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Answers: Page 3 of 12
Allie from Canada asks: I have lupus and low platelets (thrombocytopenia). I understand COVID vaccines can make low platelets worse. Can I get a COVID vaccine?
Low platelets can be a manifestation of systemic lupus. It is still safe for those with lupus to receive a COVID-19 vaccine. There is a concern of the virus vector vaccines (Astra Zeneca and Johnson & Johnson products) inducing low platelets and a syndrome called vaccine induced thrombotic thrombocytopenia (VITT). The risk of developing VITT is very rare. There is no data to suggest having low platelets in lupus would increase the risk of developing VITT. Perhaps more importantly, the mRNA vaccines (Pfizer and Moderna products) do not have the same risk associated with them. For most Canadians, the mRNA vaccines are the ones that are available to them. In Alberta, those with lupus fall under Phase 2B, meaning they would only be offered an mRNA vaccine at this time. For information on COVID19 vaccines and rheumatology medications, click here.
Erin from Jasper asks: My dentist diagnosed me with rheumatoid arthritis based on findings in my TMJ joint. What should I do now?
Rheumatoid arthritis is a systemic disease and whether or not it impacts one joint or many, it should be ideally managed by a rheumatologist. Rheumatoid arthritis is a condition that can be placed into remission with the right treatment. If not already, you should speak to your family physician or dentist about a referral to a rheumatologist to ensure there are no other joints involved and treatment options are discussed. In Alberta, all rheumatologists require a referral.
Elena from Calgary asks: Is it possible to connect with a Rheumatologist virtually? Or do appointments need to be in person?
The COVID-19 pandemic has changed how rheumatology visits happen. While some patients are still being seen in person, many are being seen virtually – either through phone or video (Zoom) appointments. Check with your rheumatologist’s office to see what they are doing, and if a virtual visit is appropriate for you. For more information on virtual visits and how to best prepared, check out our webpage and video.
Please visit our COVID-19 vaccine information page, which we will keep updating as more information becomes available. At this time (January/2021), there is no information to suggest the currently available COVID-19 vaccines are unsafe for those with lupus or taking any medications for lupus. That applies to all rheumatic conditions, in fact. If you are still not sure after reading the available information, please contact your rheumatologist.
If you review medication interactions for methotrexate, the list appears long, but in fact, is not entirely accurate. There are many medications listed that you should not take with methotrexate, but most of them are only theoretical, whereas we have years of experience knowing these combinations are in fact safe.
It is very common to use methotrexate and sulfasalazine together, and it is considered safe. Similarly, some texts suggest methotrexate should not be used with anti-inflammatories (NSAIDs) or stomach protector medications called proton pump inhibitors (PPIs). Again, these combinations are used frequently. In fact, it is not uncommon that some arthritis patients are on methotrexate, sulfasalazine, ibuprofen and omeprazole (a PPI) all at the same time.
We do recommend holding methotrexate if you require a sulfa-based or penicillin-based antibiotic, but these are really the only interactions we watch for.
Many people are asking: I have rheumatoid arthritis. Will I be able to get the COVID-19 vaccine when it becomes available?
As we answer this (Dec/2020), we do not fully know the answer yet. It is a complicated question as it relates to both the safety of the vaccine, and how well it works. Safety is really the key part, and because the technology being used to develop the COVID19 vaccines is mostly new, we do not have the experience to know for sure if it’s safe. That said, there is currently no reason to think it won’t be safe, as they are not LIVE vaccines, which are contraindicated for many individuals with arthritis because of the medications they are on. As we get closer to having vaccine available, we expect more data to also come out which will help inform this decision. Stay tuned as we learn more, and check with your rheumatologist for your particular situation.
Click here to visit our COVID-19 vaccine information page, which we will keep up to date, or our YouTube site with COVID-19 information videos.
Jonathan from Calgary asks: Is there any specific advice recommended for rheumatology patients and COVID-19?
Please click here to our page on COVID-19. We will try to keep this information up to date, but the situation remains fluid.
Lily from Edmonton asks: Is there a generic version of Enbrel or Etanercept that will do the same thing Enbrel does for less cost? I can’t get Enbrel covered anymore.
Biosimilars are new medications which are biologically similar to original biologics. In Canada, as of 2020, Enbrel and Remicade both have biosimilars available and many medication insurance plans are, or are considering, not providing coverage to the original biologic, but rather the less expensive biosimilar. For most patients, the biosimilar should be as effective and safe. However, for each individual, it is important to speak with your rheumatologist to make the right decision for you. For more information on biosimilars, please click here.
Austin from Toronto asks: I tested CCP positive but have no symptoms of rheumatoid arthritis. Am I more likely to get it now?
Anti cyclic citrullinated peptide (anti CCP) is a test which is highly associated with rheumatoid arthritis. It is not necessary to test positive to have rheumatoid arthritis, but most individuals who are positive have or will develop RA. That being said, there are exceptions to this rule, particularly if the test is not strongly positive. In particular, there is growing data to suggest individuals with pulmonary (lung) issues may test positive and not develop RA. In some instances, it may be worthwhile monitoring your joints with a rheumatologist over time to ensure you do not develop rheumatoid arthritis.
Every province has slightly different rules for coverage of advanced therapies such as tofacinitib, and biologics. That said, in most situations, working with your current rheumatologist, or your new rheumatologist if you are planning a move to Alberta, a solution is found to ensure you can continue to receive the treatment that makes you well.