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Jeanine from Sylvan Lake asks: Are cataracts associated with rheumatoid arthritis?
Rheumatoid arthritis can have a number of manifestations within the eyes, including scleritis, sicca symptoms (dryness), or even vasculitis. While not as common, cataracts can occur, although this may be more due to steroid use (e.g. prednisone) than the arthritis itself. Cataracts itself is also relatively common in the general population: those aged between 40-50 have a 5% rate of developing cataracts, so it is possible to coincidently have both. The most important thing to do from an arthritis point of view is to ensure your arthritis is under good control. If you have no inflammation, the chance the arthritis is affecting your eyes is low.
Hayley from Calgary asks: I have recently gotten sick and need to know if I should continue my methotrexate injections or hold them while I am sick ?
As a general rule, it’s ok to continue traditional DMARDs (examples: methotrexate, plaquenil, sulfasalazine, leflunomide) when sick, particularly anything mild without a fever or needing antibiotics. For those on biologics, we generally recommend that they are held, particularly if you have a fever or require antibiotics, until you are feeling better. However, during the COVID19 pandemic, we are often a little more cautious and it would be reasonable to hold any DMARD – traditional or biologic – until you are feeling better. In most cases for methotrexate, this would mean missing one dose, which wouldn’t impact arthritis control for most individuals.
Jean from Alberta asks: Is it safe to take methotrexate with sulfasalazine?
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.