I’m a teacher and I’m trying to work out if i’m clinically vulnerable or clinically extremely vulnerable. My GP seems to think i’m In the second category but I haven’t received and email or letter and my school have said I need to be in unless I can show a letter. I’m on methotrexate 20mg. Has anyone with a similar profile received an email/letter. It’s all so confusing!
Who is getting shielding letters this time? - NRAS
Who is getting shielding letters this time?
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Tillydancer
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55 Replies
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Are you on any other medications apart from methotrexate ?
No just mtx x
That, alone,( if you don’t have any other conditions) shouldn’t mean you need to shield. 
Good morning
I think if you got a shielding letter last time you are counted as clinically extremely vulnerable.
My understanding is that MTX alone would place you under vulnerable rather than extremely.
You may be able to ask your gp to provide a letter for you if he or she believes your other medical circumstances out you in the extremely bracket.
All the best
Bon
Yes that’s what it looks like from the descriptions doesn’t it? I was just surprised when my GP said I was extremely!
I often think some GPs may not fully know the categories of many of the DMARDS/biologics meds. A couple of days ago someone posted the link to the National Society of Rheumatology’s shielding chart, which shows the RA meds and categories. You would as Bon said, need to have another condition/med other than Mtx, which would put you into a higher category to be classed as clinically extremely vulnerable. I hope you can soon get the help and advice needed to ascertain which category you are in. X
This is on the rheumatology website. Not sure it will help xx
rheumatology.org.uk/Portals...
That is the March guidance before the first wave. The experience of real patients has meanr that risk levels has changed.
Thats what i thought but this was tweeted yesterday from them so confusing x
Hi , I have received one via email , I’ve been classed as extremely vulnerable , I only take Methoject 20mg .
I did receive a letter last time .
Maybe you’ll receive one in the post .
helixhelix• in reply to
Are you over 70 with other conditions? As the letter Allanah posted yesterday which is the latest government guidance suggests that MTX alone is really not a big risk.
gov.uk/government/news/clin...
• in reply tohelixhelix
No , but I’m over 60 , and I don’t have high blood pressure either . If I remember rightly from the last time wasn’t it 3 things that got you classed as being extreme , I only had one which was the Methoject , I haven’t had any steroids either this year . I admit I was surprised when I received my email .
Sezvic• in reply to
Hi, I’ve called me council yesterday bcos I did not get any letter this time (I was shielding starting March until August). The person at the council said people who are over 60 or 70 who are getting letters. As for me,I should read the guidelines on the Gov.Uk. Not having the letters make it difficult for people who are employed bcos not all managers will understand it. What a mess?!
They do put a lot of emphasis on trying to scare those of us who are 70+ .
I do know being aged does have consequences..... but TBH most 70+ I know on just one Dmard are a heck of a lot healthier than a 50-year-old who weighs 20 stone!
I think they are taking a scattergun approach and hoping they will help at least some people?
Tillydancer• in reply to
It’s all so confusing! But thanks for your reply. Do you think I should speak to my rheumatology department?
It can’t hurt.....at least they will know your true condition....my GP would be pushed to answer which category I fit in....as I’m 70+ would probably put me in highly vulnerable... but my rheumatologist just says to take care...but then I am retired & that does make a big difference.
• in reply toTillydancer
It won’t hurt to contact your RA team , they know you best , and as you work in a school that might put you more at risk , especially if you’re in contact with the children .
Its all so confusing, I received a letter last time, but now i'm on biologics as well as previous meds and gp said there was no need to shield so confused 🤷🏻♀️xx
It’s crackers!
Some authorities haven’t sent out letters yet ( mine hasn’t ) my nurse said the government hasn’t sent out up to date guidelines they are still waiting. She believes the old ones no longer apply🤷🏽♀️that’s what I was told yesterday
Tillydancer• in reply to
Oh ok that’s interesting. I gues i’llwait a few more days and see what I can find out
According to the latest guidance (linked in answer to Cherie22 above) you are in the vulnerable category, rather than extremely clinically vulnerable, here’s an extract:
“Those in the following group count as clinically vulnerable:
are 70 or older
have a lung condition that’s not severe (such as asthma, COPD, emphysema or bronchitis)
have heart disease (such as heart failure)
have diabetes
have chronic kidney disease
have liver disease (such as hepatitis)
have a condition affecting the brain or nerves (such as Parkinson’s disease, motor neurone disease, multiple sclerosis or cerebral palsy)
have a condition that means they have a high risk of getting infections
are taking medicine that can affect the immune system (such as low doses of steroids)
are very obese (a BMI of 40 or above)
are pregnant”
But doesn’t methotrexate affect the immune system? My consultant told me it does
It seems to have been decided that only being on one Dmard like Mtx does not make you extremely vulnerable. Your rheumatologist will be the only person able to advise you as he will know your exact condition.
Some people May have underlying conditions not associated with RA that do make them vulnerable ....but if you don’t have any other conditions you will not probably be considered extra vulnerable.
It does, but not very much. So far experience of real people with Covid seems to show that people on MTX have exactly the same outcome as somebody the same as them (ie age, weight etc) who is not on MTX.
Yes and I had an email saying extremely vulnerable but it refers to the CKD I'm certain about that.
Morning 🙂
I got an email this week. Last time I had to chase around gp's and rheumatologists to get a letter...I'd ask your gp for a phone consultation and have a conversation with them. It might be that you have a complication which increases your risk. I think if it's only mtx and you're keeping fairly well, you may not be on the top tier of vulnerability. Please check with your gp - most hospitals seem to not getting involved, well mine isn't 🤷🏻♀️Good luck 🤞
Thank you! Yes I think i’ll Have a conversation with the GP next week. This week has been so scary at school - they had to send 10 boys home after they found out they’d been at a party last Sat with someone who tested positive. But, they came to school as normal Mon & Tues. it’s incredibly worrying.
That's crazy that they're allowed to come to school after partying! Trouble is - who is policing it?
Parents?
You would like to think so but they are just as irresponsible
Exactly.
Everybody is blaming the government for how things are going but they aren’t responsible for all these irresponsible mostly young people who think they are immortal...but don’t appear to understand that altho they might not be very poorly themselves if they contract COVID-19.... older or sick people could die by catching it from them.
But then discipline & responsibility are so old fashioned why should they obey any rule ...just because it means they can’t do exactly what they choose?
So parents if you think your little darlings aren’t being irresponsible.. these kids must have had parents once.....make sure your youngsters man up & do obey the rules .....cos you could be the first to get infected if they are carriers.
I spoke to my go this week as first time around I was clinically vulnerable as I was only taking methotrexate and sulfasalazine. I started taking adalimumab in August and the consultant said this would put me in the clinically extremely vulnerable category. I haven't received a letter and my go said they are not sending them out this time although I know others have received them. I am extremely lucky as work have been amazing and let me shield last time and have told me they don't need a letter and to just stay at home. If you go to the versus arthritis website all the information is on there to work out which category you come under.
Thank you so much. Heading over there now to have a look...
I'm on 20mg Metoject and GP put me in the higher category - I received the latest email from Matt Hancock & Robert Jenkins BUT, rheumatologist wrote to my GP in September after a phone call appointment, saying I did not need to shield, but should strictly social distance.
That’s interesting - thanks for sharing your experience.
Sadly, I think there is going to be the same problem as last time re consistency. I have received the "extremely clinically vulnerable" email but I suspect that it's simply because I received the letter last time (from both my rheumy clinic and my GP.)
I'm 60 and on DMARDS only (no steroids or other conditions) and when I queried the letter with my rheumy nurse, he admitted that they'd simply decided to send the letter to all their patients rather than sift through the details. My GP thought that the surgery had sent it simply because they're "scared of Methotrexate" (!) I'm lucky in that I'm working from home anyway but I made the personal decision not to shield but just to be careful as I didn't feel that I was really at that much risk and I'm going to continue to do that.
If your GP thinks you're vulnerable (and you'd prefer not to go to work) maybe you can ask them to help you get an email/letter?
Yes, I made my own decision not to shield as it would have driven me mad. So just being careful.
It is hard for people who work in busy places, so this new confusion doesn’t help them.
Yes I think i’m going to try that on Monday thank you!
I got the email this week. I’m on Prednisolone, Leflunomide and a biologic. It might be worth checking the gov.uk website as last time around you could register yourself - I had to register my 83 year old dad who has COPD, asbestos related lung damage and PA because his GP didn’t bother!
I’m a teacher and I haven’t received anything, but I’m still going in this time. For my own sanity and mental health I cannot sit at home! I’m on mtx and tocilizumab, last time I was classed as clinically vulnerable, I didn’t get a letter to shield last time until a text came at the end of May, then a letter arrived at the end of June telling me I didn’t need to shield anymore. The guidance my head teacher has received from his union is that clinically vulnerable still need to come to work which is fine by me, plus he’s buying us chip butties next week 😀
I feel exactly the same way as you Ruth - really don’t want to teach remotely at all so your situation has cheered me up this morning! I’m completely confused about my actual risk level but it can’t be that high or they would have sent me a letter. T’s lovely working with the kids face to face!
I'm only teaching remotely because I've been told that my university teaching has to be done that way. I also have private students but I've kept those online too as otherwise they'd be coming to my house and that's a step too far for me. If I could only teach in person, I'd do that rather than not do it at all.
Definitely and mine are only 4 and 5 so teaching remotely doesn’t really work!
Hi. I'm on methotrexate and steroids and told the combination of both means I'm clinically extremely vulnerable. I'm also a teacher. I emailed the helpline to ask as I was only diagnosed in Sept and rheumatologist emailed me back to say to shield for next 4 weeks.
I think that it's probably the steroids that tip the balance; I hope that you're able to do what makes you feel safe.
Thanks for replying all. It’s been so helpful and such a range of situations.
I have had my letter and i have just printed it off.xxx
If you had the steroid injection (methylprednisolone 80mg IM) about a week ago. Does it make you more vulnerable?
I've had an email I'm also on methotrexate but it's been over 70 that makes me EXTREMELY vulnerable u r just vulnerable x
I've also received a text and a letter this week, as I am on Methotrexate, Hydtoxy and coming off steriods, hope to be off them soon. Luckily I work from home and to be honest this lock down doesn't change much for me, as I was being careful and staying away from shops ect before anyway. So just going to be careful over the next 4 weeks. Stay safe. X
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