Question 1

What is rheumatology?

Accepted Answer

Rheumatology is a branch of internal medicine concerned with diagnosing and treating diseases of the joints, bones, ligaments, soft tissues and the musculoskeletal system. Many rheumatic diseases are systemic — they can involve the immune system and other organs (skin, eyes, kidneys, lungs, heart, blood vessels, peripheral nerves, digestive system and liver), not just cause joint inflammation.

Question 2

Who is a rheumatologist?

Accepted Answer

A rheumatologist is a physician who has completed training in internal medicine and rheumatology (an adult rheumatologist), or a paediatrician with additional training in diagnosing and treating rheumatic and musculoskeletal diseases (a paediatric rheumatologist).

Question 3

What do rheumatic and musculoskeletal diseases include?

Accepted Answer

There are more than 200 rheumatic and musculoskeletal diseases, such as: rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, connective tissue diseases, vasculitis, Behçet's disease, ankylosing spondylitis and osteoporosis. They also include many disorders that cause joint and muscle pain — such as back pain, neck pain, and pain in the shoulders, elbows, wrists, knees, ankles and feet.

Question 4

With the spread of COVID-19, what is the infection risk for patients with rheumatic diseases?

Accepted Answer

Patients with rheumatic diseases may have weakened immunity — whether due to kidney disease, chronic lung disease, older age, diabetes or other comorbidities, in addition to the immunosuppressive medicines they take. People with several comorbidities certainly have a higher risk if they catch the virus.

Question 5

Are certain rheumatic conditions more susceptible to the virus?

Accepted Answer

Some rheumatic diseases — such as active lupus or active immune-mediated vasculitis — require more strongly immunosuppressive treatment, which makes patients more susceptible to infection and to more severe disease. Patients with systemic disease (affecting more than one organ system) who are on higher doses or stronger immunosuppression need an individualized risk–benefit assessment, so they should be followed very carefully.

Question 6

What preventive strategies can be offered to patients on immunosuppressive treatment?

Accepted Answer

Strategies have been developed by disease-control and prevention centres. Patients are advised to inform their primary-care providers that they take immunosuppressive medicines. Importantly, providers should be aware that some patients on immunosuppressants may not develop a fever, and their white-blood-cell count may not rise as it would in healthy people — so frontline physicians need a high index of suspicion when managing illness.

Question 7

How can doctors advise patients to continue anti-rheumatic or immunosuppressive medicines?

Accepted Answer

Many physicians can prescribe anti-rheumatic therapies, but every clinical case is different. International rheumatology guidelines should be followed, with emphasis on individualized care by physicians who know their patients well.

Question 8

What should I do as a patient with a rheumatic or autoimmune disease?

Accepted Answer

Contact your treating rheumatologist and consult them remotely. Adhere to physical distancing / social isolation per Ministry of Health and specialized international guidance. Distancing should include all household members living with a rheumatology patient who takes immunosuppressive medicines. It also includes close relatives and friends.

Question 9

Do I need to visit my doctor right now?

Accepted Answer

It is not advisable at present. Clinical experience shows that about 30% of COVID-19 infections are now acquired through clinic and hospital visits, pharmacies and their waiting areas — so avoid non-essential visits and use remote consultation where possible.

Question 10

I have a rheumatic disease and take immunosuppressants but have no symptoms — should I stop my medicines to lower my COVID-19 risk?

Accepted Answer

In general you are advised to continue your medicines as prescribed, while staying home and away from people as much as possible. Wash your hands carefully and frequently, and avoid touching your nose, mouth and eyes with your hands. Do not stop or change your medicines without consulting your rheumatologist.

Question 11

I work in an office with many colleagues — should I stay away from work or ask to work from home?

Accepted Answer

Patients at risk of COVID-19 who are likely to be in crowded settings (such as an open-plan office) are advised to ask their employer for special accommodations, including the option to work remotely.

Question 12

Can I travel?

Accepted Answer

Patients at risk of COVID-19 should consider postponing non-essential travel, including avoiding crowded public transport by air, land and sea. Care providers should be ready to write medical reports to help patients cancel or reschedule travel.

Question 13

I live with someone at risk of COVID-19 — what precautions should I take?

Accepted Answer

For household and close-contact precautions when living with people at risk (for example frontline healthcare workers), continuous risk assessment is recommended, along with the basic measures that limit transmission.

Question 14

If I develop symptoms such as fever or cough, should I stop taking my medicine?

Accepted Answer

Yes. If you have any symptoms that may be related to COVID-19, stop the immunosuppressive medicine — except corticosteroids (Prednisone) and hydroxychloroquine (Plaquenil). You should also be tested for COVID-19 according to your country's national guidelines. Replace NSAIDs with paracetamol, and check with your rheumatologist about the right time to resume your treatment.

Question 15

What is known about infection rate and severity in rheumatic patients, especially those on Prednisone, DMARDs or biologics?

Accepted Answer

Immunosuppressive medicines include: Prednisone (cortisone) at > 20 mg/day, Azathioprine (Imuran), Leflunomide (Arava), Mycophenolate mofetil (CellCept), Tacrolimus (Prograf), Methotrexate, and Cyclophosphamide (Endoxan). Biologic therapies such as: Adalimumab (Humira), Etanercept (Enbrel), Certolizumab pegol (Cimzia), Golimumab (Simponi), Secukinumab (Cosentyx), Abatacept (Orencia), Tocilizumab (Actemra), Ustekinumab (Stelara), Infliximab (Remicade), Rituximab (MabThera) and Belimumab (Benlysta). JAK inhibitors: Xeljanz and Olumiant. Biosimilars, e.g. Amgevita (biosimilar to adalimumab), Remsima (to infliximab) and Truxima (to rituximab). Currently there is no clear preventive information specific to COVID-19 for patients with rheumatic diseases. In fact, some of these medicines used for rheumatic disease are being tested as treatments for COVID-19.

Question 16

Are there any drug recommendations (preventive or therapeutic)?

Accepted Answer

There are currently no proven preventive, vaccine or therapeutic recommendations other than the supportive care recommended for this disease.

Question 17

What can patients do to protect themselves from this disease?

Accepted Answer

Focus on hand hygiene — washing hands well and frequently — and avoid contact with sick people, especially those who cough or sneeze. Everyone should be encouraged to wear face masks routinely.

Question 18

What can patients do together with their healthcare providers?

Accepted Answer

Patients should receive all appropriate vaccinations, including the seasonal influenza, pneumonia, whooping-cough and meningitis vaccines. These do not prevent COVID-19, but they reduce the chance of secondary bacterial pneumonia and of illnesses that can be confused with COVID-19. Patients should wash hands frequently, avoid touching the face and mucous membranes, and keep an adequate stock of essential medicines (for example a one-month supply) in case pharmacies cannot be restocked in time.

Question 19

Can we use hydroxychloroquine to prevent COVID-19?

Accepted Answer

No. Social distancing and personal hygiene alone are what prevent COVID-19 infection.

Question 20

Have biologic drugs been used to treat the inflammation caused by COVID-19?

Accepted Answer

Some biologic drugs have been used experimentally to treat severe inflammatory states from COVID-19, to try to reduce inflammation. However, there is no evidence that these drugs treat or protect against COVID-19 infection.

Question 21

If I'm on biologic therapy, am I immunocompromised, and how can I boost my immunity?

Accepted Answer

Yes. Eat a healthy diet, exercise regularly, and drink plenty of water.

Question 22

If I have no infection symptoms, should I undergo COVID-19 testing?

Accepted Answer

You should be tested for COVID-19 only if you have symptoms, and you should follow your country's national guidelines regarding these tests.

Question 23

What are the basic preventive measures for patients against COVID-19?

Accepted Answer

Wash your hands frequently with an alcohol-based hand rub, or with soap and water (at least 20 seconds). Avoid touching your eyes, mouth and nose. Maintain respiratory hygiene: cover your mouth and nose with your bent elbow or a tissue when coughing or sneezing. Keep social distancing: at least one metre between you and anyone else. Avoid crowded public transport. Avoid large gatherings. Avoid non-essential travel.

Question 24

Is it necessary to use a protective mask?

Accepted Answer

Healthy people and patients with rheumatic diseases are advised to wear a face mask, especially when caring for an infected person who shows no symptoms, or when among people who show symptoms suggestive of COVID-19. Before putting on the mask, clean your hands with an alcohol-based rub or with soap and water. If you wear a mask, you must know how to use it and how to dispose of it correctly.

Question 25

What if I have fever, or a cough with difficulty breathing?

Accepted Answer

Seek medical care promptly.

Question 26

What if I have any question?

Accepted Answer

Contact your rheumatologist.

Question 27

Rheumatology, autoimmunity and COVID-19 infection — overview

Accepted Answer

The World Health Organization declared COVID-19 a pandemic, with severe acute respiratory illness as its most dangerous outcome. Patients with rheumatic diseases — including lupus, rheumatoid arthritis, ankylosing spondylitis, undifferentiated connective tissue disease and immune vasculitis — are among those most susceptible to severe infection. Their treatments often suppress the immune system, making them more prone to viral infections such as COVID-19. The general principles are: keep taking your medicines as prescribed unless you develop symptoms, follow strict hand hygiene and physical distancing, stay up to date on vaccines that prevent confusable illnesses, use remote consultation instead of in-person visits where possible, and always coordinate any change of treatment with your treating rheumatologist.

Question 28

Why is Behçet's disease named this way?

Accepted Answer

It is named after the Turkish dermatologist Hulusi Behçet, who in 1937 described the classic triad of the disease (eye inflammation, mouth ulcers and genital ulcers) and proposed that these features may represent a single, independent disease. The Greek physician Adamantiades had described similar cases six years before Behçet, so in some countries the disease is called "Adamantiades–Behçet."

Question 29

Is Behçet's disease hereditary?

Accepted Answer

Behçet's disease is not considered a hereditary disease, but there are some genetic factors that predispose a person to it. Relatives of a patient with Behçet's, or people with recurrent mouth ulcers, will not necessarily develop Behçet's in the future.

Question 30

Is Behçet's disease contagious?

Accepted Answer

Some people think Behçet's results from an infection because the mouth, eye and genital lesions may resemble herpes. These beliefs are wrong: Behçet's disease is not contagious and does not transmit from one person to another.

Question 31

If the HLA-B51 test is positive, is that a diagnosis of Behçet's?

Accepted Answer

This test is not a specific diagnostic test for Behçet's. Researchers have found it positive in Behçet's patients of certain ethnic origins, but not in all patients. Its frequency may be higher among some patients within the same family, pointing to the importance of a genetic factor and its role in predisposition. Studies have not shown a link between specific symptoms or disease severity and a positive result.

Question 32

Which doctor treats Behçet's disease?

Accepted Answer

Behçet's disease is classified in the medical literature as a vasculitis, which is one of the rheumatic diseases. Therefore the rheumatologist (specialist in rheumatic and joint diseases) is the one who should care for patients with Behçet's. Because the disease can affect more than one organ, doctors from other specialties — eye, nerve, skin, digestive system and others — may also be involved. Treatment should be a joint effort across the different specialties to choose the right therapy for each patient. The patient should tell each of their doctors about the treatments they use, so the physician can coordinate and choose the appropriate therapy.

Question 33

Can Behçet's disease be prevented?

Accepted Answer

There is no way to predict that a particular person will develop Behçet's, and there is no known way to prevent it. We know that genetic factors may predispose a person; the only advice we can offer — especially to people with relatives affected by Behçet's — is to avoid consanguineous (relative) marriage.

Question 34

If I have Behçet's disease, can I have children?

Accepted Answer

There is no medical evidence that Behçet's disease affects fertility in either women or men. Information on pregnancy in affected women varies: a large proportion notice no effect of the disease on pregnancy, some notice increased disease activity at different stages of pregnancy, and others notice increased activity after delivery. Women with Behçet's are advised to coordinate with their doctors and plan pregnancy, ideally conceiving during a quiet (remission) phase of at least six months. Information on children born to mothers with Behçet's has shown excellent results. Some medicines used to treat certain Behçet's cases may affect fertility — discuss this with your doctor.

Question 35

What factors trigger flares of Behçet's disease?

Accepted Answer

Some information shows that exposure to injuries and trauma, as well as tooth extraction, may lead to increased disease activity or the appearance of new symptoms. So if a patient needs to see a dentist, undergo surgery, or have any procedure for any reason, the treating physician should take the appropriate measures to avoid the development of new symptoms.

Question 36

If someone has recurrent mouth ulcers, does that mean they will develop Behçet's in the future?

Accepted Answer

It is known that recurrent mouth ulcers affect about 20% of normal people. One study found that about 2.9% of people with recurrent ulcers developed Behçet's within a period ranging from two months to 15 years after the ulcers appeared. So people with recurrent ulcers who live in areas where Behçet's is more common are advised to be under periodic medical supervision.

Question 37

General advice about Behçet's disease

Accepted Answer

Adhere to your doctors' instructions and let them know of any changes you notice. Follow your doctors' instructions about periodic visits and laboratory tests, as some treatments require regular lab work to avoid medication side effects. Have a medical eye examination at least once every six months, even if you have no symptoms. If you smoke, stop smoking. Eat a healthy diet — fast food rich in fats can harm the blood vessels. If you take cortisone derivatives, eat food rich in calcium to protect the bones and reduce calories to avoid weight gain. With our best wishes to everyone for health and wellbeing. (Prepared by the Behçet's Patients' Friends Charity.)

Frequently asked questions

Rheumatology

COVID-19

Behçet's disease

Frequently asked questions

Rheumatology

COVID-19

Behçet's disease