COVID RHEUMNOW PSAs (1 - 5) Save

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 tele video 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.

Lord 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 rheumatologist, your primary care.

You should share it with your 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. What'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 and 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 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 nonsteroidal 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, 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 anti rheumatic 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, Epremelast, 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 be a major shortage here.

There might be a shortage of the medicine called hydroxychloroquine, also called Plaquenil, because 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. Hi, I'm Doctor. Jack Cush, Executive Editor of rheumnow.com. In this PSA, Patient Service Announcement or Report, I'm going to talk about your medical care.

If you didn't see our first PSA, you should. It was about your therapies, your drugs, and whether or not you should consider yourself immunosuppressed. That was called managing your arthritis medicines. Today we're going to talk about managing your arthritis or your condition or your rheumatic disease, whatever it is that you're seeing your rheumatologist for. It's important to note that in this era of social distancing, you have to make certain choices that are all about reducing your risk and maintaining your health and safety.

So, the whole idea behind whole social distancing is that you will reduce your risk of catching, an infection from someone else who you are approximated to, maybe in the same room, maybe walking by them in an aisle at Walmart, but again, keeping that distance is very important. I noticed the other day that while in line at the checkout counter at my grocery store, people sort of stacking up behind each other were actually six feet apart and maintaining that social distance. So, first let's talk about your rheumatology visits. I assume you're seeing a rheumatologist or dermatologist. You should recognize that most clinics have all gone to the policy of trying to do their visits remotely.

If you, on the other hand, can't do that because you are very sick, newly diagnosed, and in need of person to person contact, your doctor will make arrangements for you to see. Right now, most clinics are only seeing urgent patients or people who the doctor deems, necessary to have a face to face meeting. Having a face to face meeting has got to be counterbalanced against the distance that you're trying to keep with everyone to maintain your safety. So staying at home makes you safe, makes the clinic safe, etc. And we can get a lot done by doing a distance visit.

So these visits are going to be done either by phone or by televideo, either something like FaceTime if you have two iPhones, and there are other ways of having televideo visits where you can actually see your doctor and or the clinic staff to go over questions, concerns, and needs. I think it's important that if you're going to have a remote visit, a telephone visit or a televideo visit, number one, you need to have a few questions. Don't come with 10 questions. No one has time for that right now. Focus on your big issue.

Maybe one question, maybe two. Focus on your need for refills. And lastly, make sure you discuss how the COVID infection is concerning you, what your concerns are, and let your doctor answer those questions about what you should and shouldn't do. If you're going to do a televideo visit, that may involve you getting up to date with regard to software or equipment, and usually your doctor's office is going to email you instructions on how you can actually do a video visit with the clinic. If you don't know about the technology, get someone who can help you.

Younger people are obviously really good at this. We always have someone in the family who's a techy person, let them come over. Again, you can maintain your social distance with them too, but I don't know that it's important to maintain social distance amongst your own family members unless everybody in the family is going out every day and coming back home every day and bringing potential bugs. Obviously, the more people who stay home and together, the less risk you are to each other. But getting up to date on software so you can make the interaction instructive and useful, really, I mean, video visits like this eye to eye is really the best way to communicate.

It's very important that you have an appointment set to see your rheumatologist sometime between now and the next three months, at the most six months, I'm assuming six months because you just saw them in the last few weeks or last few, maybe a month ago. Otherwise, everybody should be seen by the rheumatologist in the next three months. Likewise, you should make an appointment to see your other doctors. Everybody needs to be in contact with their primary care doctor. That's really, really important.

If there are other doctors who are really, really important to your care, like right now, maybe it's your cardiologist who's the most important person in your care compared to your primary care, then yes, above all, see your cardiologist, connect with them, do a remote visit with them, and decide whether or not you need a face to face visit. You've got to get these things done. During this time when we're trying to protect your safety and maintain your health, that's going be best accomplished by being in touch with your doctor and continuing your medicines. Do not make decisions that you're not equipped to make, meaning you need to get input on the medicines you're taking, on your medical status, on the new symptoms you might be having or dealing with. Don't guess, get advice from people who want to help.

That means seeing your rheumatologist or dermatologist, your primary care, or the doctor's most important with you. Get these things done. Next, what about elective things? You know, for right now, I'm always talking to my patients about getting, you know, going to their primary care doctor at least once a year, getting health maintenance things done like mammograms, pap smears, colonoscopy if you're over the age of 50 and whatnot. If you have those things scheduled, yes, you can put those on the back burner and hold off on that.

The same can be said for annual eye exams if you're on hydroxychloroquine. You can delay that. If you're supposed to be seen in April or May, call that doctor's office and make an appointment for June, July or August. That would be fine. There's no hazard in waiting a few more months.

That is to say, assuming that you don't have current eye problems, which they might need to see you more urgently. So eye exams, you can hold off. What can you not hold off on or should not hold off on? Lab tests. Get your labs as you're supposed to.

Labs are all about keeping it safe, keeping you safe, keeping your medicines safe. You're all asking, Should I continue my medicines? Well, yes, you should. You should not stop them, and then we know that you should continue them because your labs tell me it's safe for you to continue to take your medicines. So again, during this time, while we're really cutting back on our interactions, I think it's important that you not cut back on your medical interactions because you want to stay healthy and strong, and you want to come out on the other side of this COVID-nineteen concern being just as healthy as you were going into.

In our next edition, we're going to talk about COVID safety advice. Be sure to tune in. Hi, I'm Jack Cush, executive editor of roomnow.com. This is our third installment in a series I'm calling PSAs on COVID or patient safety advice on the COVID infection and how you should be coping with this as you manage your medicines and your illness. In this edition, we're going to talk about COVID safety advice.

It's going to be a reiteration of many of the things that you've already heard, via the media, and we'll talk specifically about how it relates to you. The coronavirus, as you know, has been around for a long time, but this year we're experiencing a new strain, of the virus that is particularly, virulent. It's 10 times more virulent, meaning more likely to infect someone than the usual influenza bug. Influenza going to lead to three to four hundred thousand hospitalizations in The United States and up to twenty thousand deaths, in an average year. You know, we're nowhere near that with this virus, but it could get worse.

We don't really know what the end result is going to be, so we're taking a very aggressive stance in trying to prevent this infection. It is spread from person to person, mainly by respiratory droplets, so me saying peas and things like that where little droplets may come out or if I'm coughing or even breathing heavily around you and you're near me, you could actually, take in these respiratory droplets. Those droplets when they get on surfaces can last for hours, rarely for days, and then be contracted that way, especially if I can contact that with my hand and then start wiping my face or my mouth and bringing it to my, airway and respiratory system. So the advice is pretty simple. Social distancing, stay at home, don't go out unless you need to, do essential functions like exercise, getting a breath of fresh air, by yourself or with your spouse, doing shopping as you need to, keeping your distance while you're shopping, going to doctors if you need to.

If you're going to be congregating with people, five people or less is okay, especially if they're your family and people you're around, and each of those individuals poses little or no risk that you know of. During this period, you'll find that most hospitals are saying, Do not come to the hospital. We have a no visitor zone. That's very common. Don't get offended.

I know it could be a close family member or friend that's in the hospital, but you're not doing them any good by going to visit anymore. You need to stay at home and stay in touch with the hospitals. Most hospitals, if you're a family member, to someone in the hospital, they have a policy and a program whereby they'll stay in touch with you with daily updates, find out what that is and how that's going to work. Similarly, you should not be having any elective procedures. If you're going to have, you know, day surgery for a joint or musculoskeletal problem or for a plastic surgery problem or for a dermatologic, excision of some sort, or Mohs surgery.

All these are going to be delayed. There are no elective surgeries at this time. Only surgeries that are going to be done are urgent and emergent surgeries done in hospital centers. And again, there they're taking in the person who needs the surgery, not the whole family. What do I, what do I, I get a lot of questions about masks and gowns and gloves.

Those are really reserved for people who are on the front end of dealing with the public who are sick and managing them or assessing them. Should you wear a mask? No. Regular masks that you can get from off the shelf that you can buy, that you see most people wearing, or that was given to you while you're in the hospital, those are not really that effective. They don't have airtight gaps.

They have very loose gaps and a lot of air goes in between. And again, respiratory droplets can get in and out. You should wear a mask if you yourself are sick and you don't know your status. You should wear a mask when you go out. You should wear a mask if you go to a clinic.

You should probably call them before you go to clinic if you think you're sick, tell them what your symptoms are, they'll tell you whether or not to come in for your treatment, your evaluation, your infusion. Most people who are on infusions of medicines like Remicade, Rituximab, Orincia, Ectemra, Prolia, you need to call and find out how we're doing that. Most places have policies and changes in how the infusions are being done. You should get your infusion, but it's going to be done differently than it was done before. You don't need to wear gloves unless you are going to be dealing with people who are sick, and dealing with people and handling many other people or situations where there's a risk of transmission.

So repeated handling, dealing with people who are under evaluation and sick, family members who are sick, yeah, masks and gloves would make some degree of sense. So again, there's certain things that you need to be aware of. The main things here are prevention. You should wash your hands often, even if you're at home, even if you're with the same five people that you're living with, everybody should be washing their hands every few hours. And again, your hands with soap and water or with Purell is going to be for twenty seconds.

Again, you should see some of the videos about someone takes a dab of grease, black greasy stuff and puts it in their hands and they start washing their hands like they normally would. And they do it for like what you normally would ten seconds, five seconds. And you find out the very little of the hand is covered. You need twenty seconds focusing between the fingers on the palms, back of the hands, over the wrists. It's really it's got to be serious.

Avoid touching your own eyes, nose, and mouth because there could be something on your hands and you don't want to facilitate transmission from your hands into your respiratory system. Avoid close contact with sick people. So we talked about social distancing and six foot, but if people are sick, sorry, call me on the phone. We can talk about it. We're not going to get close together.

If you know, if you see someone sick, stay away from them. If you know they're sick, stay away from them. You know, the idea is we got to be very clear about protecting each other here. Cough your mouth, cover your mouth and sneeze into your elbow if you're going to cough or sneeze. Stay at home if you yourself are sick or if you think you're sick, wear a mask if you have to go out.

You should disinfect your work area, the area where you stay or where your hands are always working. That means your computer, the doorknobs, door handles, stairways, if you're flying, you know, I see people with disinfectants doing their tray tables and the armrests and the area in front of them if they're on a plane seat. So should you be traveling? Probably not. Certainly shouldn't be going on a cruise.

You certainly should be going outside The United States, but if travel is your business and you're in a vital services business, you can travel with probably low risk and the risk is directly related to the risk in that particular region you're coming from and going to. So, you know, where I am in Texas, we have a lot of cases. Where I like to travel to, New York, there's even more cases. So I'm going to avoid New York for a while and just deal with my risks here in Texas. Should you go to work?

I think most of our work environments have changed. I normally have 12 people I'm at work here with every day. Right now, there's three other people here. Everyone's working from home except for the three essential people. So your density is lower at work and you can have low contact and significant distance between you and your co workers to make the work environment safe.

And that's assuming you're in an essential services industry like I am and healthcare. Should you get tested? No. Because you have arthritis doesn't mean you need to be tested. You only need to be tested if you are at risk based on symptoms or based on known contact, direct contact with someone who has the proven COVID-nineteen infection.

Infection. So, someone who you had lunch with yesterday and you were sitting three feet from, you found out two days from now that they have the COVID-nineteen, you probably should be tested. Otherwise, hear a lot of stories about, Well, I was in the store, or of the checkout clerks was taken to the hospital four days later. I don't think that's a reason to be tested, okay? You need very, very close contact to make testing have a reasonable enough yield to make it worthwhile.

The thing is that most patients who have this infection have mild symptoms, right? A mild fever, mild aches, and that may be it. You should get tested if you have fever above 100 or 101, if you have aches, if you have joint or muscle pain, if you have malaise, if you are short of breath, chest pain, have a dry, hacking cough, those are all reasons to get tested. If you have a sore throat, that might be a reason. No, it's not a reason.

A runny nose, sinus symptoms, congestion all up here and spitting out gobs of green stuff. That's not a COVID infection. Call your doctor about how to manage that bronchitis, that URI upper respiratory infection. The COVID infection sometimes also gives patients GI complaints, nausea, diarrhea, or even sometimes vomiting. So those are reasons under which you should seek medical attention and seek testing.

To get testing done, you need a doctor's note to get testing, and you can do one of those drive by deals. Lastly, I think common sense is what prevails here. Stay in touch with your doctor and your physicians about your care and any questions you may have about this infection, how it affects you or your family. In our next edition, we're going to talk about COVID myths. Tune in.

Hi, I'm Jack Cush with rheumnow.com. This is our fourth installment of PSAs in the time of COVID. These are patient service advisories dealing with issues that our patients are calling about, things that you're dealing with. This one's dedicated to myths. Not surprising with the way this pandemic has come upon us, and the current state of affairs where there are a lot of unknowns.

There are a lot of myths that have been circulated that unfortunately are getting almost as much press as the facts. I'd like to dispel a number of these myths so that you can be better prepared as you go forward. Myth number one, don't take nonsteroidals if you have COVID or if you're worried about COVID. Nonsteroidal anti inflammatory drugs, NSAIDs, are exemplified by medicines like ibuprofen or naproxen. And there are prescription versions of that.

Aspirin is another version of a non steroidal. Prescription versions would be meloxicam or Celebrex or Lodine. There's a million of them, actually about 18 of them. But they're unified in their ability to be pain relievers and anti inflammatory drugs. They're highly effective, and they cause some GI side effects.

The French ministry came directive when it was dealing with some guidelines for COVID and said don't take an ibuprofen, take Tylenol instead. And it's not because non steroidals have been proven to be ineffective or dangerous in people with COVID is because it's just basic good sense. Acetaminophen, Tylenol, has much less in the way of side effects. It's much safer, has a better safety profile than anyone with anything wrong with them. Joint pain, flu, current infection, a twisted ankle, a headache.

Nonsteroidals have more GI side effects, some effects on red blood cells and maybe bleeding potential, effect on the kidney, effect on the liver. Those are all pretty uncommon, but yet they're often used both over the counter and as prescriptions. Acetaminophen is safer. It's just not an anti inflammatory. It's a pain reliever.

So, you're on those medicines, keep taking them. Do not stop them because of what's been in the news. It's wrong. Myth number two, age. Meaning, if I'm old I'm really at risk or if I'm young I'm at no risk.

If I'm old I'm staying indoors and not leaving the house until 2022 sometime. Or if I'm young, I'm going to Delray Beach and partying with all my friends because I can't get the COVID infection because it's a thing of old people. Both of these are wrong. It turns out that the coronavirus is sort of an equal opportunity infection. There are many young people who are infected with this and several have died.

In the ICU right now of almost all the hospitals, it's like half the patients are between the ages of 20 and 50. And I think that young people like from 30 is somewhat around a quarter of the patients. So, the only difference is that maybe elderly are less resilient if they get the severe form of infection, which is only like one, two, three, four, five percent. So, the idea here is that everybody's at risk. Everybody has to practice the measures that are being put forward to protect everyone.

That social distancing and everything we've talked about in the first three videos. So age is not a bad thing. It's not a good thing. It's a it's you're just like everybody else. Myth number three, Geraldo Rivera got on Fox News and said, If you can hold your breath for ten seconds, you do not have COVID infection.

Well, that's just plain goofy, and Geraldo Rivera, who never went to medical school and knows nothing about medicine, shouldn't be talking about this. Item number four, the problem's going to be fixed by heat. So when the weather turns hot, the infection's gonna go away. That's president Trump said that. That's not necessarily true.

It's 90 degrees here in Dallas today, and we have record setting numbers of people going into the hospital. So heat may lessen the problem, but it is in no way treatment for the problem. So don't be doing hair dryers up your nose or in your mouth or on your body to fix the problem or prevent infection. That's not gonna work. Don't be using UV light as a way of controlling infection.

That doesn't work either. Okay? So, heat is not the solution for this. The solutions will be told to you when you need them, if you need them. And if you don't have the infection, you're in the prevention mode.

Next, item number five, vaccines. I've heard vaccines are a good thing and vaccines are a bad thing. The main vaccine we're talking about right now is influenza. If you haven't already had it, you know, we've gone through most of the seasonal influenza spike, it spiked around late January, and influenza is tailing off. Although there are still current influenza infections going on.

If you haven't been vaccinated, you could get vaccinated, but being vaccinated, one, will not make your COVID any worse. Two, it will not boost your immune system necessarily to fight with COVID because this is a new infection. This is a virus that's mutated and your body's never seen. So, there's no memory, and vaccines work on immunologic memory, meaning your body has seen flu before and we boost the immune response so you don't get it again. Again, a vaccine won't necessarily protect you against COVID infection, but it also is something you probably should have gotten already, both for the seasonal influenza or other vaccines that your doctor deems necessary, Prevnar thirteen, Pneumovax, and the Shingrix vaccine.

Item number six. Maybe I should get a prescription for antibiotics. Antibiotics could help me. Well, antibiotics are for bacterial infections. This is a viral infection with no bacterial component.

So, antibiotics not going to help you. Likewise, garlic is not going to help you. And the only way you're going to prevent an infection from affecting you is washing your hands, social distancing, and then treating your own infection should you get one. There's a run on hydroxychloroquine, a medicine that's been reported in the news to be a potential treatment for people with the coronavirus infection. It's a potential treatment.

It's not been proven. Right now, there are a lot of patients in The United States who are already on hydroxychloroquine for their lupus or their rheumatoid arthritis. You should stay on it and not stop. But other people should not get this drug with the idea that it might actually help you. That's not gonna work here.

So, if you're trying to hoard hydroxychloroquine so that you and your family won't get this, that's bad. There are people who have arthritis, and those are lifesaving medicines for arthritis, do not inadvertently or wantonly take up all the hydroxychloroquine in the market. There's already a shortage. Second to last, stop your steroids, stop your immunosuppressive. We talked about that in the first PSA.

No, if you're on a medicine, do not stop it. Those medicines are not proven to increase your risk of getting the COVID infection, nor will you do any worse if you're on those drugs. So, do not stop those medicines. If you get a coronavirus infection proven by culture, nasal swab, then yes, you should probably stop your immunosuppressive and call your rheumatologist, the person who prescribed that. No one else should be able to stop that medicine other than the person who prescribed it.

And lastly, should I be wearing masks all the time? The answer is no. The mask you see everyone wearing is really not that good at preventing inhalation of droplets that are airborne because there are gaps on the sides and whatnot. The N, Nancy 95 masks are airtight, better at filtering those out. The people who should be wearing masks are people who are sick right now.

If you have the COVID infection, or if you have some other upper respiratory infection or seasonal flu, yes, you should wear a mask if you're going be around family members or anyone. If you're by yourself at home, you don't need to wear the mask. Okay? So, again, masks are for those who are infected themselves, not for you to protect yourself. Although it can hurt, it's just that there's going to be a shortage of masks by healthcare workers who need the masks.

So, I would advise you're not, again, hoarding those or taking those up. I'm sure there's more, but if you have questions about something you heard, speak to someone who knows. Talk to your clinic, your doctor, your family doctor, your rheumatologist, your dermatologist, and get solid guidance from them. The worst thing you can do is guess when it comes to managing risk of getting a coronavirus infection. We have one more episode, and we'll next talk about dealing with stress.

Tune in for that. Hi, I'm Jack Cush with rheumnow.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, wash 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 tele video 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. Lord 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 rheumatologist, your primary care. You should share it with your 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. What'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 and 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 nonsteroidal 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 anti rheumatic 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, Epremelast, 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 The United States or Puerto Rico, in fact. So, I think we're going to 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 be a major shortage here. There might be a shortage of the medicine called hydroxychloroquine, also called Plaquenil, because 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.