Doc Spot

Your questions answered by our medical professional, Prof. Denton

I am still concerned about COVID-19. I am on methotrexate and prednisolone, would I still run a genuine temperature? I have also read articles recommending a home oximeter in the event of catching the virus, however since I have Raynaud’s will the readings be distorted?

It is very understandable that you are fearful of COVID-19. This has been a devastating illness and patients with systemic sclerosis receiving immunosuppression such as methotrexate together with steroid treatment (prednisolone) are included in the group of individuals who were advised by the UK Government to “shield”. This is sensible because any infection may be more serious if you have a weakened immune system. Despite shielding, the nature of the pandemic has resulted in a significant number of cases occurring in patients with systemic sclerosis as well as other autoimmune rheumatic diseases. However, new expert recommendations now suggest that people who are living with such conditions may not be more likely to either contract or become severely affected by COVID-19. Therefore, whilst it is important to follow Government advice, it may be that the risk to people with Scleroderma is lower than was feared. With regard to the oximeter, it is possible for results to be lower than expected in patients with Raynaud’s but not necessarily, and so it is important to take some control readings when you feel well, so that you know what the baseline level is. Treatments are not likely to affect temperature measurements, however it is clear that fever is not always a feature of COVID-19. In general, if you are concerned that you are showing symptoms you should seek and follow the general advice and make sure that your diagnosis and treatment are fully explained.

Regarding the risk factors for COVID-19, am I correct in thinking that there is only an increased risk to patients on particular medications? I only take Nifedipine when my Raynaud’s is especially bad. I intend to return to work and normal activities as far as the restrictions allow.

There is no reliable evidence that treatments for Raynaud’s will have any adverse effects should you contract COVID-19 in terms of increased risk or severity, and so my advice is to continue with your medication as usual; however if you are concerned then you should discuss this with your clinical team. They may suggest that certain symptomatic treatments could be discontinued, however please check first.

I have Scleroderma with lung and gut involvement but no immunosuppressants. I want to keep working from home as I feel I am at risk until a vaccine is available, but my employers require a medical note. What should I do?

This is something that you should discuss with your employer and will be influenced by Government advice, since as long as this continues to state that you should work from home wherever possible then what you are asking would seem reasonable. Once the risk is classed as low and the advice changes, you may well be advised to return to work. The development of a vaccine may take a long time and so at present other measures to reduce the risk such as social distancing and other protective steps are probably more important. Whilst COVID-19 can be very serious in a minority of patients, experts have recently agreed that autoimmune rheumatic diseases such as Scleroderma are not generally associated with increased risk or severity, which is reassuring for our community.

Do you know of any specific dietary interventions that may help people with Scleroderma to boost their immunity or lower inflammation levels?

I would emphasise the importance of a good general diet and maintaining adequate nutrition, as well as taking all reasonable steps to maintain wellbeing. However, some nutrients and vitamins may be beneficial to the immune system and many patients choose to take supplements of vitamin C and vitamin D, amongst others. Whilst not proven to be helpful they are unlikely to cause any adverse effects as long as you do not exceed the recommended maximum dosage.

Can Scleroderma affect my sense of touch? I have noticed a few changes lately, and whenever I have a shower the water always feels extremely hot on my skin, despite feeling ok to the rest of my family.

Systemic sclerosis can affect sensation in the skin due to the effect on the nerves and blood vessels and because the thickened skin may have altered sensitivity due to inflammation. This could explain the symptoms that you describe. Conversely, some patients actually have reduced sensitivity to heat, so it is important in such cases to carefully check the temperatures of fluids and of objects to avoid any unintentional burns.

I have systemic sclerosis and I feel that my condition is getting worse, however my follow-up appointment is ‘on-hold’ due to the pandemic. I have read your information on annual tests and am concerned that I am not being offered these. Please can you advise what I should do?

This is an important point. Many routine clinic visits and tests have been postponed due to the COVID-19 pandemic, although these will be reorganised as the situation improves. However, the number of test slots available is likely to be reduced and there are particular potential problems for lung function testing, because extra care may be needed to reduce the risk of cross-infection. It is important to keep in contact with your specialist centre and to alert the clinical team to any changes that might suggest that your condition could be worsening, such as an increase in breathlessness. Since attendance at the hospital may be difficult, some clinics are now taking place via telemedicine. This allows urgent cases to be seen virtually and for certain tests to be given clinical priority.