Rheumnow PSA - Managing Your Arthritis Medicines Save
Rheumnow PSA - Managing Your Arthritis Medicines by Dr. Cush
Transcription
Hi, I'm Jack Cush with roomnow.com. In this video, we're going talk about managing your arthritis medications. This is sort of a scary time, especially for my patients who have arthritis, osteoarthritis, rheumatoid arthritis, lupus, psoriatic arthritis, psoriasis, ankylosing spondylitis. We're taking a lot of medicines and you're hearing repeatedly in the news how patients with arthritis and those who are immunosuppressed are at higher risk for the COVID-nineteen infection, and there's a lot of indecision and lack of information about what to do. In this video I want to give you some very clear instructions on what you should be doing and what you would hear from your rheumatologist or dermatologist or gastroenterologist with regard to many of the medicines that you might be taking.
So it's very important that you sort of first practice the behaviors which you've been given repeated instructions on in the last few weeks, you know, your hands, social distancing, making calls as opposed to visits. I think you should stay in touch with your physicians. You can accomplish a lot and be highly effective by doing telephone or televideo visits, and I think you need to do all you can to reduce your risk, just like everyone else. We're going to get over this, pandemic by changing our behaviors. That's very important and you have to do your part.
Word knows we in medicine are trying to do our part. But I want to talk specifically about the medications. Number one, have a medication list. You need a medication list to keep it all organized so that you understand it, your family understands it, the doctors you visit are going to understand it. You should share that list with your physicians, your rheumatologists, your primary care.
Share it with pharmacist as well, mainly for the purposes of confirming accuracy, which is also to say that you should probably tell people what you're not taking anymore. It's important to tell them what you are taking, including over the counter medicines, but also tell them what you're not taking. You might have stopped that blood pressure medicine. You might have stopped even an arthritis medicine because someone told you to. It's very important to share that information, to have it all, neatly put together in a list that you carry with you to your every medical visit.
Second, I heard on the news don't take ibuprofen if you have COVID. That's wrong. Let me give you some explanation. At issue here is whether you take a non steroidal anti inflammatory drug, which would include ibuprofen, Advil, Motrin, naproxen, also called Aleve, or any anti inflammatory drug like aspirin or Celebrex or Mobic or there's a whole bunch of them, right? But they're anti inflammatory.
They're also pain relievers, they're good for when you get a headache, twist your ankle, have a flare of your arthritis, or manage arthritis pain. The other drugs that you could take for pain would be acetaminophen or Tylenol, and those are effective at managing pain, not so effective at inflammation. What came out on the internet and from the French government was don't take ibuprofen, and really that was a directive to say if you have to choose to take a medicine when you are flu like and achy, take Tylenol. It's safer than taking ibuprofen. There is no rule that says you can't take ibuprofen or nonsteroidal.
It's common sense that maybe taking acetaminophen or Tylenol might be the safer choice between the two. Talk to your doctor if you're confused, but it is okay to continue taking a non steroidal anti inflammatory drug. The biggest issue we're getting questions about is, Am I immunosuppressed? I have this diagnosis, I'm taking these medicines, oh my goodness, I think I'm going to be the next person who gets COVID. The bottom line is that the thing that immunosuppresses you more than anything is being sick, Being sick from your disease, uncontrolled rheumatoid arthritis, many, many swollen joints, many, you know, uncontrolled lupus, where you've recently been hospitalized with lupus, and you're on a lot of drugs for lupus.
It's the disease that makes you immunosuppressed. This is why cancer patients are so immunosuppressed, not so much because of their chemo as much as it is because of their cancer. Secondly, really high doses and multiple medicines to fix an uncontrolled disease also add to risk of immunosuppression, so high doses of steroids are risky, and whatnot. Again, age can be a factor, and if you've been in the hospital a lot, that's a factor in saying that you might be at risk, But my average 60 year old who's doing very well with methotrexate, for their rheumatoid arthritis and their methotrexate, an anti inflammatory drug, was given to correct inflammation really doesn't have a much higher risk more than any other 60 year old. The same can be said for my 35 year old with lupus who's on two drugs for their lupus.
If their disease is well controlled, those drugs are not risky. Those drugs are tipping the balance of inflammation back to normal. They're not immunosuppressive. So, number four, do I stop my disease modifying antirheumatic drugs? No.
Don't stop any of your arthritis medicines unless your rheumatologist or the doctor who prescribed them tells you to stop. You should not stop methotrexate, sulfasalazine, hydroxychloroquine, also called Plaquenil, leflinamide, also called Arava, mycophenolate, Cellcept, Epimelast, cyclosporine. You should take those medicines if that's what you're supposed to be on. You should not adjust your dose of steroids if you're on steroids, although it might be good to be on less steroids because steroids are a big risk factor in worsening any infection. Do I stop my biologics?
No, that's injectable medicines like Enbrel, Humira, Rheumatade, Symphony, Cimzia, Orencia, Actemra, Kevzara, Kineret, the newer drugs for psoriasis and psoriatic arthritis, Cosentyx, Taltz, and Stellara, Symphony Aria. No, you should continue all of those because again, those are designed to control inflammation. Tipping inflammation back to normal makes you normal. They're not immunosuppressive. So do not stop your biologic, keep taking them as prescribed.
Lastly, what do I do about refills and should I be worried about shortages? Well, you should get your refills like you normally would. If you're getting low, call in for a refill now. There is not going to be a run on medicines or a shortage of medicines because most of these medicines are not made in countries where the coronavirus, it was, you know, rampant, okay? Most of these viruses are made in United States or Puerto Rico, in fact.
So, I think we're going be fine as far as your refills. There might be a problem with hydroxychloroquine, so get your refills. If you get monthly refills, get monthly refills. If you get usually every three months, get every three months. Again, there's not going to be a major shortage here.
There might be a shortage of the medicine called hydroxychloroquine, also called Plaquenil, that's being touted as a potential treatment, an antiviral treatment for those who have an active COVID infection. If you're on that drug, stay on that drug. We know it's helping your arthritis, your lupus, whatever. We don't know for certain that it will help prevent a coronavirus infection or make you better than someone else, and so you should not be hoarding that medicine, stocking up on that medicine, or taking that medicine if you're not supposed to be taking that medicine. Again, there are studies going on to figure out whether hydroxychloroquine or its parent medication, chloroquine, are effective in people who have this infection.
For you, we know it's effective for treating lupus and rheumatoid arthritis. Take it if that's what you're supposed to be on and don't worry about it. If you are on those medicines, call your doctor and get a prescription for the next month or three months so that you're not going be affected by a shortage. I do believe there will be a shortage of hydroxychloroquine or chloroquine. And if that happens, your doctor has other medicines they can manage your disease with.
You should tune in for more videos like this about how you can deal with the coronavirus pandemic. Talk to you next.
So it's very important that you sort of first practice the behaviors which you've been given repeated instructions on in the last few weeks, you know, your hands, social distancing, making calls as opposed to visits. I think you should stay in touch with your physicians. You can accomplish a lot and be highly effective by doing telephone or televideo visits, and I think you need to do all you can to reduce your risk, just like everyone else. We're going to get over this, pandemic by changing our behaviors. That's very important and you have to do your part.
Word knows we in medicine are trying to do our part. But I want to talk specifically about the medications. Number one, have a medication list. You need a medication list to keep it all organized so that you understand it, your family understands it, the doctors you visit are going to understand it. You should share that list with your physicians, your rheumatologists, your primary care.
Share it with pharmacist as well, mainly for the purposes of confirming accuracy, which is also to say that you should probably tell people what you're not taking anymore. It's important to tell them what you are taking, including over the counter medicines, but also tell them what you're not taking. You might have stopped that blood pressure medicine. You might have stopped even an arthritis medicine because someone told you to. It's very important to share that information, to have it all, neatly put together in a list that you carry with you to your every medical visit.
Second, I heard on the news don't take ibuprofen if you have COVID. That's wrong. Let me give you some explanation. At issue here is whether you take a non steroidal anti inflammatory drug, which would include ibuprofen, Advil, Motrin, naproxen, also called Aleve, or any anti inflammatory drug like aspirin or Celebrex or Mobic or there's a whole bunch of them, right? But they're anti inflammatory.
They're also pain relievers, they're good for when you get a headache, twist your ankle, have a flare of your arthritis, or manage arthritis pain. The other drugs that you could take for pain would be acetaminophen or Tylenol, and those are effective at managing pain, not so effective at inflammation. What came out on the internet and from the French government was don't take ibuprofen, and really that was a directive to say if you have to choose to take a medicine when you are flu like and achy, take Tylenol. It's safer than taking ibuprofen. There is no rule that says you can't take ibuprofen or nonsteroidal.
It's common sense that maybe taking acetaminophen or Tylenol might be the safer choice between the two. Talk to your doctor if you're confused, but it is okay to continue taking a non steroidal anti inflammatory drug. The biggest issue we're getting questions about is, Am I immunosuppressed? I have this diagnosis, I'm taking these medicines, oh my goodness, I think I'm going to be the next person who gets COVID. The bottom line is that the thing that immunosuppresses you more than anything is being sick, Being sick from your disease, uncontrolled rheumatoid arthritis, many, many swollen joints, many, you know, uncontrolled lupus, where you've recently been hospitalized with lupus, and you're on a lot of drugs for lupus.
It's the disease that makes you immunosuppressed. This is why cancer patients are so immunosuppressed, not so much because of their chemo as much as it is because of their cancer. Secondly, really high doses and multiple medicines to fix an uncontrolled disease also add to risk of immunosuppression, so high doses of steroids are risky, and whatnot. Again, age can be a factor, and if you've been in the hospital a lot, that's a factor in saying that you might be at risk, But my average 60 year old who's doing very well with methotrexate, for their rheumatoid arthritis and their methotrexate, an anti inflammatory drug, was given to correct inflammation really doesn't have a much higher risk more than any other 60 year old. The same can be said for my 35 year old with lupus who's on two drugs for their lupus.
If their disease is well controlled, those drugs are not risky. Those drugs are tipping the balance of inflammation back to normal. They're not immunosuppressive. So, number four, do I stop my disease modifying antirheumatic drugs? No.
Don't stop any of your arthritis medicines unless your rheumatologist or the doctor who prescribed them tells you to stop. You should not stop methotrexate, sulfasalazine, hydroxychloroquine, also called Plaquenil, leflinamide, also called Arava, mycophenolate, Cellcept, Epimelast, cyclosporine. You should take those medicines if that's what you're supposed to be on. You should not adjust your dose of steroids if you're on steroids, although it might be good to be on less steroids because steroids are a big risk factor in worsening any infection. Do I stop my biologics?
No, that's injectable medicines like Enbrel, Humira, Rheumatade, Symphony, Cimzia, Orencia, Actemra, Kevzara, Kineret, the newer drugs for psoriasis and psoriatic arthritis, Cosentyx, Taltz, and Stellara, Symphony Aria. No, you should continue all of those because again, those are designed to control inflammation. Tipping inflammation back to normal makes you normal. They're not immunosuppressive. So do not stop your biologic, keep taking them as prescribed.
Lastly, what do I do about refills and should I be worried about shortages? Well, you should get your refills like you normally would. If you're getting low, call in for a refill now. There is not going to be a run on medicines or a shortage of medicines because most of these medicines are not made in countries where the coronavirus, it was, you know, rampant, okay? Most of these viruses are made in United States or Puerto Rico, in fact.
So, I think we're going be fine as far as your refills. There might be a problem with hydroxychloroquine, so get your refills. If you get monthly refills, get monthly refills. If you get usually every three months, get every three months. Again, there's not going to be a major shortage here.
There might be a shortage of the medicine called hydroxychloroquine, also called Plaquenil, that's being touted as a potential treatment, an antiviral treatment for those who have an active COVID infection. If you're on that drug, stay on that drug. We know it's helping your arthritis, your lupus, whatever. We don't know for certain that it will help prevent a coronavirus infection or make you better than someone else, and so you should not be hoarding that medicine, stocking up on that medicine, or taking that medicine if you're not supposed to be taking that medicine. Again, there are studies going on to figure out whether hydroxychloroquine or its parent medication, chloroquine, are effective in people who have this infection.
For you, we know it's effective for treating lupus and rheumatoid arthritis. Take it if that's what you're supposed to be on and don't worry about it. If you are on those medicines, call your doctor and get a prescription for the next month or three months so that you're not going be affected by a shortage. I do believe there will be a shortage of hydroxychloroquine or chloroquine. And if that happens, your doctor has other medicines they can manage your disease with.
You should tune in for more videos like this about how you can deal with the coronavirus pandemic. Talk to you next.
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