We will continue to review this content as the COVID-19 situation evolves across the UK and guidance changes over time. It is important to check this page for updates.

To date (i.e. January 2021), arthritis is not a predisposing disease to COVID-19 infection.

Currently, drugs such as Paracetamol, and NSAIDs (non-steroidal anti-inflammatory) such as ibuprofen, are safe to use at any time, but only take these medications at the required strength and only if/when necessary.

COVID-19 vaccines and arthritis

Predisposition to COVID-19 infection:
The following are currently thought to be predispositions:
– Gender – more males
– Age – higher risk as you get older
– Ethnicity – BAME (Black, Asian and minority ethnic)
– Hypertension
– Cardiovascular disease

Major current trial:
Randomized evaluation of COVID-19 therapies: aka recovery
Led by Oxford University and funded by the National Institute of Health Research
Trial approved (11/03/20) and 6000 patients enrolled (20/04/20)
Initial data expected approximately June 2020.

It is important not to take any medication that has not been subjected to a randomized controlled trial e.g. there are rumours that hydroxychloroquine (Plaquinil) is an effective treatment and currently the observational studies would indicate that this medication may do more harm than good.

Arthritis drug tocilizumab may help severely ill patients with COVID-19
Critically ill patients with COVID-19 who received the rheumatoid arthritis drug tocilizumab were more likely to improve that patients who received no immune modulator.
BMJ 2020;371:m4579
JSA comment: this number is larger than that seen with the steroid dexamethasone in the same trial, although the results have yet to be peer reviewed.

Clinical spectrum of COVID-19 in Iceland
Among 1564 people positive for SARS-CoV-2, the most common presenting symptoms were myalgia (55%), headache (51%), and non-productive cough (49%). A substantial proportion of people with SARS-CoV-2 did not meet recommended case definitions at the time of diagnosis.
BMJ 2020;371:m4529

Study into infection fatality risk for SARS-CoV-2 in community dwelling population of Spain
Estimates of the overall risk of mortality in infected people were 0.8% (19,228 of 2.3 million infected individuals). The risk of death from COVID-19 increased with age and was higher in men than women. The results indicated that COVID-19 caused more deaths during the first wave of the pandemic than other common respiratory infections, such as seasonal influenza.
BMJ 2020;371:m4509

Testing for antibodies to SARS-CoV-2
What is the accuracy of the AbC-19 Rapid Test lateral flow immunoassay for the detection of previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection? The findings from this study suggest that around one in five key workers testing positive with the test would be false positives. A clear message must be communicated to the public that positive results from these assays do not provide evidence of immunity. Further work is urgently needed to clarify the relationship between circulating antibody concentrations and immunity to SARS-CoV-2.
BMJ 2020;371:m4262

Eye Eye
Plastic surgeons are reporting that more people are coming to them seeking otoplasty, blepharoplasty, and Botox because wearing masks and appearing on virtual calls has placed more emphasis on their eyes and ears.
BMJ 2020;371:m3943

Convalescent plasma is ineffective for COVID-19
How effective is convalescent plasma in treating adults with moderate COVID-19 disease in India?
This treatment was not associated with a reduction in progression to severe COVID-19 or all cause mortality in adults with moderate COVID-19 disease.
BMJ 2020;371:m3939

Common illness diagnoses halved in lockdown
New diagnoses of mental health conditions, cardiovascular diseases, and type 2 diabetes approximately halved in Salford during the national lockdown, according to a study published in the Lancet Public Health. There was a 16% reduction between observed and expected cancer diagnoses (163 versus 194).
BMJ 2020;370:m3737

Telemedicine: unseen unknowns
The switch to remote consultations is not good for those patients who cannot afford a mobile phone, access the internet or speak English as they will have difficulty navigating the remote entry points to consultations. Doctors of the World uses the term “digital exclusion” to describe these barriers.
BMJ 2020;370:m3701

COVID-19 and chronic fatigue
Like many flu-like illnesses, COVID-19 may lead not only to unpleasant malaise and severe acute fatigue but also to chronic fatigue with a prevalence of around 10% at three months. Post-viral fatigue studies have shown that blood concentrations of IL-6 and IL-10 in the acute phase can predict the development of subsequent chronic fatigue. The same pro-inflammatory mediators are also seen in the cytokine storm of severe COVID-19 infections.
BMJ 2020;370:m3167

New ways to manage rheumatic conditions
Recommendations on how to manage patients with autoimmune diseases, how to deal with anti-cytokine drugs used by about 20% of these patients, and how to keep disease activity under strict control in the context of COVID-19 are still lacking. The mainstay for optimal chronic arthritis management is the treat-to-target strategy. Services set up to shorten the delay between symptom onset, diagnosis and treatment (the main prognostic factors for achieving clinical remission) are currently not running properly, with all efforts being focused on patients with COVID-19. Rheumatologists should start organising new ways to follow their patients to avoid a major backwards step, losing the fantastic clinical results obtained over the past 15 years.
BMJ 2020;369:m1633

Concern at lack of clarity over change of ibuprofen advice for COVID-19 symptoms
UK medicine agencies have changed their advice on ibuprofen to say the drug can be used to treat patients with symptoms of COVID-19, although the evidence that prompted the revision has not been made public.
BMJ 2020;369:m1555

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