Sick day rules and Covid

[MichaelW]

There have been a number of posts recently concerning the above topic.

Assuming that I have followed the correct link ,the document attached detailing the sick day rules is dated October 20.

Since the latest variant, Omicron ,which was first reported in the UK in November 21 ,is generalIy considered to result in a milder infection than the previous Delta variant I wonder if the normal sick rules would be sufficient?

Luckily I have avoided COVID so far but it has taken over 5 years to reduce from 40mg (following GCA diagnosis) to my current 3.5mg so I am keen to keep my intake of Prednisolone to a necessary minimum.

[PMRpro Ambassador]

Sorry - don't understand your point? "I wonder if the normal sick rules would be sufficient?" sounds as if you think the SDRs are inadequate for Omicron?

However - even Omicorn can make people pretty sick. Both my daughters had it this spring/summer. One was really unwell in April, the other caught it from a patient at work in September. She was in bed for nearly a week, went back to work to be immediately sent home and signed off for another 2 weeks. She is younger and healthier than most of us.

[MichaelW in reply to PMRpro]

Thanks for your response. I’m not sure whether you meant inadequate or adequate in your reply but I will try to clarify my original question.

I do realise that Omicron can make individuals very ill,this is why I was at pains to underline generally in my original post.

For my situation on 3.5mg if I am unfortunate enough to catch flu I would raise my dose to 10mg per day.

However if I catch COVID, according to the guidelines, I should raise my daily dose to 20mg per day.

My inclination at the moment in the case of COVID would be to stick to 10mg per day but I was keen to understand what others think or have done.

[PMRpro Ambassador in reply to MichaelW]

I don't get why you have asked if the SDRs would be sufficient - implying they are not enough i.e. inadequate.

[MichaelW in reply to PMRpro]

I’ve done a search and found some previous correspondence from you , my normal SDR phrase relates to Rule 1 which existed pre Covid.

[MrsNails in reply to MichaelW]

Hi Michael - l’m currently on 12.5mg Pred & when l developed Covid l rang my GP so after a discussion he agreed on the Sick Day Rules for Covid 10mg Morning & Evening, then l was rang by the Covid Doctor & started Antivirals the following day, l was then prescribed Antibiotics the following week for secondary infection

I was not too bad & l didn’t take MTX again until 2weeks ago having stopped it as soon as l developed Covid

The Guidelines were produced during Covid/Lockdown to help Patient's & Doctors & as we state on the Post it is to be done in conjunction with your GP

Hope that helps

MrsN

[Ozziedays in reply to MrsNails]

I’m fascinated by these SDRs, we don’t seem to have them here in Australia! I’ve had various things including Covid during my time on pred and MTX and at no time did my GP or rheumatologist suggest changing my dosage. I was on the antiviral for Covid (molnupiravir) alongside my pred and MTX. I don’t seem to have suffered any ill effects (Covid was 4 months ago), my tapering has continued to plan and I’m now on 0.5mg.

[MrsNails in reply to Ozziedays]

Did you remain on MTX while you had Covid?

[Ozziedays in reply to MrsNails]

Yes. My partner and I caught Covid on holiday in Adelaide and had to hotel isolate for 7 days. I didn’t have enough prescription medication with me so phoned my GP in Gold Coast to get e-prescriptions sent to a nearby pharmacy who delivered additional pred and MTX to hotel. At no time did he suggest not taking / reducing these meds, the priority was continuation hence e-prescriptions.

[MrsNails in reply to Ozziedays]

Here in the U.K. we always stop MTX if we are ill in anyway - l stopped MTX immediately & had my Prednisolone increased when l caught Covid

I suggest you have a read of the Patient Leaflet with your MTX Prescription& see what it says…..

[Ozziedays in reply to MrsNails]

will do, it’s huge so I may be some time….!

[MrsNails in reply to Ozziedays]

l know 🤦🏻 Do you have a Nurse Helpline in the Rheumy Team? As it might be worth ringing them for their opinion…..

I was speaking to one of the Nurses yesterday & told her about my Covid & her very first question was ‘Did you Stop the MTX’?

[DorsetLady PMRGCAuk volunteer in reply to Ozziedays]

Yes, but it's there for your info....and you can probable skim through bits of it...

[MichaelW in reply to Ozziedays]

Thanks for the reply. From personal experience I was only made aware of the rules about three years after my initial diagnosis by a clued up Endrocrinologist during a telephone appointment. Similarly my mother in law was recently diagnosed with PMR and started on 15mg and only found out during a discussion with me. I suspect this group’s awareness is not necessarily reflective of the wider UK patient population.

[PMRpro Ambassador in reply to Ozziedays]

hormones-australia.org.au/w...

I think it is a case of non-endocrinologists are simply unaware that we, as long term steroid patients, are almost certainly suffering from adrenal insufficiency. In the UK they eventually realised a few years ago that there was a lack of awareness amongst healthcare professionals and a new emergency steroid card was developed and issued together with advice about SDRs. Steroids, adrenal insufficiency and the risks are the same, whether you are in the UK, anywhere else in Europe, the US, Australia - and so is the about the effect stopping MTX has on recovery when ill or the research done in the last year about developing an immune response to the vaccine on or off MTX.

We are aware on the forum because a few of us make it our business to be aware.

[Ozziedays in reply to PMRpro]

Thank you for sending this. I’ll discuss it with my rheumatologist when I see her later this month (although it’s a bit late in the day for me - I’ve had / been through several of the things listed, albeit with no adverse effects!)

[MichaelW in reply to MrsNails]

Thank you for taking the time to respond, obviously glad that you are OK. I have taken my eye off the ball recently re COVID so I missed your original post but having had my latest booster a few weeks ago and with the onset of Winter I wanted to be prepared in case I catch either Covid or flu.

[PastelsinArt in reply to MichaelW]

Hi, I had Covid recently but wasn't badly affected by it. Pretty much like a cold in the head. I'm currently on 2.5mg. Pred and 20mg Leflunomide. My Sick Day regime consisted of 5mg morning and evening for just 4 days. I wasn't given antivirals but monitored my oxygen levels 3 times a day. I went straight back to2.5mg. With hindsight perhaps I should have done a rapid taper over a couple of days as I felt exhausted for 2 or 3 days after going back to my normal pred. Hope this is helpful.



[MichaelW in reply to PastelsinArt]

Thanks, glad to hear that you are OK. I don’t think, given my current dosage, that I would be prescribed antivirals either but your experience is very useful, reinforcing Seacat30’s point about an oximeter

[Seacat30]

Presumably you will be able to tell from your symptoms? My older sister has severe breathing problems but got through Covid really easily last Christmas. Have you got a finger Pulse Oximeter?

[MichaelW in reply to Seacat30]

Thanks for your response.

I’m pleased to hear about your sister.

A useful prompt about the Oximeter, meant to get one last year.

[Fran_Benson Partner]

Hi MichaelW, the Sick Day Rules were developed by a team of clinicians early on in the pandemic. Many doctors advise them but not all. No-one on here can tell you whether you should or you shouldn't - they can only make you aware of them so you can discuss with your own clinician if you have Covid.

[PMRpro Ambassador in reply to Fran_Benson]

They do apply for ANY situation with illness though - not just Covid. This is explained clearly in the advice I linked to above

hormones-australia.org.au/w...

[MichaelW in reply to Fran_Benson]

Thanks for the note. I do understand the point that you make and my intention was to be aware of current experiences given that the COVID advice was established prior to the Omicron variant.

I’m lucky that I have an understanding GP but for a dynamic condition such as GCA I do have to make my own dosage decisions about ,for example ,responding to a flare or if I know in advance about a forthcoming stressful event.

In the case of catching COVID I would speak to my GP but it is useful to be prepared with information as he is likely to be receptive to my thoughts given the relationship that we have established.