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.
