Our current exceptions are:
1. If you are flaring with joint pain, SWELLING IN YOUR JOINTS, and WITHOUT fever (100.4 F) or body aches, please request a telemedicine/video medicine appointment.
2. If you receive in-office biologic medication (injection or infusion), we request you follow your schedule without alteration and will see you in the office.
Otherwise, we will reschedule you at a future date. We cannot anticipate when we will be able to reschedule at this point in time.
Please continue on all prescribed medications from our office without alteration. It is still not advised by the American College of Rheumatology to stop any treatment plans. Going off meds without any symptoms of illness may necessitate more intensive treatment of your rheumatology condition, which could put you more at risk. If this changes, we will alert you. If possible, please avoid taking daily NSAIDs (Celebrex, Meloxicam, Indomethacin, ibuprofen, naproxen, etc.) as you may be more susceptible to the virus. Topical NSAIDs can likely be continued. We recommend acetaminophen over the counter as directed instead of NSAIDs.
If you have symptoms of Covid-19, you will not be permitted into our clinic. Please contact your primary healthcare provider or call 2-1-1 for more info.
We are working around the clock to provide a reliable, HIPPA compliant web-based portal to be able to provide you with Rheumatology care and will have further instructions when this important work is completed.
This situation is fluid and changing as we have more information. Thank you for your understanding. Stay safe.
TRUSTED sources for information:
California Public Health https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx
San Diego Public Health https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/2019-nCoV/about.html
What are the symptoms of Novel Corona Virus Infection? It can take up to 14 days for symptoms of Coronavirus to appear. The most common symptoms of Coronavirus are:
A cough – this can be any kind of cough, not just dry
Joint and muscle aches
Fatigue Shortness of breath
Fever (high temperature)
Some reports of isolated diarrhea which come before the cough and fever
If you have any of these symptoms, read this advice.
What we know so far: THERE ARE COMMUNITY ACQUIRED CASES OF COVID-19 IN SAN DIGEO COUNTY WHERE THERE IS NO IDENTIFIED RECENT TRAVEL OR SICK CONTACT. EVERYONE IN THE GENERAL POPULATION IS AT RISK.
Risk factors for more severe infections that have been identified include:
Age over 60
High Blood Pressure
Diabetes
Chronic heart and lung disease
The data from studies of the outbreak we have so far, does not identify immunosuppressive treatments prescribed in rheumatology patients as a risk factor for higher risk of death, but it is a reasonable cause for concern. The situation is being monitored.
How should I protect myself?
Wash your hands properly and often. Soap and water is just as good as hand sanitizer. Wash for at least 20-30 seconds.
Cover your mouth and nose with a tissue or your sleeve when you cough and sneeze. Put used tissues into a bin and wash your hands.
Clean and disinfect frequently touched objects and surfaces.
Avoid close contact with people.
Limit all non-essential travel.
Do not touch your eyes, nose or mouth if your hands are not clean. Do not share objects that touch your mouth – for example, bottles, cups.
Stay at home if you are sick to help stop the spread of whatever infection you may have.
Is there anything else I do?
Please ensure that you have received all appropriate vaccinations, including seasonal influenza and pneumonia vaccines if you are on immunosuppressive therapies. These will not prevent COVID-19, but may lessen the chance of secondary infection and will prevent illnesses that could be confused with COVID-19.
Should I stop my immunosuppressive treatment?
Because many of the treatments (including prednisone, biologic therapies, and disease-modifying drugs) used in arthritis and autoimmune disease suppress the immune system many patients have asked if they should stop their treatment.
Our advice (reflected by advice from international rheumatology representative bodies) is that you should remain on treatment (see below). The COVID 19 epidemic may last several months and if you stop your medicine you will likely have a flare. You will then need to restart your medicine and perhaps need to take more intensive treatment.
We do not recommend stopping your rheumatology medication with the exceptions detailed below.
If you have any further questions about this please contact our office.
What if I develop an infection on treatment?
Our current advice that you should postpone your treatment should you develop an infection (with the exception of prednisone which you should continue) until the infection has adequately been dealt with. As with all infections on immunosuppressive therapy, we would advise seeking medical attention for any illness you would normally contact your family doctor about.
Additionally, if you are directly exposed to someone with Novel Corona Virus infection / COVID-19 it makes sense to postpone your treatment (again with the exception of prednisone) until you have been assessed to exclude an infection.
To clarify, we do not recommend abruptly stopping prednisone as you could have withdrawal symptoms.
What about attending Mass gatherings?
You should avoid mass gatherings period. Practice social distancing. Keep 6 ft apart. Travel only in family groups. Make outings only for essentials of food, medicine, fuel.
What about foreign travel?
Cancel all non-essential travel. It would make sense for the moment, particularly if you are on biologic therapies, prednisone or particularly if you have any other risk factors for serious infection (Age > 60, significant chest problems, high blood pressure, heart disease, and diabetes) that you should avoid any unnecessary travel. Some common sense and discretion is advised but again, err on the side of caution.
