Fast Five Quiz: Arthritis

Herbert S. Diamond, MD


July 28, 2020

Corticosteroids may have an adverse effect on patients with COVID-19 and reduce clearance of SARS-CoV-2. Some evidence suggests that people infected with COVID-19 have worse outcomes if they are taking corticosteroids. Rheumatologists are advised to avoid the use of systemic corticosteroids, particularly intramuscular long-acting corticosteroid injections (such as methylprednisolone and triamcinolone), which result in prolonged immunosuppression and also potential adrenal suppression. Patients should not stop current steroids but taper doses if possible. Intra-articular corticosteroids injections should be avoided in general, because asymptomatic patients may be incubating the virus.

According to current research, although patients with RA and lupus are known to have an increased risk for infection compared with the general public, rheumatic diseases have not been proven to increase risk of contracting COVID-19. However, more data are needed for this to be definitively established.

Recommendations also suggest that patients who are already taking nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis should not stop them if they develop symptoms of COVID-19. However, patients who are not already taking NSAIDs should use acetaminophen for fever or pain if they develop symptoms of COVID-19.

A study of patients with rheumatic and musculoskeletal diseases who contracted COVID-19 found that those taking TNF inhibitors were less likely to be hospitalized. Treatment with > 10 mg of prednisone daily was associated with a higher probability of hospitalization.

Read more about practice essentials for RA.


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