COVID-19 and arthritis

It’s not clear yet whether having arthritis makes you more susceptible. What we do know is that – much like seasonal flu – older adults and people with autoimmune disease like rheumatoid arthritis may be more likely to get seriously sick if they do become infected, so it’s important to take appropriate precautions. 

The main concern isn’t the virus itself, but secondary bacterial infection and other complications that may arise when your body’s defenses are in a weakened state.

Practice social distancing. When outside, make sure to avoid crowds and maintain a distance of 2 metres (6 feet) from those around you. 

Observe the following hygiene recommendations from Health Canada:

• Wash your hands often with soap and water for at least 20 seconds
• Avoid touching your eyes, nose or mouth, especially with unwashed hands
• Avoid close contact with people who are sick
• When coughing or sneezing:
  • cover your mouth and nose with your arm or tissues to reduce the spread of germs
  • immediately dispose of any tissues you have used into the garbage as soon as possible and wash your hands afterwards
• Clean and disinfect frequently touched objects and surfaces, such as toys, electronic devices and doorknobs
• Stay home if you are sick to avoid spreading illness to others

The routine wearing of masks by uninfected individuals is not encouraged.

Health Canada also suggests you think ahead and make a plan to ensure you have adequate supplies in case infection rates rise in the coming weeks or months.

The Canadian Rheumatology Association is also recommending you get your vaccinations updated when possible, including seasonal influenza, pneumococcal and pertussis vaccines. These vaccines won’t prevent COVID-19 but could lessen secondary infection and will prevent illnesses that could resemble it.

Some inflammatory arthritis medications suppress the immune system, which may make you more vulnerable to infection. For most Canadians there is no need to stop medications as the risk of contracting the virus is low. For some patients, however, your physician may advise you to stop certain medications in case of infection.

It is important that you do not make any changes to your medications without consulting your physician.

See the Canadian Rheumatology Association recommendations about medications. 

Many jurisdictions are beginning to implement new telehealth consultations for rheumatology patients during this time. So please follow your local developments closely. (See the provincial health ministry links under “Where can I get more information?”)

Symptoms of COVID-19 resemble a cold or flu, and may include a fever, cough, difficulty breathing, and pneumonia (in advanced cases).

If you are experiencing symptoms, phone ahead to your health care provider or public health authority and let them know: 

1. the symptoms you are experiencing,
2. any pre-existing conditions you are living with, and
3. any medications you are taking

…then follow their instructions.

If your symptoms are mild, you will probably be told to treat it like a cold or flu – isolate yourself, get rest and drink liquids. If your symptoms are moderate or severe, you will likely be sent to the hospital where they can monitor you for complications such as pneumonia.

In general, Health Canada advises the following steps if you are sick to help reduce contact with others:

• stay at home and self-isolate (unless directed to seek medical care)
  • if you must leave your home, wear a mask or cover your mouth and nose with tissues, and maintain a 2-metre distance from others
• avoid individuals in hospitals and long-term care centres, especially older adults and those with chronic conditions or compromised immune systems
• avoid having visitors to your home
• cover your mouth and nose with your arm when coughing and sneezing
• have supplies delivered to your home instead of running errands
  • supplies should be dropped off outside to ensure a 2-metre distance

Self-assessment tools

If you’re feeling unwell, first complete your provincial online COVID-19 self-assessment tool. Only if  you’re experiencing related symptoms, call your provincial health team, and they will provide the next steps.

• Alberta then call 811
• British Columbia then call 811
• Manitoba then call
  • Winnipeg 204-788-8200, 
  • Toll-free across Manitoba 1-888-315-9257
• Newfoundland & Labrador then call 811
• New Brunswick then call 811
• Northwest Territories then call 
  • Yellowknife: 867-767-9120, 
  • Inuvik: 867-490 –2225,
  • Fort Smith: 867-872-6219 or 867-872-6221,
  • Hay River: 867-874-7201
• Nova Scotia then call 811
• Ontario then call 1-866-797-0000
• Prince Edward Island then call 811
• Quebec then call 1-877-644-4545
• Saskatchewan then call 811
• Yukon then contact covid19info@gov.yk.ca

The advice is the same for both adults and children. Social distancing and public health measures should be followed for both adults and children. Encouraging your child to wash their hands and follow good personal hygiene, including avoiding touching their eyes, nose or mouth and covering their mouths and noses while coughing or sneezing, are good simple reminders. COVID-19 infection does seem to be milder in children than in adults or older individuals. It is still unclear whether children and youth with arthritis have a greater risk of COVID-19 infection, or if they risk more serious illness if they do become infected.

Many healthcare professionals are currently providing virtual care by telephone or internet when possible. Given the current strain on the health system, some non-urgent appointments may be postponed or rescheduled for a later time. If you have questions about your appointment, it is best to contact your healthcare provider’s office for further direction. Make sure to let them know if you are experiencing a fever, new/worsening cough, or if you’ve travelled outside of Canada in the past 14 days.

There is currently no publicly available scientific evidence to suggest that ibuprofen worsens the effects of the coronavirus. Patients who are using ibuprofen for other medical conditions are not being advised to stop. It is important to remember that you should not make any medication changes without consulting your physician.

Researchers around the world are actively investigating treatments for COVID-19 and trying to develop a vaccine. Another approach is to reduce the symptoms of the disease. Some medications used to treat inflammatory arthritis, like hydroxychloroquine, colchicine and tolicizumab, work by suppressing the body’s immune system. Drugs that blunt specific parts of the immune system are being tested to see whether they can prevent inflammation caused by COVID-19, which is a major complication in severe disease. These drugs are not being tested to directly treat the coronavirus infection, but to reduce the body’s overwhelming inflammatory response that occurs in certain infected individuals. While these drugs are currently approved for some indications like inflammatory arthritis, they are not approved for the treatment of COVID-19.

We know access to medications is critical for many people living with arthritis and understand that there are emerging concerns around drug supplies in certain provinces, such as Québec. We are actively monitoring the current situation and are working with stakeholders to ensure that arthritis patients have the most up to date information.

As a measure to protect drug supply, the Canadian Pharmacists Association released a statement stating that, as a temporary measure, pharmacists will limit prescriptions to a 30-day supply of prescription medications. We understand this may be a challenge for some patients and we are working to ensure patients are able to access their needed medications.

The Arthritis Society is committed to ensuring Canadians living with arthritis have the medications they need to manage and control their conditions. We are concerned with reports that some patients are experiencing challenges with accessing hydroxychloroquine. We understand the gravity of the COVID-19 pandemic and support efforts to find effective treatments. We strongly support the Canadian Rheumatology Association statement and stand ready to work with policy makers, regulators and industry to increase Canada’s supply. While we look to explore evidence-based treatments, it is vital that we also ensure patients who rely on this medication continue to have access to it.

In Quebec, INESSS has issued a directive that limits dispensing of hydroxychloroquine which will impact adults with RA and other auto-immune diseases. These are difficult times and we understand the important challenges we are facing. We are actively reaching out to government and other stakeholders to find a solution to avoid gaps in access for patients who require this medication. We are also continuing to monitor other provinces and will provide further updates.

To learn more about the wide range of financial support measures currently being implemented by the federal and provincial governments to best support Canadian communities, businesses, families and individuals who have been impacted by the COVID-19 pandemic, please visit:

• Canada’s COVID-19 Economic Response Plan for INDIVIDUALS & FAMILIES
• Canada’s COVID-19 Economic Response Plan for BUSINESSES

In addition to new supports being introduced as a result of COVID-19, you may also want to learn more about previously existing government and community supports.  

Specifically, to learn more about disability benefits programs offered at federal, provincial, and territorial levels of government, please visit the Government of Canada’s Disability Benefits site.

To learn more about community resources available in your specific community, please visit Canada 211, Canada’s primary source of information on government and community-based health and social services, at 211.ca, or call 2-1-1 from your phone (where service is available).

Health Canada: Information for Canadians
Canadian Rheumatology Association: Statement on COVID-19  
EULAR (European League Against Rheumatism): Guidance for patients with musculoskeletal disorders 
ACR (American College of Rheumatology): Message about COVID-19
Canadian Arthritis Patient Alliance: A collection of information resources for people with arthritis
Arthritis Consumer Experts: A collection of information resources for people with arthritis
Canadian Pharmacists Association: Statement on chloroquine and hydroxychloroquine (HCQ) 

For information about specific provinces:

Ontario
British Columbia
Manitoba
Saskatchewan
Alberta
Nova Scotia
Newfoundland and Labrador
New Brunswick
Nunavut
Prince Edward Island
Quebec

To minimize the spread of the virus, Arthritis Society offices across the country are closed and staff are temporarily working from home.

Similarly, we have cancelled all in-person workshops and events until late May 2020 at the earliest.