RISKS OF STEROID MEDICATION AND CORONAVIRUS

Dear all,

I hope that you are keeping safe and well.

For anyone who is concerned about any effects their medication might have on the risk of getting coronavirus, please read the advice below (updated by Dr Chetan Mukhtyar, Consultant Rheumatologist at Norfolk and Norwich University Hospital):

Prednisolone and other corticosteroids (steroids in common parlance) do not increase your risk of getting infection with Novel Coronavirus (COVID-19), but they do increase the risk of having a worse outcome.

Here are some simple Do’s and Don’ts:

Do’s

1. Practice ‘Social Distancing’ especially if you are still on corticosteroids (prednisolone and similar). Some guidance on what this is and how it can be achieved is available here ( gov.uk/government/publicati... )

2. If you develop a fever of 38 degrees Celsius or over OR develop a dry cough for more than 24 hours, do ‘Self-Isolate’. Practical tips on what this is and how it can be achieved is available here ( gov.uk/government/publicati... ). If you have to self-isolate and if you are on immunosuppressive medication besides steroids (methotrexate, leflunomide, azathioprine, tocilizumab), you must stop those (but not the steroids) when you develop those symptoms and urgently inform your doctor.

3. If you live alone, agree on a plan with someone living nearby to stay in touch at periodic intervals so that absence of contact can trigger a response. If your family live far away, it may be helpful for them to have a neighbours phone number or contact details.

Don’ts

1. Don’t stop your steroids suddenly. If you are concerned about your steroid dose, discuss this with your rheumatologist to help you weigh up the risk of relapse of PMR/GCA (and the consequent increase in dose) versus the benefit of improving your immune response to the virus. Sometimes the clever thing to do is to not reduce your steroids.

2. Don’t touch your face. Often this is done unconsciously as a way of calming ourselves. While this is difficult to do, it might be helpful to develop another distraction – tapping on a table, keeping your arms crossed etc.

3. Don’t offer to baby sit grandchildren. It may not be fair to them or to you.

Of course we strongly support the Public Health advice to keep washing hands and that NHS 111 should be the first point of call.

[Ranchero]

Good timing CandyH. The most important message I feel lies in the sentence

"Prednisolone and other corticosteroids (steroids in common parlance) do not increase your risk of getting infection with Novel Coronavirus (COVID-19), but they do increase the risk of having a worse outcome".

In other words everyone - obey all the rules and be less anxious about actually getting the infection.

[Hidden]

Hi candy h, had a telephone visit with my rheumatologist yesterday I asked her that very question about Prednisone. According to her the only time there is a negative affect to a patient who contracts covoid 19is if the patient is taking 10 my or more of Prednisone. Wonder if anyone can confirm that? By the way, I have a lot of confidence in my rheumatologist.

[PMRpro Ambassador in reply to Hidden]

If you look at the guidance document you can see this in Table 2: List of imunosuppressants that could put patients at risk if infected, they say:

"Prednisolone up to 10mg and also on other immunosuppressants (I/H), 10–19mg/day monotherapy (I); if in combination with other immunosuppressants (H/VH), 20mg or more per day (H/VH), ...

The receipt of any biologic probably puts the patient in the high or very high category."

In Table 1 they designate GCA patients as H/VH risk and PMR patients as I/H risk.

So having PMR increases your risk, being on 10mg pred or more is another risk factor.

I'm sure you have a lot of confidence in your rheumy - but NO-ONE can say who is at risk or increased risk in this case. She is saying that - but I suspect may have forgotten that PMR itself is a risk factor, whatever dose you are on. Over 10mg pred adds to it.

[Hidden in reply to PMRpro]

Sorry pro....it says that in the publication on the post??..techie issue as you know.

[Rugger in reply to PMRpro]

Which link are you referring to? (p6 - Table 2) Sorry if I've missed it and thank you so much for all you're doing for us.

[PMRpro Ambassador in reply to Rugger]

Oops! Sorry - I wrote that with the rheumatology document open myself and rather assumed Candy had linked to it because I couldn't see her links!

[Hidden in reply to PMRpro]

Ah..

[Hidden in reply to Hidden]

What was your doctors rationale of why the number is 10 mg?

[pugrescue in reply to Hidden]

yes I would also be interested in that? I assumed that any pred dose that has more or less neutralized your immune system (7.5+) would be detrimental.

[Rene20]

I have PMR I no longer take prednisolone. But take 15mg of Methatrxate once a week. Does this put me in the high risk category. I note that should I contract the virus I should stop Methatrxate and contact my gp?

[PMRpro Ambassador in reply to Rene20]

According to Table 2 of this

england.nhs.uk/coronavirus/...

being on methotrexate puts you in a high risk category. I'm not sure that that puts you into the category of the 12 weeks of total self-isolation but it certainly means you should be minmising contacts at home and being careful when you go out shopping, keeping 2m from other people outside and not hugging anyone even inside and being scrupulous about hygiene - and that, of course, means all family who live with you should be doing the same.

[Peptink in reply to Rene20]

I’m interested to hear how that’s working for you in dealing with the PMR and no prednisone. How quickly did you wean off? Is it working for you with the Methatrxate?