Coronavirus and JIA05 January 2021 Updated: 5 January Please click below for useful advice for child / teenage rheumatology patients about COVID-19 from CCAA, and the latest guidance from Paediatric Rheumatology and Ophthalmology. Latest guidance Updated: 20 March We have now created a dedicated section about Coronavirus so that you can view all the important and up-to-date information in one place! Visit NRAS Website Updated: 16 March Given the fast-moving pace of government announcements regarding Coronavirus, we have updated our statement as follows: It is completely understandable that people affected by autoimmune conditions like RA and JIA, whether they have the disease themselves or are a close family member of someone with inflammatory arthritis, are very concerned at the escalating pace of the impact of COVID-19 in the UK and the almost daily announcements coming from No. 10. What is Coronavirus? Coronaviruses are a common group of viruses known to infect both animals and humans. At the end of 2019 a new strain of coronavirus was identified as causing a cluster of pneumonia cases in Wuhan City, China. This has been referred to by various names including novel coronavirus, Wuhan coronavirus and SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). It causes a respiratory illness known as COVID-19 that most frequently consists of mild symptoms of cough, fever and shortness of breath. In a minority of cases, COVID-19 can lead to serious problems like pneumonia or even death. Key websites where you can get ‘official’ information Please refer to the following organisations’ guidance for further information on the outbreak and how to protect yourself. Please note that the advice about what to do may vary between the devolved nations. NHS 111 has an online coronavirus service that can tell you if you need medical help and advise you what to do: https://111.nhs.uk/service/covid-19 (available in England, Scotland, Northern Ireland and Wales)England: Public Health England has a blog on the virus which they are updating very regularly: https://publichealthmatters.blog.gov.uk/2020/01/23/wuhan-novel-coronavirus-what-you-need-to-know/Scotland: Health Protection Scotlandare updating their website with the latest news daily: https://www.hps.scot.nhs.uk/a-to-z-of-topics/covid-19Wales: Public Health Walesare updating their website with the latest news daily: https://phw.nhs.wales/topics/latest-information-on-novel-coronavirus-covid-19/Northern Ireland: Public Health Agencyare updating their website with the latest news daily: https://www.publichealth.hscni.net/ Other links: https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-publichttps://www.nhs.uk/conditions/coronavirus-covid-19/https://www.who.int/emergencies/diseases/novel-coronavirus-2019https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adultshttps://www.mind.org.uk/information-support/coronavirus-and-your-wellbeinghttps://www.sparn.scot.nhs.uk/wp-content/uploads/2020/03/20-03-24-COVID-patient-information-SPARN.pdf Are people with Rheumatoid Arthritis or children/young people/adults with Juvenile Idiopathic Arthritis at greater risk? A number of medications used by people with the above conditions have the potential to change the immune system; these include steroids (prednisolone), DMARDs (methotrexate, leflunomide, sulphasalazine etc.) and biologics/biosimilars (etanercept, adalimumab etc.) and JAK inhibitors (tofacitinib, baricitinib). From the evidence so far, there is no increased risk of catching coronavirus for those taking conventional DMARDs such as methotrexate, leflunomide, sulphasalazine or hydroxychloroquine. However, the advice of the British Society for Rheumatology, our Chief Medical Advisor, Professor Peter Taylor, MA, PhD, FRCP, FRCPE, (Professor of Musculoskeletal Sciences, University of Oxford) and other expert rheumatology sources, is to continue with these medications. Rheumatology patients on steroids, biologics or JAK inhibitors are likely to have a lowered immune resistance. However, poorly controlled rheumatic disease can also lower resistance to infection and as well as causing all the complications of rheumatoid arthritis or juvenile idiopathic arthritis. And it can be harmful to suddenly reduce the dose of steroid medication. Therefore, the advice of the expert rheumatology sources, is to continue with your medications unless otherwise directed by your healthcare team and take all sensible precautions to keep safe as in the section below, “What can I do to keep myself safe?”. If despite these measures, you should develop symptoms of infection, advice is given in the section below, “What to do if I feel unwell”. What can I do to keep myself safe? We recommend following the current government and Public Health England advice and taking precautions such as regular handwashing, covering your mouth and nose when coughing and sneezing, and avoiding close contact with people who are unwell. For those taking immunosuppression such as steroids, biologics/biosimilars or JAK inhibitors, we would suggest the extra precaution of avoiding crowded places such as public transport or large gatherings where possible. For people on these drugs, especially careful thought must be given to avoiding unnecessary travel or potential contact with infected individuals and observe all the current “preventative” measures including good hydration, adequate sleep and especially hand hygiene. There is no evidence that wearing a mask reduces the risk of transmission to unaffected individuals. What to do if you feel unwell If you have an underlying condition such as RA or JIA and feel unwell or notice any of the symptoms mentioned above, you should call NHS 111 and seek further advice on whether you need to be tested. If you are very unwell with fevers, as is the case with any infection, follow the practice you have been advised by your rheumatology team which would normally be to pause immunosuppressive therapy such as biologics/biosimilars or JAK inhibitors, except steroid, for the duration of the infection and until you feel well. It is very important not to stop steroids (prednisolone) abruptly as this could make you unwell. If possible, discuss details of your individual case with your GP or the Rheumatology team. Further information on what to do can be found here: https://www.nhs.uk/conditions/coronavirus-covid-19/ As per normal advice (with or without the threat of coronavirus), for people who are immunosuppressed, influenza and pneumococcal vaccines are recommended. If you have not had your annual flu vaccine we would recommend that you do so as soon as possible and this can be arranged via your GP or Pharmacist. People aged 65 and over only need a single pneumococcal vaccination. This vaccine is not given annually like the flu jab. People with a long-term health condition may need just a single one-off pneumococcal vaccination. For more information about vaccines, visit www.nras.org.uk/statement-about-flu-vaccines Travel In the event that you have to travel, either here or abroad, keep up to date with the latest advice from your travel company, your travel insurance provider and the Foreign Office: https://www.gov.uk/foreign-travel-advice Contacting NRAS As you might imagine, our helpline is receiving a huge amount of calls at the moment and to ensure that you get the information you need from us quickly, here are some tips: People who don’t have symptoms of the virus, haven’t come into contact with anyone and are otherwise well (apart from their RA/JIA) can get their questions answered by reading the information in this bulletin on our website and on the other official sources of government information listed here. We suggest they follow the information in this bulletin and take the same precautions as the general public and don’t need to stop taking their medications.Anyone who believes they have the virus or may have been in contact with someone who has the virus should follow the advice above, under ‘What do if you feel unwell). Advice from British Society for Rheumatology (BSR) to clinicians and health professionals: https://www.rheumatology.org.uk/News-Policy/Details/Covid19-Coronavirus-update-members It is important to recognise that the situation is changing all the time and we will regularly update this guidance as new information becomes available.