What to Know About Psoriatic Arthritis and COVID-19

From verywellhealth.com

Psoriatic arthritis is a systemic type of arthritis that develops in some people with psoriasis, an autoimmune disease that causes plaques on the skin. It causes inflammation in many joints of the body.

People with psoriatic arthritis are often prescribed immunosuppressive medications to manage their symptoms and reduce inflammation. Because this type of medication weakens your immune system response, people with psoriatic arthritis who take these medications are at increased risk of acquiring infections, possibly including a coronavirus infection.

Psoriatic Arthritis and COVID-19 Risk

Commonly prescribed medications for psoriatic arthritis include nonsteroidal anti‐inflammatory drugs (NSAIDs) and disease-modifying drugs like methotrexate. They can help reduce inflammation and related symptoms. If these medications fail to improve symptoms, biologic medications are recommended next.

Biologics are a class of drugs that suppress the immune system to reduce inflammation in autoimmune diseases. Tumor necrosis factor (TNF) is a specific cytokine, a cell-signaling protein produced by the immune system, that causes inflammation. Because TNF is elevated in patients with psoriatic arthritis, TNF inhibitors such as Humira (adalimumab), Remicade (infliximab), Enbrel (etanercept), Cimzia (certolizumab pegol), and Simponi (golimumab) are commonly prescribed to treat this condition.

Interleukins are also inflammatory cytokine proteins that are often elevated in psoriatic arthritis. Interleukin inhibitors are therefore also used to manage symptoms. However, biologics like TNF inhibitors and interleukin inhibitors may increase the risk of infections and lower the body's ability to fight infections, including COVID-19.

Despite the immune-suppressing quality of biologic medication, there is no direct evidence at this time that suggests taking methotrexate or biologics increases the risk of COVID‐19. It is possible that these drugs may provide a protective factor against pulmonary fibrosis, a major complication associated with worsened outcomes and death from COVID-19.

Both methotrexate and biologics also have the potential to reduce the risk of developing cardiovascular disease in those with psoriatic arthritis and may therefore be protective against COVID-19 since cardiovascular disease is a major risk factor for COVID-19 infection.

If you have psoriatic arthritis, it is recommended that you continue your medication to prevent worsening of symptoms and progression of your condition. Always consult your doctor before stopping or changing the dosage of your medications.

Complications of Psoriatic Arthritis and COVID-19

While evidence is still preliminary and more research is needed, current evidence suggests that patients with psoriatic arthritis treated with immunosuppressive medications are not at increased risk of complications from COVID-19 compared with the general population.

Research supports that people with psoriatic arthritis are not at an increased risk of hospitalization compared with the general population, and that the use of biologics is not associated with worsening symptoms from COVID-19.

Psoriatic Arthritis Treatments and COVID-19

Hydroxychloroquine, a malaria drug with antiviral properties, has recently been used to treat symptoms of patients hospitalized with COVID-19. Research suggests that psoriasis and psoriatic arthritis can be aggravated by hydroxychloroquine since the medication may increase the production of interleukins.

In one study of 18 patients with psoriasis treated with hydroxychloroquine, 50% developed a new onset of psoriasis, 27.8% experienced aggravated symptoms, and 22.2% experienced a relapse of psoriasis after treatment.

Because of its potential in worsening psoriatic arthritis symptoms, hydroxychloroquine is not recommended to prevent or treat COVID-19 in patients with psoriatic arthritis.

The use of monoclonal antibodies along with quarantine at home are recommended for people with psoriatic arthritis who become infected with coronavirus.

If hospitalization is required, it is recommended that people with psoriatic arthritis are treated with remdesivir, dexamethasone, and baricitinib.

Frequently Asked Questions

How can I stay on top of my treatment for psoriatic arthritis during the COVID-19 pandemic?

Telehealth visits are recommended for patients with psoriatic arthritis to maintain communication with their healthcare providers and avoid exposure to COVID-19. Current research suggests that short-term breaks from in-person visits with rheumatologists do not have a major negative impact on the severity or progression of psoriatic arthritis symptoms, and that telehealth visits should be used to supplement in-person care whenever possible.

Should I get a COVID-19 vaccine if I have psoriatic arthritis? 

Although patients with rheumatologic conditions like psoriatic arthritis have not been included in widespread clinical trials for the COVID-19 vaccines, the National Psoriasis Foundation Task Force recommends that people with psoriatic arthritis should get a vaccine to decrease their risk of COVID-19 and related complications.

Should I stop taking my medications for psoriatic arthritis to decrease my risk of COVID-19?

For people with psoriatic arthritis who got COVID-19, no significant difference in symptoms has been reported between those who discontinued their medication and individuals who continued with their regular treatment.

There is no evidence at this time that suggests that biologic medication increases the risk of COVID-19. Stopping treatment is not recommended by the American College of Rheumatology because it can cause worsening psoriatic arthritis symptoms and increased risk of flare-ups. In those who tested positive for COVID-19, discontinuation of medication should be considered on a case-by-case basis.

How to Stay Safe

To minimize your risk of COVID-19, the Centers for Disease Control and Prevention (CDC) advises those who may be at increased risk to:

Stay home as much as possible.

Avoid crowds and limit close contact with other people in public (maintain a social distance of six feet).

Avoid touching your eyes, nose, or mouth in public.

Disinfect or avoid touching frequently used surfaces in public places, such as doorknobs, elevator buttons, and shopping carts.

Wash your hands with soap and water for 20 seconds or use an alcohol-based hand sanitizer to clean your hands after going outside or touching public surfaces.

Symptoms of COVID-19 may appear between two and 14 days after exposure, and can include:

Cough

Shortness of breath

Fever

Chills

Loss of taste or smell

Sore throat

Headache

Muscle or body aches

Diarrhoea

Nausea or vomiting

Congestion

Fatigue

If you have any of these symptoms, it is best to get a COVID-19 test to determine if you have been infected. You can visit the website of your local or state health department to find a testing location near you. COVID-19 tests are typically covered by your health insurance or free if you are uninsured.

A Word From Verywell

While people with psoriatic arthritis taking biologic medications may be at an increased risk of infections, there is no evidence at this time that they are at an increased risk of acquiring COVID-19 or having more severe symptoms if they do become sick. It is recommended that people with psoriatic arthritis continue their medication and get a COVID-19 vaccine. Do not stop your medications without consulting your doctor first. Talk to your healthcare provider about your concerns regarding COVID-19 and medications.

https://www.verywellhealth.com/psoriatic-arthritis-and-covid-19-5176460