MTX and shielding

[kathylash]

This week I received a letter from my GP to shield. I take methotrexate and sulphasalazine. I’m confused because rheumatology nurses said I don’t need to shield. What have you all been told.

[Hidden]

I have had 4 separate letters 2 tell me to shield 2 tell me I’m very high risk. I’m on a biologic and methotrexate 🤷🏽‍♀️🤷🏽‍♀️

[patsymay13]

Hi Kathy I'm on methotrexate and hydroxy my gp was sending me a letter he thought I should b in the shield group but I spoke to rheumatology and they said I didn't need to b I think it all depends on the individual as to whether you have any other risks attached x

[Ruth12345]

I have a number of issues, as well as RD ie asthma high bp etc. Im on 11 meds, non are biologicals and no letter. Hay ho. I just read the tables and made my own choice. 🌈

[cass24]

I'm in the same situation (and posted about it recently). I'm on mtx and hydroxychloroquine and rheumy told me very clearly that I didn't need to shield, but two days later I got a letter (addressed from my GP) suggesting that I should!

As far as I can work out, initial letters came from consultants/hospital departments but GPs have subsequently been asked to go through their patient lists and identify anyone *they* feel may be at risk, and may well (in some cases) have erred on the side of caution without necessarily looking into the finer details of each individual.

I know I was personally a bit shocked/upset to receive a letter when I wasn't expecting one but as others pointed out to me, the letters are really only advisory and if you have been advised differently from your rheumatology department (and have no other underlying conditions of which they may not have been aware) then it's really up to you to decide which guidelines to follow in your particular circumstances.

[KittyJ]

I’m on a biologic, mtx and hydroxy and I have been told nothing. No contact from GP or rheumatology.

I’m just doing what I feel is right for me, what else can I do 🤷🏻‍♀️

[Pinkypie2018]

I take the same meds as you and also received the gp letter to shield. However I also have high bp so I assumed that's why I received the letter. I have received no contact from rheumatology team. The letter did come in handy for work purposes as I was able to sign on the furlough scheme as I didn't feel comfortable working with the public. If in doubt you can ring your gp for advice on what's best for you.

[Blueskysunshine]

Hi Kathy, I’m new on here and found the forum whilst trying to work out what measures I needed to take. The Leeds Hospital social distancing for rheumatology patients flowchart is very useful - last updated 2 April

leedsth.nhs.uk/assets/f6d9e...

[RosieA in reply to Blueskysunshine]

That is useful thank you. I think I might print out a copy as am a little fed up of having to navigate through everyone (professionals) interpretation of the guidance. I have been put in different groups and even within that had different advice as to what the groups mean. This flow chart encapulates good common sense I feel as it sees beyond the meds / age / co-morbidities, e.g flaring, other infections. Thank you for posting.

[Hidden]

I'm on Mtx, Leflunomide and pred. Also have Bronchiectasis. I've had 2 shielding letters.

[Boxerlady]

I'm on Methotrexate and Hydroxychloroquine with no other health issues and I've been sent TWO shielding letters! 🙄

[Longlocks]

I’m only on Benepali and have had a letter an email and text and told to shield. NRAS said social distance but Rheumatology nurse said be as antisocial as possible 🤷‍♀️🤷‍♀️🤷‍♀️🤷‍♀️. I’m staying home but it’s easier for me as I have a great network of people and priority food deliveries. My only worries are financial as I’m a mobile hairdresser. Still I’m pain free with this new injection and I’m of the attitude I will NEVER get this opportunity again to spend time at home and do stuff (guilt free) so I’m making the most of it. I’ve been baking/cooking and best of all I’ve had time to get back to doing my art again. Best advice STAY IN AND STAY SAFE XXXX

[Therapy6650]

I’m on biologics and methotrexate and I’ve not received a letter from anyone !! I just took responsibility for myself and made my own decision . Work have Put me on furlough to support me which has been very supportive.

The important thing is you protect yourself and do what you need to do to keep yourself safe.

[Susan55]

I’m on Benepali I’ve not received a letter or text my rheumatologist nurse just said carry on with the injections I’ve had no advice from them or my Dr. My daughters have put me into isolation and are doing all my shopping for me.

I’m just wondering when they start to phase things back in and not having been sent a shielding letter will I be expected to go back to work .

[cass24]

Just a little update on this for anyone who is interested. I spoke to my lovely GP this morning and apparently the guidance they have received rather simplistically states that shielding letters should be sent to (amongst others) -

"People on immunosuppression therapies sufficient to significantly increase risk of infection."

Obviously that's somewhat open to individual interpretation which no doubt explains why there seems to be quite a bit of inconsistency in who is receiving the letters. As I suspected, in the case of my own GP practice, they've made the assumption that methotrexate falls into that category despite the fact that more detailed advice from the NRAS and other sources suggests that Mtx alone is actually UNlikely "to significantly increase risk of infection", at least to the point where strict shielding should be necessary.

Personally I've no complaints with my GP erring on the side of caution (even if the letter did upset me a little initially) and will be continuing my daily (strictly) social distancing stroll/limp... although do feel for those who feel they maybe should have received a letter and still haven't.