GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis)

Guidance for Psoriasis and Psoriatic Arthritis Patients
during COVID-19 pandemic

Purpose

This guidance was prepared by rheumatologists, dermatologists and patient members of GRAPPA to provide guidance to persons with psoriasis and/or psoriatic arthritis during the current COVID-19 pandemic, in particular to those taking immunosuppressant medicines.

There are tremendous variations in guidelines across the world, especially as they apply to physical distancing, mask use, and access to healthcare. First and foremost, we recommend that you follow national and local regulations. Your primary source of medical advice should come from your own health care providers.  Treat the information below as additional guidance or clarification.


I have psoriasis and/or psoriatic arthritis, and I am on medication(s) for same. (i) Am I at increased risk of contracting COVID-19? (ii) If contracted, would I be at increased risk of having a more severe experience of COVID-19?

(i) COVID-19 is a new disease. Currently doctors do not have enough evidence to say whether or not having psoriasis and/or psoriatic arthritis, and being on medication(s) for same, increases your risk of contracting COVID-19. Seek your doctor’s advice. They will advise you so as to minimize any increased patient risk.

(ii) Patients belonging to any of the following groups may be at increased risk of developing complications from COVID-19:

  • You are aged 70 or older;
  • You are under 70 with a long-term underlying health condition such as lung disease, heart disease, diabetes or cancer. Broadly speaking, this group usually includes anyone instructed to get a flu shot each year on medical grounds.
  • Patients with psoriatic disease are more at risk of having additional medical conditions (comorbidities) such as heart disease, lung disease, diabetes, and high blood pressure. These are known to be associated with complications of COVID-19;
  • You are taking medication(s) that can affect your immune system. Some, but not all, medications used to treat psoriatic arthritis and/or psoriasis can affect your immune system. Your doctor is the best person to advise if this applies in your case.

Note that guidance regarding COVID-19 related risk may vary between countries.

What should I do to reduce my risk of contracting COVID-19 or of putting others at risk?

Practice good hand-washing and sanitizing. Wash your hands often for at least 20 seconds using soap and water. Dry your hands thoroughly. If the skin of your hands is chafing use a moisturizer. If you can’t access soap and water, use an alcohol based hand sanitizer of no less than 60% alcohol. European Centre for Disease Prevention and Control (ECDC): Video on COVID-19: How to wash your hands properly

Avoid touching your face.

Cough or sneeze into an elbow or tissue. Use disposable tissues and dispose of them immediately after use.

Practice sensible physical distancing. Stay 2 meters (6 feet) apart from others, including when greeting others; no shaking hands, no hugs.  Avoid crowded public transport and large groups of people.

Stay home, if you are under a local government instruction to do so. Note most national guidances allow you to go out for essential items.

Even if you are not under a local government instruction, you should still stay home if you are at all able to do so.

Clean and then disinfect frequently touched objects and surfaces.

Wash clothes more frequently, especially if you are sneezing into them. Wash at highest temperature indicated by care labels of the clothing.

Q: Should I wear a face mask?

A: Experts differ in their advice about mask usage. The use of surgical or cloth face masks may reduce the risk of an infected person spreading COVID-19 to others, but do not protect you very much from acquiring the infection. Check your local directives about wearing a mask. For more see: U.S. Centres for Disease Control and Prevention (CDC) CDC cloth face covers and European Centre for Disease Control COVID-19 Q&A

Q: Will wearing gloves (such as vinyl, latex, or rubber gloves) protect against COVID-19? 

A: No. Regularly washing your bare hands offers more protection against catching COVID-19 than wearing gloves. For more see: World Health Organisation (WHO), Coronavirus disease (COVID-19) advice for the public


What are the symptoms of COVID-19?

Common symptoms of coronavirus include: A fever (temperature above 38° Celsius or 100.4° Fahrenheit); any kind of cough, not just dry; shortness of breath or breathing difficulties. Symptoms can be similar to those of cold and flu, such as fatigue, malaise, body aches, and headache. Gastrointestinal symptoms, including nausea, vomiting, abdominal pain, diarrhoea, and loss of appetite and smell have also been reported. Symptoms can range from very mild to very severe. Patients with coronavirus may also not display any symptoms at all.

It can take up to 14 days after exposure for symptoms of coronavirus to appear. If you have any of these symptoms, behave as if you have the virus and follow the guidance in the next section (“I have COVID-19 symptoms. What should I do?”).

I have COVID-19 symptoms. What should I do?

  • If you have a fever, cough, and/or difficulty breathing, seek medical attention as early as possible. Follow your local/regional guidelines about accessing health care for COVID-19 related symptoms. Most guidelines will advise you to phone or email your doctor, health care center, or local COVID-19 hotline before presenting in person. Visits and testing may be coordinated by phone or video visit.
  • Self-isolate immediately. If you prove COVID-19 positive you usually have to self-isolate for a minimum of 14 days.
  • Make sure to inform the doctor that you have psoriasis/psoriatic arthritis, and of any immunosuppressant medication(s) that you are on, as well as your other medications.
  • Until you are cleared by a doctor, proceed as if you are COVID-19 positive and stay home.
  • If you have been diagnosed with COVID-19, follow the advice of your provider regarding quarantine and when you can safely be released from quarantine. Follow this advice whether your symptoms are severe or mild or you are asymptomatic.

General advice on psoriasis/psoriatic arthritis medication and COVID-19 infection

Many patients are asking if they should stop their arthritis and/or psoriasis medications to prevent infection with COVID-19 or a more severe course of COVID-19 should they become infected. It is GRAPPA’s position that patients should not stop, reduce or delay taking medication for arthritis and/or psoriasis unless told by a doctor to do so.

  • If you have symptoms and a confirmed diagnosis of COVID-19, you must check with your medical providers about continuing your medications. We generally advise patients to stop their medications if they are ill.
  • If your doctor has previously given you guidance about temporarily stopping, reducing or delaying taking your medication in specific circumstances, then follow that advice until you can get further medical clarification.
  • If you are taking non-steroidal anti-inflammatory medications (NSAIDS) for your arthritis you should continue on these medications unless otherwise advised by your physician. In case of pain or fever, you may consider paracetamol or acetaminophen as well as NSAIDs, in accordance with your habits and doctor suggestions. If in doubt, consult your doctor.

Q: I am on immunosuppressant medication. It is impossible for me to maintain physical distancing in my job. What should I do?

A: If you are considered an essential worker by your local guidelines (e.g. health care worker, grocery worker), you should advise your supervisor or Human Resources representative that you have underlying health conditions or treatments that may put you at increased risk. Additional measures such as personal protective equipment (mask, gloves, gown), being excused from public contact, and working from home may be considerations depending on your job. You may need a letter from your doctor supporting these accommodations.

Q: May I start new medication for my psoriasis or psoriatic arthritis at this time or should I wait until the end of the COVID-19 pandemic? What about vaccines?

A: You should seek advice from your doctor or rheumatologist before proceeding with any new medication or vaccine.

Access to health care

Many patients are asking about access to medical care for non-COVID-19 related healthcare issues during the pandemic. There is tremendous variation in access to care: some areas may be “business as usual”, while others are under considerable pressure, forcing redeployment of healthcare workers to help at the front line. Some providers have transitioned to telehealth visits.

All questions regarding appointments, medical issues, access to medications or care, insurance, or hardships related to the pandemic should be directed to your medical provider(s). If you experience significant difficulty in contacting your provider, check whether national or local COVID-19 hotlines are available to help you.

Well-being

The COVID-19 outbreak may be a very stressful time for people, provoking fear, anxiety, and strong emotions amongst adults and children. It is important that you address the potential impact on both your mental and physical well-being. Please remember, physical distancing does not have to mean social or self-isolation. There are many resources available to help you maintain a healthy lifestyle:

CDC: COVID-19 - Stress & Coping

Coronavirus and your well-being from “Mind” mental health charity.

Stresscontrol.org teaches you how to control stress, including live online classes and video.

Useful websites

Versus Arthritis (U.K.):
COVID-19 - what is it and where to go for information

European League Against Rheumatism (EULAR): Guidance for patients COVID-19 outbreak

Arthritis Ireland: COVID-19 information for people with arthritis

National Psoriasis Foundation (U.S.): Recommendations for Patients with Psoriatic Disease

Global Healthy Living Foundation: GHLF COVID-19 Patient Support Program

National Rheumatoid Arthritis Society (U.K.): COVID-19 and RA - Frequently Asked Questions

American College of Rheumatology (U.S.): Patient-Resources-When-and-How to-Seek-Care.pdf

World Health Organisation (WHO): COVID-19 advice for the public

U.S. Centers for Disease Control and Prevention: COVID-19 Main Page

European Centre for Disease Prevention and Control (ECDC): Main page, COVID-19 Q&A