drugs should be stopped and a specialist should be contacted immediately. Chronic Rheumatism patients COVID-19 Coronavirus symptoms are generally the same as other patients, for example, high fever, dry cough, loss of smell, flu symptoms, weakness and shortness of breath are the main symptoms. However, we must remember that some of the rheumatism patients, due to the immunosuppressive medication they use, are the most common symptom of Coronavirus; High fever may not appear or may appear late. It is useful to remind this point as well. If the patient has other symptoms without fever or has any doubts, it is recommended that they call their doctor and the Ministry of Health Coronavirus Advisory Line ALO 184.
As a result, the decision to continue taking rheumatism medications should be made, taking into account the possible benefits and risks. This decision should not be made unilaterally by the patient, but in consultation with his doctor. In order to evaluate and discuss this decision, it is recommended to talk to the doctor by phone or a similar "on-line teleconference meeting" method without leaving home. The most important protection method for chronic rheumatism patients is to stay away from the virus, and until the epidemic is over or until a vaccine/anti-viral drug is released, the best method to reduce the possibility of contamination is still to stay at home.
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