Please be aware that these recommendations are subject to change at any time; this a new disease and new research is constantly becoming available in our field. Many of our medications are in active study as methods to treat more severe cases of COVID. We will update these guidelines when new or contradictory studies are available.
Scenario 1: I am healthy and have no COVID exposures
Continue all your medication.
Yes, we want you to stay on your biologic (injection or infusion medications). We do not think that stretching the interval in between your medication is doing you any favors. If you have a flare, your biggest risk is starting prednisone. So, keep your disease controlled!
Prednisone use should be minimized and kept at lowest tolerable dose to reduce your risk. However, we do not want people to stop prednisone without a safe taper of drug.
Some misconceptions: NSAIDs can be used in COVID. There is nothing wrong with these drugs other than their already known side effects. If you are on an ACE inhibitor or an ARB (for your blood pressure or kidney), we want these to continue also.
Scenario 2: I am healthy but have an exposure to COVID (family member, someone I work with)
Continue your hydroxychloroquine (plaquenil), sulfasalazine, NSAID and same prednisone dose without adjustment.
There are no clear answers on whether to continue methotrexate or leflunomide in this scenario, so this is up to personal comfort.
You can continue your biologic medication if you are taking a TNF inhibitor (Humira, Enbrel, Cimzia, Simponi or Remicade), Orencia, Actemra, Kevzara, or a JAK inhibitor (Xeljanz, Rinvoq and Olumiant).
We are happy to talk on the phone to discuss your unique situation at any time! Do not start or stop any medications before contacting your rheumatologist.
Scenario 3: I have tested positive for COVID
Continue your hydroxychloroquine (plaquenil) and sulfasalazine.
You can continue NSAIDs provided you have no kidney problems or severe respiratory symptoms.
Again, do not discontinue your prednisone.
Discontinue your methotrexate and leflunomide.
You can remain on your TNF inhibitor, Orencia, Actemra, Kevzara or JAK inhibitors .
However, we do recommend holding Rituxan.
We are happy to talk to you about your clinical scenario any time. If you have a more severe case, we will want to talk to you about your medications. Please call the office!