Patient Support during COVID-19

Dear Rheumatology Patients

Please be advised that our Rheumatology services have been restricted due to COVID-19.

Our overall aim is to reduce your physical contacts and thus reduce your risk of contracting and passing on COVID-19 in order to end this pandemic as soon as is possible.

We will prioritise existing patients on immunotherapies and urgent new patients but please understand that as this goes on we will have to spend more and more time in managing the COVID-19 pandemic. This is going to happen with all hospital specialists.

For the moment we will move all review appointments to telephone or video consultation in order to ensure your treatment continues safely.  We will manage your queries but please understand there may be delays in responding.  We will do our best.

If you need to contact us, please download this patient query form and follow the instructions.

We will have to do the minimum of monitoring blood tests to further reduce your contacts and because blood testing services will be restricted.

Please see current advice for patients with rheumatological conditions that is posted on the Arthritis Ireland website – there is also a Q&A on the Arthritis Ireland Facebook page that we hope you will find helps answer your questions.

There is also a helpful information leaflet that we have put together.

Please stay safe.

David Kane & Ronan Mullan

Consultant Rheumatologist’s

Tallaght University Hospital
We understand that rheumatology patients on immunosuppressives (biologics, steroids, drugs such as methotrexate) are feeling particularly vulnerable and anxious due to the novel Coronavirus disease Covid-19.

What we know so far is:

By far, the  most effective thing that you can do now to protect yourself is to prevent the spread of infection for yourself and others by following the advice on
- Wash your hands very regularly for at least 20 seconds using soap and water. Dry hands thoroughly afterwards
- Avoid touching your face, especially eyes and mouth
- Cough or sneeze only into an elbow or a tissue put the tissue into the bin afterwards. Do not reuse it
- We recommend to wear a mask as per HSE guidance – on public transport and when indoors and unable to keep a social distance
- Practice sensible social distancing (currently 2m but under review) especially from people who appear to be ill, e.g. coughing or sneezing
- Don’t shake hands, and avoid hugs
- Avoid busy public transport and large groups of people
- If you are in a high risk group you should be socially isolating as much as is possible

Most patients will have a mild illness and recover but if we all take the actions listed above we will protect those who will develop severe illness if infected. The mortality is 1-2% and high risk groups for severe disease have been identified as age over 70, chronic heart and lung disease, diabetes and active cancer. The data from studies of the outbreak that identified these risk factors did not identify immunosuppressive treatments prescribed in rheumatology patients as a high risk factor for mortality. However patients on immunosuppressives have a reasonable cause for concern as this is an infectious disease and we are monitoring data and international guidelines on the disease in order to best advise you, our patients.

Our advice is to not stop steroids suddenly or you may become very unwell.  At present there is no known benefit to stopping your immunosuppressive rheumatology medication but if you have stable disease you should discuss with your rheumatologist whether the dose of the immunosuppressive medication can be safely reduced during this pandemic. The COVID-19 pandemic may last several months so if you reduce or stop your medicine you will be more likely to have a flare during this period and need to restart your treatment or have to take more intensive treatment with steroids.

If you are on immunosuppressives and have other high risk factors for COVID-19 or have had a history of recurrent or opportunistic infections while on immunosuppressive therapy you are high risk and should socially isolate (cocoon) to protect yourself.  If you have symptoms of a viral infection - cough. shortness of breath, breathing difficulties, fever (high temperature) – continue steroids but hold your other immunosuppressives and seek advice with your GP or rheumatologist or consult the HSE website – do not stop steroids suddenly without medical advice