During this pandemic, many medical offices and healthcare organizations have changed to telemedicine to continue treating patients while limiting ER and hospital visits and protecting the healthcare workers and critically ill patients.  Also, patients with autoimmune diseases already have a weakened immune system from their condition and the medications they are taking.

For Rheumatology, most visits can be done virtually. Routine visits are currently on hold!

– Patients can get their medications renewed for Lupus, Rheumatoid Arthritis, Sjorgren’s Syndrome, Psoriatic arthritis, OA, gout, and other conditions. Given the current Plaquenil/Hydroxychloroquine shortage in most cities during the COVID-19 pandemic, patients can request for a 3 month supply.
– I am taking calls to answer questions about disease activity, lab and imaging results, and changes concerning dose adjustments. Patient education is still going on!

– Outpatient biologic infusions are being palace on hold for nonurgent cases. Most medication concentrations can stay in a person’s body for a few weeks.
Are there Rheumatology emergencies?
There are a few emergencies in this specialty. The conditions that would require an emergency room visit or hospitalization are:

Any acute neurologic conditions that can be seen with neuropsychiatric lupus or vasculitis- Any acute chest pain or cardiac symptoms indicating heart attack given that individuals with lupus, RA, Takayasu vasculitis and psoriatic arthritis are at risk for premature atherosclerotic disease.- Any rapid progressive muscle weakness, difficulty swallowing and breathing seen with myositis (a disorder of muscle inflammation)
– An infection in the joint or “septic joint”Patients usually present with acute redness, swelling, warmth, fever, and immobility of the joint. Your doctor may ask for blood work and radiographic imaging first or have you come into the office for drainage if suspected. Gout or a flare may sometimes mimic these symptoms.
– Patients with  Antiphospholipid syndrome are at risk for developing clots in the legs or arms (deep vein thrombosis), or a clot in the lungs (pulmonary embolism) and brain (stroke).
-Patients with Lupus developing severe kidney disease (nephritis) which can be characterized by facial or leg swelling, change in urine (frothy appearance or blood).
Please call your doctor first if you have any issues or concerns before heading to the ER to avoid your exposure. I urge you to let the ER and hospitals conserve their resources for true emergencies during this crisis. I am here for you!

Thank you to Dr. Jennifer Lincoln and Dr. Leslie Kim for highlighting this important discussion and spreading the message. I hope this will continue to help all patients and our healthcare workers survive this crisis. #drmaggiecadet