Rheumatology

Coronavirus (COVID-19) - General Advice for Rheumatology Patients

Date of Advice 19th May 2020 

The information below explains the latest advice for rheumatology patients of North Bristol NHS Trust, University Hospitals Bristol NHS Foundation Trust, Weston Area Health Trust and the Royal United Hospitals NHS Foundation Trust.

Coronavirus (COVID-19) is a new type of virus that can affect the lungs and airways.  We understand this is a very worrying time for people with long-term health conditions, including those taking medications for rheumatology conditions that may reduce the body's natural defenses (immune system).

General advice:

As things are changing very quickly, the most up to date reliable health information can be found at www.nhs.uk.

The latest rheumatology advice for patients can be found at www.versusarthritis.org.

General advice that will help you stay safe and well includes:

• washing your hands with soap and water often - do this for at least 20 seconds
• using hand sanitiser gel if soap and water are not available
• covering your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
• putting used tissues in the bin immediately and washing your hands afterwards
• avoiding close contact with people who are unwell
• avoiding touching your eyes, nose, or mouth if your hands are not clean

 

This situation is developing constantly. For the most up to date information on the situation, please refer to https://www.gov.uk/coronavirus.

 

Rheumatology medicines

Should I still take my rheumatology medicines if I feel otherwise well?

Yes. Our current advice is that all patients should keep taking their rheumatology medicines as recommended by their rheumatology team. Although many of the rheumatology medicines may reduce the body's natural defences (immune system), stopping your rheumatology medicines may cause your condition to flare which may then need even stronger medicines to get the condition back under control. Very bad flares sometimes need to be treated in hospital. We are working hard to avoid hospital admissions unless absolutely necessary to try and limit the potential spread of the infection. Should I stop my medicines if I feel unwell?

If you develop symptoms of coronavirus (new cough, shortness of breath or fever), we suggest that you stop your rheumatology medicines (e.g. methotrexate or biologic medications) while you have symptoms. When you feel well again, you should restart your rheumatology medicines. If you are taking steroids, you should continue these as stopping them suddenly can make you very unwell.

It is safe to continue Hydroxychloroquine and/or Sulfasalazine if you have symptoms of coronavirus.

Please let your rheumatology team know via the rheumatology helpline if you stop your medications or are on steroids and develop symptoms of coronavirus.

Should I come to the hospital if I have symptoms of coronavirus?

If you have mild symptoms and feel you can manage at home, you should stay at home. If you feel very unwell and think you need to see a doctor urgently you should look online at www.111.nhs.uk/covid-19/. If you do not have internet access, then contact the NHS by telephone on 111 who will provide appropriate advice. If you have a question about your rheumatology condition, or your rheumatology condition is getting worse, please call the rheumatology advice line at your hospital.

I have regular infusions (a drip medicine in the vein) at the hospital for my rheumatology condition. What should I do?

If you have an infusion due in the next few weeks, please contact your rheumatology team to find out what your team suggests. If you are not due an infusion in the next two weeks, please do not contact the team yet as plans may change again before your infusion is due. If you have any symptoms of coronavirus (new fever, cough, shortness of breath) or have been in contact with someone who does please contact your rheumatology team before coming in to get your infusion.

I have regular blood tests. What should I do?

Please continue to have your bloods tested. If your GP is unable to do blood tests, please let your rheumatology team know via your rheumatology team advice line.

Should I stop my anti-inflammatory medicines (also known as NSAIDs. E.g. Ibuprofen, Naproxen etc.)

Current advice is that you should continue to take the lowest dose you need to help control your arthritis symptoms. Up to date advice on this can be found at: www.nhs.uk/conditions/nsaids/

I have other questions. What should I do?

Please try to use online information from trusted websites before contacting your rheumatology team as we are exceptionally busy. Trusted websites with coronavirus information include:

www.nhs.uk

www.111.nhs.uk

www.versusarthritis.org

www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public

Whilst social media can be helpful, please be aware not all information on social media is reliable or accurate. Please use trusted websites for health information rather than social media (twitter, Facebook etc.).

Should I be shielding?

The government has issued general guidance. Please click on link below.

https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Most of our rheumatology patients should be shielding (and at this stage this is the safest option) but there will be some who are lower risk (e.g. if not on any medications or only one medication).

Please find a link here to a letter based on advice from the British Society of Rheumatology which includes a flow chart to give you more detailed information about who should be shielding. 

I still have questions who should I contact?

Please contact your local rheumatology helpline. This is being staffed as a priority, but we are experiencing a high volume of calls so please see if you can find the answers in the links above wherever possible.

 

The helpline number for UHBristol rheumatology patients is

0117 342 4881

 

 

IMPORTANT INFORMATION FOR OSTEOPOROSIS PATIENTS

 

New Patients

Due to the ongoing COVID-19 outbreak, we are experiencing delays and reductions in our Osteoporosis service. We are reducing the number of face to face appointments and treatments based at the hospital, in order to reduce footfall in the hospital to project patients and staff.

Your appointment is likely to be over the telephone and some routine treatments for osteoporosis will not be available.

It is likely that the reason for your GP referral to our Osteoporosis Service is to consider an injectable treatment (such as zoledronate or denosumab) to protect your bones. Unfortunately, our ability to provide these treatments will bereduced in the upcoming months.  Consequently, some patients are at the risk of not being on any bone protection..

Therefore, we would ask you to contact your local GP for advice on alternative treatments in the meantime. This is particularly important if you have already tried a tablet treatment such as oral alendronic acid (alendronate), and this did not agree with you.

We will be offering telephone consultations and  can then discuss any side effects or concerns regarding osteoporosis treatments over the phone  

 

Some alternative medications for you and your GP to  consider:  

 

If intolerant to alendronic acid tablets (mainly digestive symptoms), please consider:

• Soluble version of alendronate (Binosto)-men and women
• Weekly Risedronate(35mg)-men and women
• Monthly Ibandronate(150mg)-women only
• Consider adding gastric protection (eg omeprazole or ranitidine)

 

If contraindication to, or intolerant to oral bisphosphonates, please consider:

• HRT: in young postmenopausal women with low thrombotic risk, particularly if menopausal symptoms present. Avoid if history of any gynaecological malignancy (suspected or confirmed).
• Raloxifene: only for postmenopausal women with low thrombotic risk and normal renal and hepatic function. Avoid if history of uterus bleeding or malignancies.
• Strontium ranelate-men and women. Do not prescribe in patients with cardiovascular disease, risk factors for clotting, or history of severe allergic reactions

 

For further information to aid treatment choices, please visit:

https://www.sheffield.ac.uk/NOGG/NOGG%20Guideline%202017.pdf

https://bnf.nice.org.uk/

 

Referrals for bone mineral density test (DXA)

If you have been referred for a DXA test, please be aware that this may be postponed or cancelled, depending on your particular case. Please expect your DXA to be deferred in case you are over 70 years of age or suffer a medical condition for which you should be shielding.

For referrers, please, be aware that we will be cancelling DXAs in those patients whose FRAX-calculated fracture risk is in the high category, or those who have suffered a hip/vertebral fracture, as these patients should start anti-osteoporosis treatment irrespective of DXA results.  For further help on decision making without DXA, please visit FRAX website at https://www.sheffield.ac.uk/FRAX/tool.aspx?country=1.

We would also recommend in general not to send patients for follow up DXAs (e.g. to consider drug holiday) during the covid19 pandemia, and continue with their current bone protection.

 

 

Known Patients

Do not discontinue your osteoporosis treatment (including calcium and vitamin D supplements). For the patients already on injectable treatments, please be aware:

-For Zoledronic acid, it is likely we will postpone your treatment. A delay of few months on your treatment should not significantly increase your risk of fracture. Zoledronic acid has a long-lasting effect.

-For Denosumab, you are advised to continue with your injections. If you are about to finish a 5-year course,  please do not interrupt treatment. This medication can be administered safely for at least 10 years. 

-For Teriparatide, you should keep up with your daily injections.

 

For more details on how to protect your bones during the COVID19 pandemic, please visit:

https://theros.org.uk/information-and-support/coronavirus-and-osteoporosis

 

 

Welcome to the Rheumatology Department Website at University Hospitals Bristol NHS Foundation Trust. 

Our mission statement is to work with our patients to enable them to live well through multi-professional team working, evidenced based-care, education and research and patient- centred partnerships.

We see and treat patients with a range of inflammatory rheumatic diseases and also run an osteoporosis service. We have a range of specialist rheumatology nurses and allied health professionals who provide highly skilled care for people with rheumatic diseases. We have a fully equipped physiotherapy and occupational therapy department and a day-case unit for infusions. Our active patient advisory group helps us to deliver patient-focused care and research.

We are an NHS England specialist centre for autoimmune rheumatic disease (connective tissue disease and vasculitis) and rare bone disease (osteogenesis imperfecta). We host a Regional MDT for Tocilizumab in Giant Cell Arteritis. We also run services for patients with rheumatic diseases moving from paediatric to adult rheumatology, called transition services.

We are also co-located with researchers from the University of the West of England (UWE) and University of Bristol (UofB) focusing on original research into health related quality of life and self-management of chronic diseases. We also work with the research nurses from the Medical Research Team at UHBristol, offering patients the option to enrol into national disease registries, patient-focused research projects and novel therapeutic trials.

We are a teaching hospital and host and support medical students from the University of Bristol.

We are based in location B504 (Level 5 of the King Edward Building at the Bristol Royal Infirmary) with satellite clinics at South Bristol Community Hospital.