Last updated 13 May 2020
Authors: Dr Jacqui Bollmann, Consultant Occupational Physician and Force Medical Adviser South Yorkshire Police
Dr Emma McCollum, Occupational Physician, Torbay and South Devon NHS Foundation Trust
Reviewed by: Prof Karen Walker-Bone, Professor of Occupational Rheumatology and Honorary Consultant Rheumatologist, University of Southampton and Director, Arthritis Research UK/MRC centre for Musculoskeletal Health and Work
|
Rheumatology condition
|
Vulnerability
|
References
|
| Ankylosing spondylitis | Add 2 years
Add another 6 years (total 8) if on immunnosuppressants |
Provisional guidance, may change as new evidence emerges |
| Chronic Fatigue Syndrome/CFS/ME | Low | Unless also on immunosuppressant treatment |
| Connective tissue disorders and inflammatory conditions
ANCA-associated vasculitis Aortitis Autoinflammatory syndromes Bechet’s disease Churg strauss syndrome Cogan’s syndrome Cryoglobulinemia Fibrodysplasia ossificans (progressive) Giant cell arteritis/temporal arteritis Granulomatosis with polyangiitis Hypocomplementaemic urticarial vasculitis IgA vasculitis IgG4- related disease (IgG4 RD) Interstitial lung disease (ILD) related to CTD/RA Kyphosis/scoliosis for rare bone disease (severe) Microscopic polyangiitis Osteogenesis imperfecta (severe) Polyarteritis nodosa Pulmonary Hypertension (PH) related to CTD/RA Relapsing polychondritis Still’s disease, adult onset Takayasu disease/arteritis Vasculitis (any) Wegener’s, eosinophilic granulomatosis with polyangiitis |
Add 2 years
Add another 6 years (total 8) if on immunnosuppressants |
Provisional guidance, may change as new evidence emerges |
| Fibromyalgia | Low | Unless also on immunosuppressant treatment |
| Juvenile idiopathic arthritis | Add 2 years
Add another 6 years (total 8) if on immunnosuppressants |
Provisional guidance, may change as new evidence emerges |
| Myositis, polymyositis, dermatomyositis, antisynthetase syndrome
|
Add 2 years
Add another 6 years (total 8) if on immunnosuppressants Add further years for additional comorbidities |
Provisional guidance, may change as new evidence emerges |
| Osteoarthritis | Low | Unless also on immunosuppressant treatment |
| Polymyalgia rheumatica | Add 2 years
Add another 6 years (total 8) if on immunnosuppressants |
Provisional guidance, may change as new evidence emerges |
| Psoriatic arthritis | Add 2 years
Add another 6 years (total 8) if on immunnosuppressants |
Provisional guidance, may change as new evidence emerges |
| Rheumatoid arthritis | Add 2 years
Add another 6 years (total 8) if on immunnosuppressants |
Provisional guidance, may change as new evidence emerges |
| Sjogren’s syndrome, primary
Risk assess by medication and overlap connective tissue disease
|
Add 2 years
Add another 6 years (total 8) if on immunnosuppressants |
Provisional guidance, may change as new evidence emerges |
| Treatment
Steroid (prednisolone) ≥ 20mg (0.5mg/kg) daily for more than 4 weeks Cyclophosphamide at any dose orally or within last six months IV Steroid (prednisolone) >5mg per day for more than 4 weeks plus at least one other immunosuppressant, biologic/monoclonal or small molecule immunosuppressant Any two immunosuppressant, biologic/monoclonal or small molecule immunosuppressant with any co-morbidity |
Very high | https://www.rheumatology.org.uk/Portals/0/Documents/Rheumatology_advice_coronavirus_immunosuppressed_patients_220320.pdf?ver=2020-03-22-155745-717
https://www.rheumatology.org.uk/Portals/0/Documents/COVID19_risk_scoring_guide.pdf?ver=2020-03-24-171133-657 https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/clinical-guide-rheumatology-patients-v1-19-march-2020.pdf |
| Treatment
Some medications would place the individual across two risk bands depending on other factors Cyclophosphamide IV or oral Mycophenolate mofetil Myfortic Tacrolimus BIOLOGICS: Anakinra SCc Apatacept IV or SC Apremilast Belimumab IV Ixekizumab Rituximab (Mabthera, Rixathon, Truxima), especially if taken in the last 12 months Sarilumab Secukinumab Anti-TNF drugs: Etanercept (Benepali, Enbrel, Elrezi) Tocilizumab Ustekinumab JAK inhibitors: Baricitinib oral Tofacinitib oral |
Very high or high | |
| Treatment
Well controlled patients with minimal disease activity and no co-morbidities on single agent broad spectrum immunosuppressive medication, biologic/monoclonal or small molecule immunosuppressant Well controlled patients with minimal disease activity and no co-morbidities on single agent broad spectrum immunosuppressive medication plus sulphasalazine and/or hydroxychloroquine Well controlled patients with minimal disease activity and no co-morbidities on single agent broad spectrum immunosuppressive medication at standard dose (e.g. methotrexate up to 25 mg/week) plus single biologic The following medications: Azathioprine Ciclosporin Leflunomide Methotrexate Prednisolone 10-19mg/day |
High | https://www.rheumatology.org.uk/Portals/0/Documents/Rheumatology_advice_coronavirus_immunosuppressed_patients_220320.pdf?ver=2020-03-22-155745-717 |
| Treatment
Well controlled patients on Hydroxychloroquine Only inhaled or rectally administered medication Prednisolone <10mg daily Single agent 5-ASA medications (e.g. Mesalazine) Single agent 6-mercaptopurine Sulphasalazine Patients after apheresis Patients after stem cell transplant, depending on how long after |
Increased or low | https://www.rheumatology.org.uk/Portals/0/Documents/Rheumatology_advice_coronavirus_immunosuppressed_patients_220320.pdf?ver=2020-03-22-155745-717
Consider co-morbidities, disease control and guidance at bottom of table in reference |
Risk of severe illness or death if contracts COVID-19. Read more
Likely to need hospitalisation if contracts COVID-19, with protracted illness and heavy NHS burden. Read more
Increased risk compared with healthy individual but should recover.
No greater risk than healthy individual.