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COVID-19 and Rheumatoid Arthritis: How are They Linked?

Curated by Claudia Shannon / Research Scientist / ishonest

COVID-19 is a disease caused by the new coronavirus SARS-CoV-2. The virus is highly infectious and spreads through respiratory droplets in the air.

Anyone can contract the new coronavirus. However, people with autoimmune diseases like rheumatoid arthritis (RA) are more likely to get infections, including COVID-19.

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Treatments for RA may also affect the immune system, increasing the risk of COVID-19.

RA is often treated with hydroxychloroquine, a drug that was thought to have potential benefits for COVID-19. However, health officials have ruled that hydroxychloroquine is not effective for COVID-19. It has been recognized that the drug can cause serious side effects involving the heart.

Read on to learn about how COVID-19 affects RA, and what you can do to protect yourself.

How COVID-19 affects people with RA

RA is a chronic inflammatory disorder. It mainly involves the joints, but it can affect other tissues as well. RA is a result of the immune system mistakenly attacking the body.

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As a result, people with RA may be more at risk for COVID-19 compared to others. If infection occurs, the immune system might be compromised in fighting the virus.

The risk is higher for someone with RA if they:

  • are an older adult
  • have other medical conditions, like type 2 diabetes or obesity
  • have severe, unmanaged RA
  • have been previously hospitalized with a respiratory infection

These factors increase the chances of developing more severe complications of COVID-19.

Additionally, RA is sometimes treated with drugs called immunosuppressants. These medications work by reducing your immune system’s response.

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Immunosuppressants can help manage RA, but they might also increase your susceptibility to infectious diseases.

RA can cause complications involving the heart and lungs. Since COVID-19 is a respiratory disease, people with heart and lung issues are more likely to have serious symptoms, too.

Will COVID-19 make RA symptoms worse?

Scientists are still studying the link between COVID-19 and RA.

However, infections are a known trigger of RA flares. This happens when your symptoms increase in severity. If you contract the new coronavirus and develop COVID-19, the infection may cause a flare.

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Coping with the infection is also emotionally taxing. The stress can increase disease activity and worsen RA symptoms.

COVID-19 symptoms in people with RA

Generally, if you have RA, the symptoms of COVID-19 are similar to that of other people with COVID-19 who don’t have RA.

The most common symptoms include:

  • fever
  • dry cough
  • fatigue
  • shortness of breath

Less frequent symptoms include:

  • headache
  • chills
  • sore throat
  • muscle aches
  • loss of appetite
  • nausea
  • vomiting
  • diarrhea
  • loss of smell
  • loss of taste
  • confusion
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It’s also possible to have joint pain, which is a rarer symptom of COVID-19.

COVID-19 and hydroxychloroquine

Hydroxychloroquine is an oral drug. It was originally used to prevent and treat malaria. Today, it’s approved by the Food and Drug Administration (FDA) to treat RA.

Lab studies had reported that hydroxychloroquine could prevent growth of the new coronavirus. There were also a few reports of people with COVID-19 taking the drug and getting better.

Hydroxychloroquine was thought to help because it has an antiviral effect that disrupts enzymes the virus needs to infect healthy cells. The FDA continued to explore the research as it became available.

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U.S. President Donald Trump publicized hydroxychloroquine for COVID-19 just before the EUA was issued. The EUA also permitted states to stockpile the drug for this use. All of these factors resulted in a hydroxychloroquine shortage.

In fact, hydroxychloroquine was associated with serious heart problems in people with COVID-19. The FDA ruled that the potential risks outweigh the benefits.

Moreover, Trump’s support for hydroxychloroquine referenced a small, poorly designed 2020 study.

For several months, people with RA and other autoimmune conditions had a difficult time getting their prescribed medication.

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But the shortage is now resolved, according to the FDA.

Protecting against COVID-19 if you have RA

Since some RA medications suppress the immune system, you might wonder whether you should stop taking them to protect against COVID-19.

But it’s crucial to keep taking your medications as directed. Stopping your medication can trigger a flare. This could cause serious complications, which require even more medication.

Also, when you have a flare, you may have a higher risk for infection.

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Always follow your doctor’s directions. They’ll let you know if you should change or stop your medication.

In the meantime, follow the general rules for COVID-19 prevention:

  • Stay at home whenever possible.
  • Avoid nonessential travel and crowds.
  • Wash your hands regularly with soap and water for at least 20 seconds.
  • Use hand sanitizer with at least 60 percent alcohol if soap and water aren’t available.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Stay at least 6 feet away from others outside your household.
  • Wear a mask when you’re in public.
  • Avoid close contract with people who are sick.
  • Clean and disinfect frequently touched surfaces often.

You can also take the following steps to ensure you have enough medication:

  • Ask your doctor for a refill if you’re due or almost due.
  • Ask your doctor for a 90-day supply instead of the usual 30 days.
  • Contact other pharmacies if your usual location is out of stock.

When to see a doctor

If you think you have COVID-19, avoid simply showing up at the hospital. If you do have the virus, it can quickly spread to other people.

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Instead, call your primary care doctor or rheumatologist. They can explain the next steps, depending on your symptoms.

Schedule a phone or online appointment whenever possible. This will allow you to stay at home and avoid potentially exposing others to the virus.

Watch for serious symptoms of COVID-19. If you notice the following symptoms, call 911 immediately:

  • difficulty breathing
  • persisting chest pain or pressure
  • confusion
  • difficulty staying awake
  • bluish lips or face

Be sure to tell the first responders on the phone that you have RA and suspect COVID-19.

COVID-19 treatment and symptom management

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To date, there’s no cure for COVID-19. Instead, treatments manage symptoms. Treatment also varies greatly, depending on your specific symptoms.

If you have mild symptoms, you’ll likely recover at home. Here’s what you can do to manage your symptoms:

  • Take over-the-counter (OTC) cough medicine.
  • Take OTC pain relievers.
  • Stay hydrated.
  • Get lots of rest.

You’ll be asked to stay at home and self-isolate from people in your household.

If you have severe symptoms, you might need hospital treatment. Your healthcare team will create a treatment plan based on your symptoms, age, and overall health.

Outlook

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For people with RA, the outlook of COVID-19 recovery varies greatly. According to a 2020 review, your outlook mainly depends on your age and any other conditions you have.

People who are older and have other health conditions are more likely to have a poor outlook. This is especially true for heart disease. Severe RA, which can lead to heart and lung issues, can also lead to a poor outlook.

But you can improve your outlook by managing your RA and any other health conditions you have.

You can also further improve your outlook by avoiding or limiting your exposure to the virus. Wear a mask, practice physical distancing, and wash your hands often.

Takeaway

If you have RA, be sure to take extra steps to protect against COVID-19. You may have a higher risk for getting the virus or developing severe symptoms if you do develop COVID-19. This is especially true if you’re older or have other medical issues.

Scientists are continuing to learn about the link between COVID-19 and RA. Still, it’s best to keep taking your medication and follow the general guidelines for preventing COVID-19.

Read more on: arthritis


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