Managing Psoriatic Arthritis During the COVID-19 Pandemic

Risk, Protective Measures, Symptoms to Watch for, and More

If you have been feeling worried, overwhelmed, or hopeless about managing psoriatic arthritis (PsA) during the current worldwide pandemic, you are not alone. These feelings are being experienced by many living with autoimmune diseases like PsA that leave you immunocompromised and at an increased risk for COVID-19.

You probably have many questions about how to best manage PsA and your overall health during the pandemic. Learn about your risk for COVID-19 and its complications, how to continue managing PsA during the pandemic, and your health as the world slowly returns to normal.

Personal Risk for COVID-19

PsA is both a rheumatic disease and an autoimmune disease that causes inflammation in the joints. PsA can also affect your skin by causing skin inflammation related to psoriasis, an autoimmune skin condition that causes skin cells to build up and form dry, red, inflamed patches. 

Having psoriatic arthritis can increase your risk for any type of infection. Also, people with autoimmune diseases, like PsA, might be more vulnerable to developing COVID-19 and having a more severe disease course with COVID-19.

Rheumatic diseases are often grouped under arthritis, which describes more than 100 different conditions that affect the joints and bones.

Many rheumatic diseases are autoimmune and inflammatory conditions that cause your immune system to attack its healthy tissues—joints, bones, muscles, and even vital organs (skin, eyes, lungs, etc.). These conditions are systemic, which means they have whole-body effects.

Immunocompromised

Psoriatic arthritis and other autoimmune diseases can leave you immunocompromised, meaning that you have low immune system defenses. This affects your ability to fight off illness and infection, including COVID-19.

Autoimmune diseases are known for increasing vulnerability for all types of infection—viral, bacterial, fungal, and more. The increased risk is believed to be linked to biologic drug therapies used to treat PsA and other types of systemic, autoimmune diseases.

According to a study reported in 2011 in Arthritis Research & Therapy, people with autoimmune diseases who develop severe infection have significantly reduced survival odds.

Your Infection Risk

A study out of British Columbia published in 2018 in the Annals of Rheumatic Disease looked at infection risk in people with psoriatic arthritis and/or psoriasis, together known as psoriatic disease.

The results found people with both PsA and psoriasis had a higher risk for infection compared to others in the general population, specifically, people who use disease-modifying anti-rheumatic drugs (DMARDs) and hormone therapies.

While the study’s authors confirmed the increased risk exists, they were unsure whether increased risk was related to psoriatic disease, treatments, or both.

A study reported in 2016 in the Journal of Rheumatology investigated the “rate, type, characteristics, and predictors” of infection within a group of people with PsA and a group of people with psoriasis without arthritis.

Among the 695 PsA participants, there were 498 infections, and among the 509 participants with psoriasis without arthritis, there were 74 infections. The time to the first infection in people with PsA versus psoriasis was 1.6 times, and it was even higher in people using biologics.

Being female and biologic therapies were considered risk factors for higher infection risk in the people with PsA. 

Some people with PsA might have other conditions in addition to PsA. Comorbidities are the presence of two or more medical conditions in one person. Some of these comorbid conditions make it harder to fight infections. Such comorbidities might include heart disease and lung conditions like chronic obstructive pulmonary disease (COPD).

Your Risk for COVID-19

Researchers are studying how COVID-19 might affect people with autoimmune diseases. They know certain conditions increase risk, and they want to know why and how autoimmune diseases might increase vulnerability to COVID-19 and its complications.

The Centers for Disease Control and Prevention include people who use immunosuppressive drugs, like corticosteroids, as those who might be at higher risk for severe COVID-19 complications like pneumonia.

While a higher risk for infection exists, the most recent research on autoimmune and inflammatory diseases finds people with these conditions might not develop more severe infections.

And even with an increased risk for infection, it seems that people with PsA and other rheumatic diseases are not contracting COVID-19 at higher rates, which is what doctors initially thought would happen.

A study reported at the 2020 American College of Rheumatology (ACR) Convergence found people with rheumatic conditions were less likely to become infected with COVID-19, whether or not they used biologics.

The researchers couldn’t explain why this was, but they suspect people with rheumatic conditions were taking protective approaches more seriously to reduce their risk.

Taking Preventive Measures

While having PsA alone may not increase your risk for your COVID-19, it is still important for you to take protective measures to avoid exposure to coronavirus, the virus that causes COVID-19. And this is especially important if biologic therapies or corticosteroids are part of your PsA treatment plan.

how to cope with psoriatic arthritis during covid19
 Laura Porter / Verywell

Follow Your Treatment Plan

One of the most important things you can do to stay healthy is to follow your treatment plan and take all medications as prescribed, even conventional and biologic DMARDs. There has not been enough data to support stopping these medications for people with PsA during the pandemic.

The National Psoriasis Foundation’s medical board issued a guidance statement about COVID-19, which stated, “patients who are not infected with SARS-CoV-2 should continue their biologic or oral therapies for psoriasis and/or PsA in most cases.”

Also, they advise that people in high-risk groups—those over age 65, who smoke or have chronic medical conditions should talk to their doctors about continuing or changing therapies.

Additionally, the NPF recommends that if you test positive for COVID-19 that you stop taking biologics. Of course, you should never stop biologic drug therapy until your doctor confirms you can stop treatment.

Practice Social Distancing 

Social distancing is powerful in preventing the spread of COVID-19 and reducing your risk for this very serious infection. Also called physical distancing, social distancing means keeping space between yourself and others who are not members of your household.

The Centers for Disease Control and Prevention have defined a safe distance as at least 6 feet or 2 arm lengths in both indoor and outdoor spaces. Social distancing should be practiced with other preventive measures, including wearing masks, washing hands with soap and water, and avoiding touching your face with unwashed hands.

Wear Face Coverings

If you must leave your home, make sure you wear a cloth face covering or disposable mask. According to CDC Director Dr. Robert Redfield, “Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus – particularly when used universally within a community setting.”’

Take off your mask once you get home and wash your hands and face. The CDC also recommends handling your masks only by the ear loops or ties and being careful not to touch your eyes, nose, or mouth when removing your mask.

Masks should be washed regularly to keep them clean. It is a good idea to have more than one mask so you can replace a dirty one with a clean one each time you leave home.

Manage Stress

Managing stress in the middle of a pandemic isn’t easy, but it is vital. Stress can trigger PsA symptoms and lead to disease flare-ups (periods of high disease activity).

The National Psoriasis recommends both meditation and exercise to help you manage stress related to PsA and your worries during the current pandemic. With exercise, consult with your doctor before starting a new exercise routine. Both exercise and mediation can help reduce anxiety and depressed moods and improve your sleep.

If you are still struggling to cope, reach your doctor about a referral to a mental health counselor.

Treating PsA During the Pandemic

It can be a challenge to stay on top of your treatments and doctor appointments during the pandemic. But this doesn’t change the need for medical treatment. 

Consider using telemedicine to keep up with your health care. Telehealth allows you to follow up with your doctor and make sure you are keeping up with treatments. This way, you are safe at home, and the important aspects of your PsA care aren’t being ignored during this crucial time.

Telemedicine has become a vital and effective tool during this pandemic. It is done in different ways, including video chats, mobile applications, online visits, and secure messaging like email and text.

These methods can give you access to wellness visits, medication consults, follow-up for ongoing care, mental health therapy sessions, and so much more.

To help you prepare for an appointment, whether in-person or through telehealth, use our downloadable Doctor Discussion Guide below. It'll help you learn relevant terminology, anticipate questions you may want to ask, and more.

Psoriatic Arthritis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

DDG - Woman

The research so far on telemedicine's effectiveness during the pandemic shows it is a vital and effective tool for treating PsA during the pandemic. One study reported in mid-2020 found telemedicine to be a valuable method for the social distancing of all parties—medical staff and at-risk patients.

Don’t ignore PsA because you are worried about going to the doctor’s office. Use telemedicine when possible. The only time you would need to go in—according to the National Psoriasis Foundation's guidance—is if you are a new patient, if your doctor has requested a full skin or joint exam, or if you are experiencing severe symptoms.

If you are concerned about managing your health during the pandemic, the risk for COVID-19, or access to PsA medications, reach out to your doctor. Your doctor is a great source of information during this time, and they are fundamental to helping you maintain your best health.

Symptoms to Watch For

The symptoms of COVID-19 you would experience will be the same with or without PsA. According to Johns Hopkins Medicine, the most common symptoms of COVID-19 are “fever, body aches, dry cough, fatigue, chills, headache, sore throat, loss of appetite, and loss of smell.”

Some people experience more severe symptoms like a high fever, a severe cough, and shortness of breath that might be related to pneumonia or other complications.

It takes about 2 to 14 days to develop symptoms after exposure to the coronavirus. If you develop symptoms, call your primary doctor or rheumatologist. They will let you know if you need to get tested and what to do if symptoms worsen.

It is not recommended that you go to the hospital. Your doctor will likely meet with you using a telemedicine visit so you can stay home and avoid getting others sick.

If You Test Positive

If you test positive for COVID-19, your doctor will prescribe medications and give you recommendations on how to manage symptoms best. You will need to self-isolate, including away from family members. If you need to leave home to pick up medicines or go to the doctor, wear a mask and keep your distance from others.

You should also watch out for dangerous complications of COVID-19. Call 911 if you experience any of the following symptoms:

  • Breathing troubles
  • Pain or pressure in your chest
  • Confusion
  • Inability to stay awake
  • Bluish lips or skin

Contact Your PsA Doctor

If you become infected with COVID-19, contact the doctor that manages your PsA care. They will let you know if you need to make changes to your current PsA treatment plan. Unless your doctor has advised you differently, continue taking all of your medications, including biologics and corticosteroid therapies.

As you recover, make sure you keep in touch with your doctor. They need to know if your COVID-19 symptoms get worse or if you experience a PsA flare-up. Last, ask your doctor when it is safe to restart medications they were stopped. Good communication is key to keep you healthy during this time.

Getting Back To Normal

The world will eventually go back to normal, but that is going to take some time.

In a February 4, 2021 interview, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, shared with cable news network CNN that about "70% to 85% of the U.S. population should be fully vaccinated against COVID-19 before the country can begin to return to a sense of normalcy."

Even though normal is a little way down the road, you still need to live your life as best as possible while protecting yourself. Now that a vaccine will soon be available to everyone, you are probably wondering whether it will be safe for you to be vaccinated against COVID-19. 

People with autoimmune diseases and who immunocompromised are not excluded from the vaccine even though the vaccine has not been thoroughly tested on them.

But this is not unusual as most vaccine trials usually start with large groups of healthy adults. Other groups, including people with autoimmune diseases, are included in phase 4 studies after the vaccine has been proven safe and effective and approved by the U.S. Food and Drug Administration.

The National Psoriasis Foundation has recommended people with PsA get their vaccine as soon they can—provided they have not had contradictions to vaccines in the past.

The American College of Rheumatology advises that certain immunosuppressive medications should be paused temporarily to possibly increase the effectiveness of the Covid vaccine. For example, those on TNF blockers, IL-17 inhibitors, IL-12/23 inhibitors may remain on the medications without interruption while those on methotrexate should pause this medication for at least a full week after each vaccine.

Talk to your doctor about whether the COVID-19 vaccine is right for you. Because there is plenty of inaccurate information about the vaccine, your doctor is going to be the best source of information for any questions you have on the vaccine and its safety.

Even after you receive the COVID-19 vaccine, you should continue to practice preventive measures like mask-wearing, social distancing, and washing your hands. This is because the currently available vaccines don’t guarantee complete immunity. They have only been proven to offer 95% immunity against COVID-19.

A Word From Verywell

The pandemic is a challenging time for anyone trying to manage a serious health condition like psoriatic arthritis. Continuing and staying on top of your PsA care has become more challenging because of the virus and its impact on the world around us.

But these barriers shouldn’t keep you from prioritizing your health care, including follow-up visits, prescription refills, and infusion therapies. Telemedicine is a crucial tool, but there are times where you will have to go into a healthcare facility.

Your healthcare providers are taking every precaution to keep you safe during this time, including limiting the number of people in their offices, implementing COVID-19 screening measures, masking, physical distancing, and disinfecting frequently touched surfaces.

Don’t let your fears about exposure to the virus compromise your health by avoiding your health care.

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