Coronavirus and Arthritis: What You Need to Know
Please check back regularly. We will stay in touch with the top experts and give you updates on this quick moving story, with a focus on what people with suppressed immune systems need to know.
Updated March 26
Q: What’s a coronavirus?
Q: How does it spread?
It’s unlikely this virus can survive on hard surfaces very long, though it’s not clear how long, says Timothy Brewer, MD, a professor of epidemiology at the University of California, Los Angeles. Preliminary research is showing it's a matter of days, not hours. That is why it’s so important to wash hands frequently and thoroughly and not touch your face, as well as keep surfaces clean. Isopropyl alcohol, hydrogen peroxide and bleach can all effectively kill surface viruses in about a minute. Soap and water as well as disinfectants like Lysol also do the trick, though not quite as well.
CDC provides guidance for how to disinfect surfaces.
Q: How contagious is it?
But the data that goes into that calculation keeps changing, and there are various ways to do the calculation, which means right now there is no one agreed upon answer. However, a February 2020 review in the Journal of Travel Medicine found that overall, most scientists’ estimates are hovering roughly around a 3 R0, with some being higher and some lower. That means one person can infect three others, a transmission rate far higher than the seasonal flu, with significant consequences. The number of people infected grows exponentially. The 3 R0 will likely change as more reliable data is gathered, and lead to greater consensus.
Until then, best advice is still thorough and frequent handwashing and social distancing. See below for more guidance on infection prevention.
Q: How deadly is the virus?
Q: Who’s at risk for serious COVID illness or complications?
The CDC website goes on to say: "If you are at increased risk for COVID-19 complications due to age or because you have a severe underlying medical condition, it is especially important for you to take actions to reduce your risk of exposure." It recommends, if COVID-19 is spreading in your community, taking extra measures to put distance between yourself and other people, including staying home as much as possible and avoiding crowds, especially in poorly ventilated spaces.
We asked Michael George, MD, a rheumatologist and epidemiologist who studies infections in patients with autoimmune disease, who should follow this guidance. He says it particularly applies to those with more severe disease or who have been hospitalized in the past with a respiratory infection or have interstitial lung disease, COPD or asthma, for example. Those with more mild disease may want to ask their doctor for guidance.
People with osteoarthritis, or non-autoimmune types of arthritis, who have risk factors, such as age (over 60 years) or severe underlying medical condition should follow the CDC guidance on crowd avoidance, too. And, Dr. George adds, “everyone should follow the general precautions,” such as handwashing, not touching your face, eyes, nose or mouth
Infection Risk and Prevention
Q: Am I more likely to catch COVID-19 if I have autoimmune or inflammatory arthritis?
For COVID-19 and seasonal flu, we do know that older adults and those with pre-existing health problems – especially cardiovascular disease, diabetes and high blood pressure – and those who have been hospitalized before with infections are most at risk.
The experts emphasize that one of the main concerns for people with autoimmune disease who contract seasonal flu or COVID-19 is secondary bacterial infection, or complications, that may follow the original viral infection.
For these reasons, it’s important to call your doctor right away if you think you’ve been exposed or are experiencing flu-like symptoms. Be sure to state that you are taking immune-suppressing drugs. (Read more below on immunosuppressant drugs and risk.)
Q: How can I protect myself?
- Avoid crowded places. The CDC suggests that older people – over 60 years old – and those with severe chronic medical conditions avoid going to places where there are a lot of people. This means avoiding movie theaters, busy shopping malls, travel on planes, public transportation and church. If your workplace or commute involve passing through or being with lots of people, ask about telecommuting, if possible.
- Wash your hands. We can’t stress this enough. Wet your hands with clean, running water, then lather them with soap. Scrub both sides, between your fingers and under your nails for at least 20 seconds – about as long as it takes to sing the alphabet song twice. Be thorough, and follow the WHO technique.
- Use hand sanitizers on the go. Don’t rely on them, but when soap and water aren’t an option, use a hand sanitizer that contains at least 60% alcohol. Keep a bottle in the car, at your desk and in your purse or pocket.
- Disinfect surfaces regularly. Clean high-touch surfaces like countertops, light switches, doorknobs and the inside of your car with disinfectant. Use a mixture of 60% isopropyl alcohol and 40% water to kill germs on high-touch objects and surfaces, like your cell phone, computer keyboard, remote, doorknobs and faucets. Wash eyeglasses with soap and warm water every day.
- Cover your mouth and nose when you cough. Throw away all your used tissues immediately.
- Practice your fist bump. Try to forgo handshakes and hugs for the time being.
- Skip the mask. Standard surgical face masks won’t screen out viruses in healthy people, but if you’re sick, a mask can help block droplets from sneezing or coughing so you won’t infect others. The U.S. Surgeon General has asked healthy people to not stock up on masks because the priority is that health care providers have them and they may experience a shortage if the general public buys them up.
- Call ahead. If you have cold or flu symptoms call your doctor instead of rushing to urgent care or the emergency department. If you don’t have a doctor and are sick enough to need emergency care, call ahead and let the hospital know you’re on the way.
- Keep up to date with reliable sources. Check back with us regularly for updates, and follow major news outlets and health authorities, such as the CDC, WHO, and The New York Times.
Q: Can I catch COVID-19 from my pet?
Q: Am I at extra risk because I take immune suppressing medications?
The concern with immune suppression is that the virus could replicate more freely and cause more severe or extensive disease, says Dr. Winthrop. For this reason, it’s important if you are taking these medications to contact your doctor right away if you think you’ve been exposed or are experiencing flu-like symptoms. (See question addressing symptoms.) Be sure to state that you are taking immune-suppressing drugs.
Experts warn patients not to stop or change dosage of medication without calling their doctors.
Q: I take hydroxychloroquine (Plaquenil) and heard about a shortage. What should I do if I can’t get a refill?
- If you are due for a refill, don’t wait until the last minute.
- If your refill is for 30 days, ask your doctor for a 90-day supply to give you a cushion in case it’s difficult to find later.
- If your pharmacy can’t fill a full 90-day prescription due to short supply, see if you can take what’s available now and be contacted as soon as new stock comes in.
- Be sure to tell your pharmacist the reason you are taking the medication. Some states give pharmacists the discretion to decide which prescriptions to prioritize, if, for example, stock is low.
- If the drug is out of stock, ask the pharmacist for help locating a refill. Another location in the same chain, a nearby hospital pharmacy or a compounding pharmacy may be able to fill it.
- If you still can’t refill your prescription, ask your doctor for guidance.
Q: Should I continue to get my arthritis treatment at an infusion center?
Q: I heard NSAIDs can worsen coronavirus? Should I avoid taking that drug?
A rheumatologist at Brigham and Women’s Hospital in Boston and professor of medicine at Harvard Medical School, Dr. Solomon says that people who usually use NSAIDs with the approval of their doctor likely can continue to take them as needed for aches and pains if using over-the-counter products, or as directed if taking prescription NSAIDs (such as celecoxib, or Celebrex, meloxicam, or Mobic). As always, you should talk to your doctor for guidance appropriate for your specific needs.
He adds that treating early or mild symptoms of any virus, including coronavirus, with acetaminophen (Tylenol) makes sense for people who have no pre-existing conditions that make it unsafe, such as liver disease. Call your doctor to report to report viral symptoms (cough, fever, shortness of breath or diarrhea) for directions on self-treating at home or when to seek further medical care.
Dr. Solomon is a member of the Arthritis Foundation’s Medical and Scientific Advisory Committee.
Symptoms and Exposure
Q: What are the symptoms of COVID-19?
Q: What should I do if I think I have this virus?
Your doctor can also help you decide how to treat your illness. If you have a more mild illness your doctor may recommend that you rest, drink liquids, take tylenol or NSAIDs for fever, and stay isolated from others. If you have a more severe illness you might be sent to the hospital to be monitored for complications such as pneumonia.
Q: If I am infected, is my family at risk?
Q: Who can get tested for coronavirus?
Until testing is more widely available and the shortage of protective gear and supplies eases up, authorities are asking that only high-risk people and the sickest patients get tested.
Generally, to qualify for testing, you will have to have symptoms compatible with COVID-19: a fever, cough, shortness of breath and possibly gastrointestinal issues. (The CDC has a Coronavirus Self-Checker
Q: What should I expect during the test?
Q: What should I do if I test positive?
Older adults and those with severe underlying chronic medical conditions (like heart or lung disease or diabetes) appear to be at higher risk for developing more serious complications. Because of that, contact your doctor even if your illness is mild.
If you have severe symptoms, such as trouble breathing or persistent pain/pressure in the chest, get medical attention right away.
If you think you need emergency care, call ahead to alert your doctor or the hospital. If possible, wear a mask to protect others.
Q: Are kids with arthritis at increased risk from coronavirus?
Q: I’m concerned about my child with JA contracting the coronavirus. What are the steps I can take to keep my child safe?
Pediatric rheumatologist Richard K. Vehe, MD, director of the Division of Pediatric Rheumatology at University of Minnesota Medical School in Minneapolis, says there are some steps that can help protect your child. The most important thing you can do is to follow the general prevention advice that applies to everyone. The Centers for Disease Control and Prevention (CDC) website, cdc.gov, has general and specific advice on how to prevent infection. It’s updated frequently, so check back regularly. Some of this advice includes, but is not limited to, the common-sense things such as washing hands often, avoiding touching the face and avoiding close contact with those who are sick.
When it comes to medications, we don’t know that they increase your child’s risk of getting this virus, so we recommend that you continue them, as usual, to stay healthy. If your child does get this virus, contact your child’s rheumatologist immediately. In some special circumstances, some medications might need to be increased or decreased.
Possible use of this drug for COVID-19 symptoms has caused access challenges for people with arthritis. Learn what you can do if you have problems getting a refill.
Learn who can get tested, how it works and what you should do if you test positive.
Information From CDC
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