Practical Tips

Information produced and reviewed by the Australian Rheumatology Association 16th February 2023.

Vaccination

Vaccination is the best way to protect yourself, and others around you, from COVID-19.
All patients with AIRD should have the COVID-19 vaccine.
Many patients with AIRD are recommended to have a 3rd primary vaccine dose.
All patients with AIRD should have booster doses after the 3rd primary dose OR, if not eligible for the 3rd primary dose, after the 2nd primary dose. A second booster is recommended 3 months after the 1st booster or COVID-19 infection.
A third booster dose (“the 2023 Booster”) is now recommended for some people 6 months after their previous booster dose or most recent COVID-19 infection-whichever was most recent.
This will mean that some people with rheumatic diseases will be up to their 6th COVID-19 vaccine dose ie. a primary course of 3 doses, original booster, 2022 winter booster and the 2023 booster dose.
for more information on the COVID-19 vaccine and the third booster dose and who should have it, please refer to the ARA Covid-19 Vaccination information sheet here.
It is reassuring to note that evidence has shown that patients with Rheumatic disease are likely to experience mild, Flu-like symptoms from COVID-19, when vaccinations are up to date. Patients being treated with Rituximab and cyclophosphamides may be an exception to this and should discuss their individual circumstances with their rheumatologist.

Other things you can do to reduce your risk

Wear a mask (preferably N95), ensure it is worn correctly and in appropriate or mandated situations.
Wearing eye protection (glasses) has been shown to reduce the risk of contracting COVID-19 by 15%.
Regular hand washing and good personal hygiene practices continue to be vital.
Maintain social distancing especially indoors and avoid crowded or indoor venues.
Shop online if possible.
Work from home where you can. If you cannot work from home, optimise physical distancing and hygiene measures in the workplace.
If you are on rituximab or cyclophosphamide, you should contact your rheumatologist to see if you are eligible for an additional antibody treatment that may improve your immunity to COVID-19.

Have rapid antigen tests (RAT) at home. Most importantly know how to use them.
Think about who would be able to look after your kids, pets and other dependents if you became unwell.
Think about who could take you to have a PCR test/medical appointment if you needed one if you were unwell.
Ensure you have enough prescriptions and medicines for 2 weeks in case you have to isolate.
Ensure you have access to a thermometer, masks, hand sanitiser, simple pain relief, throat lozenges, tissues and sufficient food if you are unable to have it delivered.

If you have a fever, (≥37.5°C) or history of fever (e.g. night sweats, chills) OR acute respiratory infection (e.g. cough, shortness of breath, sore throat) OR loss of taste or smell or any other symptoms of COVID-19 perform a rapid antigen test (RAT) if you have one. If you do not have a RAT you will need to have a PCR test.

EVEN IF YOU DO NOT HAVE SYMPTOMS, IF YOU TEST POSITIVE FOR COVID-19, CONTACT YOUR RHEUMATOLOGY TEAM.
Contact your rheumatology team for specific advice about treatment, as decisions to pause or continue treatment should be made on a case-by-case basis
If you are on glucocorticoids/steroids (e.g. prednisolone), do not stop them suddenly; seek advice from your treating team.
There are currently 2 oral antiviral medicines available in Australia via the Pharmaceutical Benefits Scheme (PBS) for the treatment of adults with COVID-19, who are at increased risk of severe disease:
- Molnupiravir (brand name Lagevrio)
- Nirmatrelvir + ritonavir (brand name Paxlovid) – this treatment can interact with many other medicines so speak to your doctor or rheumatology team if you have any questions.
These medicines are most effective if taken as soon as possible after a diagnosis of COVID-19. You should wait for 3 months after COVID-19, before having your next COVID-19 vaccination.
People with AIRD may be eligible to receive other treatments when the above are not suitable or available, please seek advice from your rheumatology team if you have any questions.
Isolate according to your state government rules and tell your contacts.
If you are very unwell, please call an ambulance as you would do normally in an emergency situation.

If you are on a medicine for AIRD you may be able to get this prescription from your doctor electronically via a text or e-mail. This is not available for all medicines.
Call your pharmacy to ask about home delivery of medicines.

Some telehealth (phone or video) appointments are funded by Medicare. Contact your rheumatologist about this option.
Make sure you keep in touch with your treating team so there is no interruption in prescriptions.
If you need blood tests, Medicare rebates may allow you to have these collected at home.
If you are on a biological or a targeted synthetic DMARD, please keep in touch with your rheumatologist to ensure there is no interruption of your treatment supply.

It is important to maintain healthy habits to keep your immune system as strong as possible.
Emotional stress, lack of sleep and physical exhaustion can impact your immune system further, making you more susceptible to illness.
Eat a healthy diet that includes plenty of fruit and vegetables.
Ensure you exercise each day.
- This is helpful for general physical and psychological health, but especially while physically and socially isolated.
Get plenty of sleep—aim for eight hours every night
Take steps to relieve stress—try yoga, meditation or light exercise you can do at home.
For more suggestions on how to stay healthy at home, take a look at the Healthier. Happier. website.
The Australian Government website Head to Health is also a good resource for tips on maintaining good mental health and reducing stress.