Arthritis: Symptom in the face that can be a sign of autoimmune disease

From express.co.uk

ARTHRITIS is very common condition that causes pain and inflammation in the joints. Symptoms can appear in a number of places other than the joints, including on the face

Around 10 million people live with arthritis in the UK. The most common form of the inflammatory joint condition is Osteoarthritis, making up 90 percent of cases. Less common is rheumatoid arthritis. The difference between the two conditions is that osteoarthritis occurs when the cartilage joint wears out whereas rheumatoid arthritis is an autoimmune disease where the immune system attacks the body.

As with other forms of arthritis, Rheumatoid arthritis mainly affects the joints. However, other symptoms can impact other areas of the body. For example, a patient may experience dry eyes or chest pain if these areas have become infected. Other non-joint related symptoms of rheumatoid arthritis include tiredness, lack of energy, a high temperature, sweating, a poor appetite, and weight loss.

As well as reducing quality of life, rheumatoid arthritis can cause a number of complications. It can increase an individual’s risk of developing carpal tunnel syndrome, a condition that causes pressure on nerves in the wrist. Symptoms include aching, numbness, and tingling in the thumb, fingers, or part of the hand.

A symptom of rheumatoid arthritis can appear on the face. (Image: Getty Images)

Widespread inflammation, joint damage, cardiovascular disease, and cervical myelopathy are also potential as a result of developing rheumatoid arthritis. Unfortunately, there is no cure for rheumatoid arthritis, but treatments can be prescribed in order to reduce inflammation and relieve pain.

A series of medications, treatments, and therapies can be employed in order to alleviate discomfort of patients with rheumatoid arthritis.

Surgery can be used to help restore the ability of an individual to use their joint while dietary changes may also be employed. For more information on rheumatoid arthritis, contact the NHS or consult with your GP. 

Rheumatoid arthritis is an autoimmune condition where the immune system attacks the joints. (Image: Getty Images)

Elsewhere, experts from the University of Oxford have found a drug used to treat rheumatoid arthritis could be used to treat Covid.

Researchers have found the drug baricitinib can reduce the risk of a patient dying from COVID-19.

Professor Sir Martin Landray said in a statement: “What we have now is a suite of drugs which tackle the immune system at different levels, and [in] slightly different ways, which depending on the patient and their circumstances, and their other illnesses and so on, can be used either alone or in combination”.

The results of the study also suggested that baricitinib’s impact was such that patients treated with the drug were less likely to require mechanical ventilation.

While the drug’s impact was found to be small, it was nevertheless beneficial. In the fight to save a live, sometimes the smallest margins can make the biggest difference.

Despite the ongoing burden of Covid, the NHS continues to try and serve all those who require its assistance.

https://www.express.co.uk/life-style/health/1576228/URL-arthritis-symptoms-symptom-face-dry-eye

Can you get arthritis after Covid-19? Here's what you need to know

From hindustantimes.com

Are you troubled by severe joint pain with swelling post Covid-19? It could be reactive arthritis. Here's what you need to know

Recovered Covid-19 patients may continue to experience symptoms like body ache and fatigue in many cases. While most post-Covid complications ease on their own, for others you need to be watchful of specific symptoms. For instance, severe joint pain and body stiffness in the early morning are signs that you may be suffering from reactive arthritis, a type of inflammatory arthritis.

Reactive arthritis occurs post infection, associated with bacteria causing infective diarrhoea or urinary tract infection. The body's immune system seems to overreact to the infection and starts attacking healthy tissue, causing it to become inflamed. But the exact reason for this is unknown. People who have a gene called HLA-B27 are much more likely to develop reactive arthritis than those who don't but it's unclear why.

Covid-19 is known to cause certain autoimmune diseases which includes reactive arthritis. The symptoms start a week after Covid infection and affects males more than females.

Symptoms of reactive arthritis

"The joint pains mainly affect knees, ankles and feet though occasionally may also involve wrist and shoulders. The intensity of pain in reactive arthritis tends to be moderate to severe in intensity, associated with joint swelling, early morning stiffness lasting for more than half an hour," Dr Puneet Mashru, M.D (Medicine); S.C.E Rheumatology (U.K), Consultant-Rheumatologist at Sir H N Reliance Foundation Hospital told HT Digital.

How to diagnose reactive arthritis

"The diagnosis of reactive arthritis is a clinical diagnosis. We generally recommend blood tests for signs of inflammation, antibodies associated with other types of arthritis and genetic marker linked to reactive arthritis (HLA b27)," adds Dr Mashru.

How to manage reactive arthritis

* The arthritis can be managed by using painkillers in most patients and the disease may resolve by itself over a few weeks.

* Using icing may also help to alleviate the pain and reduce inflammation.

"If these agents are insufficient then joint injections or arthritis medications (disease- modifying antirheumatic drugs) like sulfasalazine or occasionally a short course of oral steroids may be needed," says the rheumatologist.

A physiotherapist can provide you with targeted exercises for your joints and muscles once the acute inflammation starts reducing. Strengthening exercises increase the joint's support by developing the muscles around the affected joints. Range-of-motion exercises can increase your joint's flexibility and reduce stiffness.

https://www.hindustantimes.com/lifestyle/health/can-you-get-arthritis-after-covid-19-here-s-what-you-need-to-know-101644391299728.html

Getting a Third Dose of the COVID-19 Vaccine When You Have Rheumatoid Arthritis

From everydayhealth.com

Should everyone get it? Is it safe? We have answers.

In late August, the Centres for Disease Control and Prevention (CDC) recommended that people who are moderately or severely immunocompromised get a third dose of the Pfizer-BioNTech or Moderna mRNA vaccine. This group, which includes people on medications commonly used for rheumatic diseases such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), remain vulnerable to contracting COVID-19 even after they’ve had their two shots, the agency said.

To help people understand what this means for those with these diseases, the American College of Rheumatology has again updated its clinical guidance for physicians.

People with RA have many questions about the COVID-19 vaccine, and especially about this newly added dose. To get answers to common questions, we spoke with Juan J. Maya-Villamizar, MD, a rheumatologist at the Rheumatology Centre of Palm Beach, in Lake Worth, Florida, and a medical adviser to the digital arthritis community CreakyJoints.

Everyday Health: Does the CDC’s recommendation that people who are immunocompromised get a third shot of their mRNA vaccines apply to everyone with rheumatoid arthritis?

Dr. Juan Maya-Villamizar: It isn’t the fact that people have an autoimmune condition like RA that is the issue, but rather that people with these diseases generally take immunosuppressive drugs. The need for the third shot covers people on most of the medications we use for RA with the exception of the drug hydroxychloroquine.

Some medications that trigger the need for a third dose include steroids, tumour necrosis factor inhibitors (TNFi), interleukin-6 inhibitors (IL-6), methotrexate, sulfasalazine, leflunomide, azathioprine, mycophenolate, and Janus kinase (JAK) inhibitors. People who are not on immunosuppressive drugs because they have low disease activity or who are only on hydroxychloroquine are not part of this group.

EH: Why will people on these meds benefit from that third shot?

JMV: The data so far are preliminary, but what it has shown is that antibodies against COVID-19 are often not generated after the second dose. In some studies, up to 50 percent of patients who are on an immunosuppressive medication did not make antibodies. By getting the third dose, the number of people who finally develop antibodies goes up. Even so, not everyone will make them.

EH: The CDC is not calling this a booster, but rather a third shot in the series. Why are they making that distinction?

JMV: They want to clarify that a booster is when someone gets an antibody response but then it starts fading, and the next shot is to regain the response. Here they are saying the third shot is part of the series of vaccines needed to create the response in the first place. Also, it emphasizes how important this third shot is for immunocompromised people in order to make the immunization effective.

EH: When should a person get the third dose?

JMV: The recommendation is to get the shot at least four weeks after the second shot of your Pfizer or Moderna vaccine. If possible, you should stick with the same one you had before. So if you had Moderna for your first two shots, you should try to get that for your third. The implication of the CDC’s words “if possible” is if you’re not able to get the same vaccine for some reason, you can get the other mRNA vaccine.

So far there is no official recommendation about another shot for people who initially got the Johnson & Johnson vaccine, but we expect that to be coming.

EH: Are there risks to getting an additional shot?

JMV: For immunocompromised patients there have not been any risks reported, other than reactions that are expected for any vaccine: localized arm pain or reactions, or symptoms like you get with a cold such as muscle aches, fever, or chills. If you had a reaction to your prior shots that doesn’t mean you will have one after the third shot, but it is possible.

People with RA may also get a little flare of joint pain. The recommendation is to use your typical medications, such as acetaminophen, ibuprofen, or Aleve. Be sure to talk to your rheumatologist if you feel you’re having a severe joint pain reaction.

Of course, with any type of intervention there is always a very small percentage of unexpected reactions. If something comes up that concerns you after you get the third shot, speak to your doctor.

EH: The American College of Rheumatology recommends that people briefly shift the timing of some of their medications when they get the first or second shot if their disease is stable. For example, they suggest that JAK inhibitors should be delayed for a week after each COVID-19 vaccine dose. Do these same recommendations apply for the third shot, too?

JMV: The task force agreed that certain medicines should again be held for one to two weeks around the vaccine, such as mycophenolate and JAK inhibitors. But they did not reach consensus about shifting medications around the third shot for many medicines, including steroids and most biologics. I myself am telling my patients whose disease is stable to follow the same recommendations as for the other shots, since this may help improve response to the vaccine. Everyone should talk to their doctor about their own treatment situation.

EH: Are there other things people with a rheumatic disease should know about the vaccines?

JMV: Without question everyone should get vaccinated. Recent data show that most hospital admissions for COVID-19 are in unvaccinated patients. It’s clear that getting vaccinated decreases your risk of a hospital admission and prevents you from getting stronger forms of the disease. Staying out of the hospital has additional benefits for immunocompromised people because of all the other infections that live there.

If you have specific concerns that are holding you back from being vaccinated, be sure to share them with your doctor.

Even after you get the three shots, it’s still important for people who are immunocompromised to diligently follow other COVID-19 prevention measures, such as wearing a mask; avoiding large gatherings, especially in poorly ventilated spaces; and maintaining at least six feet of distance from other people.

https://www.everydayhealth.com/rheumatoid-arthritis/getting-a-third-dose-of-the-covid-19-vaccine-when-you-have-rheumatoid-arthritis/

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

The Bottom Line on PsA Treatment During COVID

From healthcentral.com

Yes, we’re still dealing with a pandemic, but now is no time to quit seeing your doc

In the world of diseases, psoriatic arthritis is a double-edged sword. On one end you have the inflammation, joint pain, stiffness, and swelling that comes courtesy of arthritis. On the other end are the hallmark red, itchy, scaly patches of skin that psoriasis brings (consider yourself doubly blessed).

According to the National Psoriasis Foundation, psoriatic arthritis affects about one million people in the United States. Most people with the disease develop psoriasis first and arthritis later. And it doesn’t take much for one disease to turn into the other—especially in the way of the psoriasis. “When I think someone has psoriatic arthritis, I'll go on a rash hunt, and a lot of times, the only thing I’ll find is a little patch of psoriasis behind the ears,” says Martin Bergman, M.D., chief of the division of rheumatology at Taylor Hospital in Ridley Park, PA and clinical professor of medicine at Drexel University College of Medicine.

Finding that tell-tale patch is critical to helping your doctor correctly diagnose PsA, and the sooner the better since research shows that patients fare far better when their condition is treated early and consistently. Which takes us to our next point: Managing your PsA requires regular treatments and evaluations, and that means seeing your doc—yes, even during COVID.

Taking COVID Into Account

When you have a chronic, inflammatory disease like PsA, consistent, regular care and medication are key to managing the condition so you can live a normal, discomfort-free life. That said, lately, thanks to COVID concerns, more and more people are postponing regular doctors’ appointments. According to a study by the Kaiser Family Foundation, nearly half (48%) of adults say someone in their household has postponed or skipped medical care because of the coronavirus outbreak, and what’s worse, 11% of adults overall said their family member’s condition got worse as a result of postponing or skipping medical care due to coronavirus.

The thing is, a chronic condition like PsA is with you for a lifetime, so, like a stage-five clinger, it’s always going to be there even when you're feeling well, and still has the ability to cause inflammation, Dr. Bergman says. What this also means is: You cannot stop treatment. “If you stop your medicine, it’s going to take longer to get it back under control, and every time you do that, you have inflammation,” he says. “And inflammation causes damage.” Worst-case scenario? “PsA can destroy joints and lead to deformity and dysfunction. You can get to a point where you can't make a fist, you can't bend your wrist, and you have difficulty walking.” Not to mention, long gaps between restarting your medicine can cause your body to build up resistance. “You can make an otherwise effective medicine ineffective,” Dr. Bergman says.

Why Regular Care Is Key

If you’re taking your meds on the regular and following your doctor’s orders, chances are, you’ve got the condition under control and you're feeling good. But, if you are experiencing a flare, which usually looks like increased joint pain, stiffness, swelling, tenderness, and fatigue, you need to see your doctor for an in-person check-up. 

The reason this is so crucial is because having a flare-up tells your doctor that your medication isn’t working, Dr. Bergman says. “I need to figure out why. Is it because I have you on the wrong medicine or dosing schedule? Are you not taking the medication the way I wanted you to? It's important to have flares followed because it may mean you need to adjust, change, or stop and restart a new medicine,” he said.

And the problem with telemedicine are the subtleties. “I can't pick up a slight change in the swelling of a joint of your wrist; I have to feel it," he says. "This is why I like to see my patients every three months.”

While you may be apprehensive to step inside your doctor’s office, there is no research to suggest having PsA increases your risk for COVID or make your symptoms worse, Dr. Bergman says. In addition, guidelines published in Arthritis & Rheumatology by the American College of Rheumatology state there is no compelling evidence those with rheumatic disease are at a greater risk of COVID‐19 complications.

Still need extra reassurance to feel secure seeing you doc? Practices have more safety protocols in place than ever before:

• Distanced waiting room seating (or no waiting room altogether)

• Screenings and paperwork ahead of time

• Serious room sanitization

Bottom line: Avoiding your doctor's office will have virtually no effect on whether or not you get COVID, but it most certainly will effect how well you're able to manage your psoriatic arthritis. Moral of the story? Don’t put off your appointments.

https://www.healthcentral.com/article/the-bottom-line-on-psa-treatment-during-covid

Keeping yourself healthy when working from home

From versusarthritis.org

We are all adjusting to the changing situation around coronavirus and how it affects our lives. It’s likely many of us are working from home and it’s important to think about how this may affect our musculoskeletal health and wellbeing.

A survey by the Institute of Employment Studies (IES) revealed a significant increase in musculoskeletal complaints. Many of those surveyed reported new aches and pains, especially in the neck, shoulder and back. For expert advice on managing pain, read coronavirus and how to manage your pain at home.

Our Versus Arthritis wellbeing experts Cherry, Workplace Wellbeing Manager and Yash, Organisational Development Partner, share their top tips to help you look after your musculoskeletal health while working from home.

First and foremost, remember to be kind to yourself and to others. These are unprecedented times, so be kind, take it day by day and do what you need to manage your health and wellbeing.

Work life balance – have a routine!

Our routines may look slightly different now and may be disrupted day to day. The current situation is not a normal one, so it’s important to make sure you’re balancing work with other family demands.

• Whilst our routines may have had to change, try to keep to some routine where possible, so that you can manage your wellbeing. Read more advice about arthritis and coronavirus – looking after your wellbeing.
• Think about how you’ll structure your day, including how you can now use your ‘commuting time’ e.g. maybe for some additional family time or time to set aside for exercise and rest.
• As part of that routine include an ‘end’ to your workday, whether that’s moving away physically from where you’re set up to work, packing up your equipment so it’s out of sight or just mentally ending the day by switching off.
• When ‘ending’ the workday, try to do so a good few hours before bed, so you can include a wind-down routine to help you sleep, rather than still having work on your mind. Sleep is essential for our wellbeing and for ensuring good musculoskeletal health. Read our top tips for good sleep.

Stay connected

It’s important to look after our emotional wellbeing during the current crisis, especially if you’re self-isolating. Working from home can add to feelings of isolation if not managed, which can have a negative impact on our overall wellbeing, so staying connected is really important.

• Keep in touch with colleagues, friends and family members regularly so that you’re not feeling isolated.
• Stay connected with work. At Versus Arthritis we have regular ‘Great Conversations’ rather than appraisals and it’s more important than ever that we check in regularly, with our managers so we’re clear on what we need to achieve and can adapt as needed.
• Staying connected will mean different things to different people, so find out what works for you.
• Use Skype/Teams/Zoom to have collaborative conversations (informal and formal) and use the video function.
• Don’t just focus on work, initiating scheduled virtual check ins, coffees, quizzes can be a great way to keep in touch and break down ‘virtual’ barriers.
• Ask how colleagues are doing and share how you’re feeling or adapting. This is challenging for everyone so check in with colleagues, and if you’re struggling, talk to your manager, colleague, or organisational wellbeing support.
• If you’re worried about your arthritis and coronavirus and want to chat to someone, call our helpline or visit our online community and talk to other people.

Find a suitable space

If you’re used to working in an office, then your current environment most likely doesn’t have the same equipment and set up, and you may find you’re sharing your workspace with other family members.

• Create a suitable and safe space dedicated to work that limits distractions, and that you can set up with everything in the right place for work.
• Try and aim for a space with adequate lighting, comfortable chair and desk, monitor and laptop set up properly and at the right height. Read more about getting the right support at work.
• Avoid working from a soft surface with no support such as working from your bed or slouching on the couch (however tempting!). This may feel comfortable at the time but will soon lead to aches and pains.
• Consider alternative ways of creating a comfortable working environment where you don’t have the same set up as you would have in the office, e.g. by using supporting cushions to help chair comfort and height, or raise the height of the computer screen.
• Be conscious of your posture and try and avoid spending too long in the same position.

Keep moving!

With all meetings taking place virtually, and without the office distractions, we can end up sitting at our desk and staring at our computer screen longer than we usually would. As humans though we were designed to move, and this is particularly important for our joints.

• Take regular breaks from sitting throughout the day – get up from your chair at least every hour (preferably more!) to move, stretch and take a break from your computer screen.
• Stand during a call, put the kettle on, or put reminders in your diary if you have too!
• Keep active – find 20-30 minutes regularly for some form of exercise and choose one you enjoy and that is manageable and realistic for you.
• For ideas on exercise options check out our exercise resources and specific exercises to manage pain. You can get more inspiration from the We are Undefeatable website. They have ideas ranging from chair exercises, yoga to dancing in your kitchen.
• Let’s Move with Leon is our free exercise programme featuring weekly 30-minute movement sessions delivered to your email inbox.  Sign up today, and we’ll be there to support you every step of the way. 

Eat a healthy, balanced diet

When you’re stuck at home and your routine is potentially different to usual, it’s easy to find yourself snacking during the day or missing meals, whilst exercising less. But we know that keeping a healthy diet and weight can be important for your musculoskeletal health.

• Make sure you don’t forget your lunch breaks and keep healthy snacks to hand.
• Try batch cooking healthy foods you can keep in the freezer – they can help ensure you have healthy lunches and dinners available. These can be easy options for a day when cooking may be more difficult. Read more tips – healthy eating made easy.
• If your current routine does mean you work later, try and take a break for dinner so you’re not eating too late.

https://www.versusarthritis.org/news/2020/april/keeping-yourself-healthy-when-working-from-home/

Does lupus or arthritis affect your prognosis if you get COVID-19?

From health.harvard.edu

By Robert H. Shmerling, MD

Soon after the coronavirus pandemic began, we learned that older adults and people with certain chronic conditions, such as high blood pressure or diabetes, are at increased risk for severe COVID-19. One condition on that list is an immunocompromised state (a weakened immune system). This can be due to a number of conditions, including having had an organ transplant, having HIV, or taking medications that suppress the immune system.

If you have an autoimmune condition such as rheumatoid arthritis or lupus (also called systemic lupus erythematosus), you may wonder how this affects your risk. It’s thought that these conditions occur because the immune system misfires and attacks organs in the body. And many people with these disorders are treated with medications that suppress the immune system.

Two newly published studies examine this. While the results are not definitive, they do provide some reassurance. Most people recovered from COVID-19, and most of their prior treatments did not seem to worsen their infections.

Lupus and COVID-19

In the first study, researchers enrolled 226 people with lupus. After comparing those who had COVID-19 with those who did not, they found that

• nearly 60% of those with COVID-19 and lupus became sick enough to be hospitalized, and 10% were admitted to the intensive care unit.
• about 10% died.
• risk factors for hospitalization were similar to those reported in people outside of this study who did not have lupus. For example, race (more hospital admissions among those who were Hispanic or nonwhite), other chronic diseases (including kidney failure, lung disease, and hypertension), and being overweight or obese were more common among those needing hospital admission.
• steroid treatment for lupus was nearly two times higher among hospitalized patients (54%) compared with those who were not hospitalized (29%). However, this difference was not statistically significant.
• treatment with other immune-suppressing medications taken for lupus (such as azathioprine or mycophenolate) was similar in both groups.

Inflammatory arthritis and COVID-19

The second study included 103 people with inflammatory arthritis (which includes rheumatoid arthritis and related conditions) who were also diagnosed with COVID-19. Some were hospitalized with severe disease, while others were treated as outpatients. Here’s what the study found.

• 26% of study subjects were hospitalized.
• About 4% died.
• Risk factors for hospital admission included being 65 or older, high blood pressure, and lung disease.
• Steroid treatment for inflammatory arthritis was more common among those hospitalized (37%) than those treated as outpatients (about 4%).
• Biologic therapy (such as etanercept or infliximab) did not appear to increase the risk of severe COVID-19. One other type of treatment — JAK inhibitors, which include tofacitinib (Xeljanz) — was more common among those requiring hospital admission. However, few patients were taking this medication.

Why these studies aren’t the last word

These studies only included patients with COVID-19 and either SLE or inflammatory arthritis. It wasn’t possible to rigorously compare the study participants to people without lupus or arthritis. Also, these studies did not include large numbers of people with lupus or arthritis who tested positive for the virus, yet did not have symptoms of COVID-19 (asymptomatic infection). Nor did they confirm the diagnosis of COVID-19 in every suspected case. So, while this research offers some new information, the true impact of lupus or arthritis on people who develop COVID-19 hasn’t yet been determined.

Finally, the lupus study was small: only 41 subjects had confirmed COVID-19. Although the findings on steroid treatment weren’t statistically significant, that might not have been true if the differences observed persisted in a larger study.

The bottom line

Public health experts often include people with autoimmune disease on the list of those who are more likely to have a bad outcome if they develop COVID-19. The relatively high rate of hospital admission for lupus patients with COVID-19 confirms an increased risk for severe disease. Other standard risk factors (such as high blood pressure or lung disease) apply, but steroid therapy may increase risk even further. Other studies have come to similar conclusions (see here and here).

There was some good news to emphasize in these trials: the survival rate among patients with lupus or inflammatory arthritis who develop COVID-19 was relatively high. Also, biologic therapy did not appear to worsen prognosis for the arthritis patients. And other immune suppressants did not worsen prognosis for those with lupus. And, the hospitalization rate for COVID-19 among patients with inflammatory arthritis was similar to what has been reported for people without arthritis.

These findings add to what we are learning about COVID-19. Clearly, we need to learn more. For example, is there a dose of steroids to treat chronic illness that is so low that it does not increase the risk of a worse prognosis with COVID-19? Do certain medications (such as biologics) actually reduce the risk of severe COVID-19? Until we do know more, it remains particularly important for people with lupus and inflammatory arthritis — especially those taking steroids — to be especially vigilant about measures to avoid COVID-19.

https://www.health.harvard.edu/blog/does-lupus-or-arthritis-affect-your-prognosis-if-you-get-covid-19-2020110921230

What To Know About COVID-19 And Arthritis

From southfloridareporter.com

Experts do not yet understand how COVID-19 may affect someone with arthritis relative to the general population.

However, it appears that people with inflammatory or autoimmune arthritis may be at greater risk of contracting the infection, and developing more severe symptoms, than others.

Keep reading to learn more about the potential effects of COVID-19 on those with certain types of arthritis. This article also covers some precautions that people can take to reduce their risk of contracting the virus.

How does COVID-19 affect people with arthritis?

Neither researchers nor doctors know the exact effects of COVID-19 on people with arthritis. The World Health Organization (WHO) and other expert bodies are still learning about the impact of the virus on people with pre-existing health conditions.

According to the Arthritis Foundation, people with autoimmune or inflammatory arthritis with high disease activity generally have a higher risk of infections due to reduced immune function.

Regarding children with arthritis, the Arthritis Foundation suggests that factors such as arthritis type, disease activity, the involvement of organs, and the level to which their immune system is suppressed may all play a role in the risk of coronavirus infection.

Some research suggests that people with rheumatoid arthritis (RA) have an increased risk of infection because their immune system is impaired. This is typical in autoimmune conditions such as RA.

Furthermore, these people may take medications — such as corticosteroids and immunosuppressive drugs — that also affect immune function. This may increase their risk of contracting the virus.

The presence of other underlying conditions, such as diabetes or heart disease, can further increase risk.

Is COVID-19 more dangerous for people with arthritis?

There is not yet enough evidence to confirm this, but it seems that people with autoimmune or inflammatory arthritis may be at higher risk of infection or severe COVID-19 symptoms.

The Centres for Disease Control and Prevention (CDC) report that conditions or medications that weaken the immune system increase the risk of severe illness with COVID-19.

Experts suggest that the main concerns for those with autoimmune conditions who develop COVID-19 include secondary bacterial infections and other complications that may result from the initial viral infection.

In general, those who take immunosuppressive medications, such as biologics or corticosteroids, are at higher risk of a severe viral infection. People who take immunosuppressive medications and who develop flu-like symptoms should call their doctor immediately.

Healthcare professionals typically do not recommend immunosuppressive treatments in those with active infections, but the risk of disease flares is also worth consideration. A person can determine whether to discontinue, taper, or maintain their medication by consulting their doctor.

Those who take immunosuppressive drugs and who do not have symptoms of COVID-19 should discuss their options with their doctor. In some cases, the risk of arthritis flares may outweigh the potential benefits of stopping treatment.

In either case, it is important that people do not adjust their dosage or stop taking their medication without first seeking medical advice.

Symptoms to look out for

Common COVID-19 symptoms, according to the WHO, include:

• a dry cough
• fatigue
• a fever

Other symptoms may include:

• aches and pains
• breathing difficulties
• gastrointestinal symptoms, such as diarrhoea
• a stuffy or runny nose
• shortness of breath
• a sore throat
• red or watery eyes
• severe headaches

In most cases, the symptoms will begin within 2-14 days of exposure to the virus. Most people will experience only mild symptoms, though some will have more severe ones.

Some individuals may be asymptomatic. This means that they have the illness but do not display any symptoms. It is important to note that those who are asymptomatic can still transmit the virus to others.

Extra care and precautions

The CDC explain that the virus SARS-CoV-2 which causes COVID-19 spreads very easily and efficiently between people. To reduce the risk of contracting the virus, people should:

• Wash the hands regularly with soap and water, for at least 20 seconds.
• Use an alcohol-based hand sanitizer containing at least 60% alcohol when soap and water are not available.
• Maintain a physical distance of 6 feet (2 metres) from other people, especially those who are unwell.
• Limit the time outside of the home, including in grocery stores and on the streets. When it is necessary to leave the home, try to wear a face mask.
• Stock up on food, medications, and other essential items to reduce the number of trips outside of the home.
• Disinfect surfaces and everyday household items frequently. Examples include faucets, door handles, toilet handles, keys, and remote controls.
• Avoid sharing utensils, towels, and other personal items with other people.
• Isolate sick members of the household in a separate bedroom and bathroom (if possible) until their symptoms resolve. These people should wear a face covering such as a mask when using shared spaces.
• Avoid all nonessential air and sea travel and other forms of public transport.
• Discuss the use of arthritis medications with a doctor to see if it is advisable to continue with the treatment.

Anyone who believes that they have had contact with someone with COVID-9 should:

• monitor their symptoms closely and check their temperature daily
• call their doctor immediately if any symptoms develop
• seek immediate medical attention if severe symptoms, such as breathing difficulties, occur
• call ahead before going to any healthcare facility

Treatment and symptom management

There is currently no specific treatment for COVID-19. Treatment aims to relieve symptoms in those who contract the virus. Options include:

• cough medicines
• fluids
• pain-relieving medications
• rest

Clinical trials and vaccine development studies are in progress at many medical centres around the world.
People who get severely ill typically require hospitalization. In the hospital, medical staff may use oxygen therapy or ventilators, or they may use other specialist treatments to alleviate the symptoms and prevent or manage complications.
Those with arthritis who contract COVID-19 should discuss their arthritis treatment with their doctor. The doctor, most often a rheumatologist, may suggest continuing with the treatment, tapering it off, or temporarily stopping use.
Medical professionals will advise their patients on a case-by-case basis.

What to do if the test is positive

A doctor will provide individual instructions to those who test positive for SARS-CoV-2. Typically, those who have mild symptoms can isolate and recover at home. Self-isolating prevents the spread of the virus to others.
Those with severe symptoms require urgent medical attention and perhaps a hospital stay. People with underlying conditions and those who take immunosuppressive drugs may also require additional medical care.

Outlook

The outlook for people who contract COVID-19 varies greatly. It depends on several factors, including:

• the severity of the disease
• the person’s age, sex, and ethnicity
• the presence of any underlying conditions
• the use of any immunosuppressive treatments

Current research indicates that around 80% of individuals experience mild-to-moderate symptoms, 13.8% develop severe disease, and 6.1% become critical and require intensive care.
Prompt medical treatment may improve the outlook and reduce the risk of complications. In severe cases of COVID-19, complications include pneumonia, organ failure, and death.

Summary

At present, experts are still unsure of the exact effects of COVID-19 on individuals with arthritis.
It appears that people with autoimmune or inflammatory arthritis and those taking immunosuppressive drugs may be more at risk of contracting the virus and experiencing more severe illness.

Those who have arthritis and develop flu-like symptoms should contact a doctor immediately, even if their symptoms seem mild. They will advise on the person’s arthritis treatment options and the next steps in COVID-19 diagnosis and treatment.

https://southfloridareporter.com/what-to-know-about-covid-19-and-arthritis/

UK Arthritis charity launches chatbot to offer Covid-19 advice

From uk.news.yahoo.com

A new chatbot is to offer health advice to arthritis sufferers during the Covid-19 pandemic.

The online tool has been developed by UK charity Versus Arthritis and is thought to be the first of its kind to specifically help people with a long-term health condition during the Covid-19 outbreak.

The tool, called Cova, has been developed in just two weeks and can be found on the Versus Arthritis website, where it offers information on medical advice and medication, isolation guidance, maintaining mental and physical health and managing work and finances.

Chatbots are artificial intelligence-powered tools which can automatically reply to questions and quickly provide the information requested by a user.

         The Cova chatbot provides information to arthritis sufferers around Covid-19. (Filament)

The tool was created alongside AI specialist firm Filament.

The charity said the chatbot can also be added to any website through a simple piece of code.

It added that the tool had been created after it saw a 71% increase in calls to its helpline from February to March.

The chatbot also includes a coronavirus risk calculator, developed by the British Society of Rheumatology, which helps people with arthritis and other musculoskeletal (MSK) conditions assess whether or not they are more vulnerable during the Covid-19 pandemic.

It is the charity’s second chatbot, following Ava, a virtual assistant released more than three years ago which offers general health information to people with arthritis and other MSK conditions.

Amanda Neylon, director of insight, data and technology at Versus Arthritis said the aim of the new software was to give people more options for getting vital health guidance.

“Getting up-to-date, high-quality, trusted health information and services that are available 24/7 are important at the best of times, but particularly during our current crisis,” she said.

“Cova is a one-stop-shop where people with arthritis and MSK conditions can go with confidence to get the information they need to maintain their health and wellbeing.

“Our helpline and face to face services provide essential support for people every day.

“During this period of uncertainty, we need to increase our digital services, which include our online community, website health information, social media, and virtual assistant, to support the millions of people with arthritis and MSK conditions particularly those who are most at risk from the coronavirus.

“We’ve been pioneering the use of AI technologies in the charity sector for several years with our chatbot Ava.

“Our nimble and innovative response will have a big impact for people in a time of great change and uncertainty.”

https://uk.news.yahoo.com/arthritis-charity-launches-chatbot-offer-114247457.html

Arthritis drug to trial as coronavirus treatment

From maltawinds.com

Scientists hunting for ways to adapt existing drugs for use by coronavirus patients are launching a clinical trial in New York to test whether an arthritis treatment could help sufferers and improve survival rates.

Sanofi, the French pharmaceutical company, and Regeneron, a US biotech, are trying to find out whether Kevzara, approved to treat rheumatoid arthritis, could help reduce patients’ inflammatory response to coronavirus. Many critically ill Covid-19 patients develop acute respiratory distress syndrome, as their immune system kicks into overdrive. 

The trial will start at New York hospitals but be expanded to 16 sites. It is expected to enrol up to 400 critically ill coronavirus patients, studying the drug’s impact on their fever and need for extra oxygen. It will also look at whether it prevents deaths or even hospitalisation. 

Many pharmaceutical companies have started trials based on existing drugs, which have proven they are safe to take, to see if they are effective at treating Covid-19. The drugs fall into three broad categories: antibodies taken and adapted from people who have recovered from the virus and used for infusions for the sickest patients; antivirals, such as drugs designed for HIV, Ebola, and malaria, which could stop the replication of the virus in the earlier stages; and anti-inflammatories, such as Kevzara, for treating immune system reactions like the one that occurs in the later stage of the disease.

A study in China of favipiravir, an antiviral developed by the Japanese Fujifilm group, is due out soon, while the first results from a study into remdesivir, an antiviral originally developed by California-based Gilead for Ebola, is expected in mid-April.  Kevzara is an antibody but was not designed for Covid-19.  Christos Kyratsous, vice-president of research in infectious diseases at Regeneron, said the drug may be able to provide some “temporary support”, especially in countries where the healthcare systems are overloaded.

He said anecdotal evidence from studying similar antibodies in China made him optimistic, “but we believe that it needs to be tested in the clinical setting to make sure the data we are getting is unbiased”, he said.  John Reed, Sanofi’s global head of research and development, said Kevzara could be a potentially important treatment option across the world.

“We expect to rapidly initiate trials outside the US. in the coming weeks, including areas most affected by the pandemic such as Italy.” Sanofi and Regeneron are working on efforts to develop a vaccine to Covid-19.  Regeneron is prepared to scale up manufacturing if the trial shows Kevzara is effective, Mr Kyratsous said, with facilities in Alberta, New York and Ireland.

https://maltawinds.com/2020/03/17/arthritis-drug-to-trial-as-coronavirus-treatment/

Arthritis medicine identified as a potential cure for coronavirus

From irishpost.com

A COMMONLY USED arthritis drug could prove to be a vital weapon in the fight against Covid-19.
Health authorities around the world are scrambling to find suitable and effective treatments for the deadly coronavirus, which has killed over 5,000 people since the outbreak began in December.

Recently, arthritis medicine has been used on coronavirus patients in Italy, producing "excellent results".
The thinking behind using the medicine is that it could help patients' immune systems by and stop the virus form attacking healthy cells.

Drugs which treat immune disorders like arthritis could help ease damage to the lungs and respiratory system caused by the immune system's overreaction to the Covid-19 virus, rather than killing it.

The drug in question, called Kevzara, was approved by the Food and Drug Administration in 2017 to treat rheumatoid arthritis.

An Italian hospital has confirmed that the drug "has shown it is effective against pneumonia caused by COVID-19."

One of the two patients treated - who was on life support - was taken off it last week because of the improvement in his condition.
The hospital said it had started treating two other patients with the virus on Tuesday and another two Wednesday.

https://www.irishpost.com/news/arthritis-medicine-identified-potential-cure-coronavirus-181600