Top Q’s About Seeing Your RA Doc During COVID
From fears of a flare to worries over human contact, we’re taking your questions straight to the pros.
If you’re living with rheumatoid arthritis, an autoimmune disease where the immune system targets your own body and attacks the joints, chances are you were taking your meds, seeing your doc, and managing the condition like a champ to avoid the stiffness, swelling, and pain that comes courtesy of the condition. But then came COVID. And all the uncertainty surrounding the sometimes-deadly virus may have sent your usual clockwork care into a tailspin. And you’re not alone, the CDC reported an estimated 41% of U.S. adults delayed or avoided medical care because of concerns about COVID-19, including 12% who reported having avoided urgent or emergency care.
However, managing a chronic disease like RA means sticking to your daily care plan and seeing your doctor for checkups—even in the face of a pandemic—to keep symptoms in control. To help your stress stay in check and ease any in-person visit angst, we asked some top rheumatologists to answer every question under the sun about the effects of COVID on RA, so you can get right back to your regularly scheduled care, stat.
Does being immunocompromised put me at higher risk of catching COVID?
In short, possibly. A 2020 study published in Clinical Rheumatology found that patients with RA are at a higher risk for coronavirus. The medications used to treat RA can slow down the immune system a bit, which might put you at risk for infection, says Brian LaMoreaux, M.D., senior medical director rheumatology at Horizon Therapeutics in Chicago. But (and it's a big but), if you are infected, you don’t have significantly worse outcomes than other patients, according to the study. (The data is preliminary.)
I’m afraid to be out in public, can I put my RA treatment on hold for now?
No. RA is a life-long condition that requires life-long care. “It's a disease that simply doesn't go away on its own; you’re seeing ongoing inflammation from your own immune system that damages the joints and the body,” Dr. LaMoreaux says. “You're not going to be able to solve it with things like exercising more or eating better; you need to manage it with pharmacotherapy,” he says.
Interrupting treatment can cause irreversible damage. “It's much easier to prevent the damage than to help the body heal that damage later, which takes a very long time,” he adds.
What COVID precautions is my doctor’s office taking to ensure patient safety?
“The risk at a doctor's office is going to be very small because offices are taking a lot of precautionary measures,” Dr. LaMoreaux says. There’s a good amount of screening for symptoms done (through questionnaires) even before you set foot in the office and again when you come in, Dr. LaMoreaux says. Appointments are staggered, and rooms are thoroughly cleaned between patients.
“We tend to wear both a mask and a face shield, and we ask patients to wear a mask. Most healthcare providers have had a chance to get the vaccine, and that means their chance of getting and spreading COVID is greatly reduced,” Dr. LaMoreaux says.
I don’t want to wait in a room with people who might have COVID–is there a solution?
There sure is. “Waiting rooms are not really being used right now, because we don't want people to intermix and share the same air,” Dr. LaMoreaux says, explaining that patient appointment times are being staggered instead. To minimize patient-to-patient contact even further, “some practices will let you wait in your car and call you when it is your turn to be seen,” says Lynn Ludmer, M.D., medical director of rheumatology at Mercy Medical Center in Baltimore, MD. “The idea is to bring patients straight back to an exam room when it’s their turn,” Dr. LaMoreaux says.
The reality is, you have a greater chance of catching COVID being out in the community. “The majority of people who contract COVID are exposed through family gatherings, bars, and gyms, not in medical settings where CDC prevention guidelines are closely followed,” Dr. Ludmer says.
Will I come in contact with COVID patients if my doc’s office is in a hospital?
The short answer is no. “Hospitals now are very advanced in terms of triaging and identifying possible COVID patients early. And pretty much every hospital has a specific place and healthcare providers that are now dedicated to taking care of COVID patients,” Dr. LaMoreaux says.
“You don't want to have COVID patients down the hall from patients who come in with heart issues or need monitoring for something else; they're put in separate places and these rooms have extra precautions,” he says. “Just because your doctor sees patients on an outpatient basis in the hospital, does not mean you should avoid seeing them; the hospital doesn't want you to get COVID just as much as you don’t.”
Why can’t I just do virtual appointments?
In some cases, telehealth visits are fine, especially if you are an established patient with no active problems who just needs a visit to monitor medications and symptoms, Dr. Ludmer says. “However, if patients are not doing well then an in-person visit, which includes a physical exam is preferable,” she says. The reason is some symptoms just can’t be measured virtually.
“We’re feeling all of the joints for swelling and tenderness, which gives us an important idea of where there's inflammation in the body, and how much is there,” Dr. LaMoreaux says. “The physical exam is really how we assess rheumatoid activity and then make therapy decisions based on the patient's symptoms.”
I’m stressed about coming into the office, can that cause a flare?
Unfortunately, it can cause a flare or worsen an autoimmune disease. “A lot of things go along with stress, including impaired sleep, which can further drive up inflammation,” Dr. LaMoreaux says. “That's why I would recommend calling in to your doctor's office and finding out what their protocols are,” he says. “They can share information with you that will hopefully ease your anxiety and help get you into the office safely.”
Can’t I just prolong treatment if I’m having a flare?
In a word, no. “If you're having a rheumatoid flare and you don't tell anybody about it, that means you have unchecked inflammation in your body and your current medicines are not enough to help you,” Dr. LaMoreaux says. “Unchecked inflammation causes joint and organ damage, like erosions or pure structural damage, and this is stuff that we can't always get back." Remember, it is always easier to prevent harm being done to your body than it is to try and repair that harm down the road with RA.
If that’s not enough to convince you, “Over time, chronic inflammation can lead to damage to the joints, resulting in deformity and loss of function. Untreated chronic inflammation is also a risk for cardiovascular disease,” Dr. Ludmer says.
RA & COVID Risks: Clinical Rheumatology. (2020). “Managing rheumatoid arthritis during COVID-19.” ncbi.nlm.nih.gov/pmc/articles/PMC7474575/
COVID & In-Person Medical Care: CDC Morbidity & Mortality Weekly Report. (2020). “Delay or Avoidance of Medical Care Because of COVID-19–Related Concerns — United States, June 2020.” cdc.gov/mmwr/volumes/69/wr/pdfs/mm6936a4-H.pdf