New Guidelines for rheumatology patients on immunosuppression published

In the last 24 hours some guidelines have been published by the Irish Society for Rheumatology  (ISR) which offer advice additional advice (to the Stay at Home advice offered by the HSE) to patients on immunosuppressive therapies.

Because patients who are on treatments which suppress their immune systems are at higher risk than others, additional restrictions have been recommended to keep them safe.

Which medications?

Firstly, the guidelines help identify the medications which put patients at risk (see the blue box at the bottom of the graphic). This list includes standard immunosuppressive therapies, biologic medications, and steroid medications.

High Risk Group

The guidelines also help identify those who are, because of their age, underlying medical problem(s), or steroid intake at especially high risk.
It recommends that those at especially high risk Cocoon.
Examples of those in the very high risk category would be those over 70 yrs, those taking regular steroids (prednisolone / deltacortril), those with underlying heart or lung problems, high blood pressure, recurrent infections, or those with diabetes.

Increased Risk Group

Those on immunosuppressive treatments who do not fall into the high risk group still need to be careful. They still need follow the HSE stay at home guidelines, can exercise outside, but two additional recommendations are made; that they limit social contact, and that they do avoid shopping.
It is Cocooning advice but with an allowance for exercise.

Essential Workers

The Government have identified certain categories of workers who are deemed essential, many of whom are keen to stay at work despite the fact that they are immunosuppressed. This is very challenging. Many of those who are in this category who are under my care, have been calling because they are either keen to remain at work, or anxious to remain at home.

My feeling on this is that those who are immunosuppressed should not be in any work environment where they could be exposed to someone with Corona Virus infection.

As there are so many who could be infected, even without symptoms of Corona Virus, any contact is a potential source of infection.

Anything other than staying at home is going to increase their risk. Home working seems to be the obvious solution where practical for most.

This is going to be an increasing problem for those working in healthcare over the among months. I’m not sure I have a simple solution for this – but expect that if you are on any of immunosuppressive treatments on this list – and you inform your employer (and you should), it is likely you will be sent home.

Updated safety information

Over the coming weeks, we will begin to get a sense of the impact of Corona Virus infection for rheumatology patients from an international research project which aims to define the risk more clearly. Until we know more, I would err on the side of caution.