Coronavirus (COVID-19)

Last Updated: 8/27/2021 (included FAQ regarding the vaccine)

If you have a fever, a persistent cough or are experiencing shortness of breath, PLEASE DO NOT ENTER our premises. Do not go to the reception area, even if it is just to reschedule the appointment. Many of our patients are on immunosuppressive medications and exposing them to COVID-19 must be avoided. We are checking patient temperatures at the front door. Everyone must wear a mask. Except for a translator, do not bring anyone else with you to your appointment.

The doctors of AARA understand and trust in the science and the efficacy and safety of all of the vaccines that have been developed and are available in the US to prevent COVID 19. These include PfizerBNT which has now officially been fully approved by the FDA, and the Moderna which is pending full FDA approval, and the J&J vaccine which is still under emergency use by the FDA. We agree with the national agencies including the FDA and the CDC that booster shots are in the best interest of those patients who are immunocompromised from autoimmune rheumatic diseases e.g., RA, SLE among others and those who are taking medications that may immunocompromise them including biologics, jak inhibitors and prednisone among others. These boosters are advised to be taken when they may be available. It is important to note, that the administration is making it a national recommendation that all people receive booster shots starting in September, 8 months after their last vaccine shot, pending the final CDC recommendation on this and preferably with the same vaccine they initially received.

Please contact your rheumatologist team for specifics as to how to time the vaccines around your medications.

We are closely monitoring the public health recommendations and announcements from the Centers for Disease Control and Prevention regarding the COVID-19 (coronavirus) pandemic. Among other things, the CDC suggests washing your hands frequently and practicing social distancing. Some follow-up appointments may be done through phone or video conference (Telehealth), but we will let you know beforehand if that’s the case for your appointment. If you use immunosuppressive drugs, and have no symptoms of infection, you should continue your usual treatment.

The safety of our patients and staff is paramount, so we’ve added extra precautions: Those who have traveled internationally, come in contact with COVID-19, or experienced flu-like symptoms such as a fever, persistent cough, or shortness of breath in the past two weeks must reschedule their appointments, free of charge. We have increased our frequency of disinfecting high-touch areas and usage of gloves and masks. We also perform a complete deep cleaning every night.

What you need to know about COVID-19 (Coronavirus disease) while being a patient at AARA.

At Arizona Arthritis and Rheumatology Associates (AARA), we care deeply about our patients and your health is our top priority. As you know, COVID-19 (Coronavirus disease) has been identified and confirmed in our state of Arizona. We are taking extreme precautions to minimize the flow of patients into the office and limiting them to those who are receiving infusions and in-office administered medications only. We are deep cleaning all of our surfaces throughout the day and performing a complete deep cleaning each evening. We have shifted to telemedicine calls to ensure our patients are getting the care they need and to minimize the flow of patients through the office. You may be called to discuss your care either before or after your infusions in order to minimize your time in the office to just the time to get your infusions.

We are staying up-to-date with all of the evolving science in patients who are on immunosuppressive medications in the face of this pandemic. Thus far, major medical organizations in the field of Rheumatology such as the American College of Rheumatology and the European League Against Rheumatism have given some guidance. As always, we stand committed to continue to provide the best and safest care possible to all of our patients. Many of our patients who are on immunosuppressive medications have already reached out to our offices regarding whether or not they should discontinue some or all of these medications.

To date, the most effective way of limiting the spread of the virus is frequent handwashing for a minimum of 20 seconds with soap and remaining 6 feet apart from others (social distancing).

The reason that this virus is different than others that we deal with is that it may be spread by contact of people who are not having symptoms. The most common symptoms are fever, dry cough and/or shortness of breath. What we know at this point is that in the early stages of the viral illness, you may experience body aches and fatigue, but then shortly thereafter within 2-3 days you may have a high fever of >102 degrees. The incubation period, which is the time it takes before seeing clear symptoms of Coronavirus may take up to 14 days. We also know that the virus may be present on surfaces and be contracted by contact with theses surfaces. This is why frequent hand washing is essential. It is also important to avoid touching your eyes, nose or mouth, as this is how the virus is transferred into the body.

We offer the following advice:

Although our disease modifying medications delivered by pill, subcutaneous injection or intravenous infusion are immunosuppressive, they are used to re-balance a person’s overactive immune system that causes the disease. We try not to overly suppress their immune system which could increase the risk of infection.

People who use immunosuppressive drugs, and have no symptoms of infection, should continue their usual treatment. As always, if signs of infection with fever and other influenza-like symptoms should occur, a brief break from the immunosuppressive therapy may be appropriate. This assumes, however, that the patient is not completely dependent upon these specific medications. Prednisone and other cortisone (steroid) preparations should never be discontinued abruptly.

Understanding that patients with autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis and lupus are at high risk for developing infections if their diseases are not well controlled on medications, it is vital that you continue on your infusion medications to maintain that control. If you stop them abruptly, your disease may flare and require steroids (Prednisone or Medrol). Being on excessive steroids may worsen the course of an infection, especially with this novel virus.

Patients on Prolia should continue their injections as abrupt discontinuation can increase the chance of spine fractures. Infection, bone surgeries and dental surgeries would continue to be reasons to delay the Prolia injection.

Patients have also contacted our office inquiring about how COVID-19 may, or may not, affect their particular disease state. Although we do know that there some issues that put some people at higher risk, such as age over 65, diabetes, heart disease, lung disease and those who are immunosuppressed, at this point, there is no clear evidence around specific rheumatic diseases that we treat at AARA.

There are many ways that you can help us effectively help treat you and minimize your specific risk. Your partnership includes:
a) Being better informed about this viral illness and as such see the links below, visit our website and learn the answers to the most frequently asked questions.
b) Frequent hand washing
c) Informing us by telephone or portal messaging that you have symptoms of fever, dry cough or shortness of breath or have come into contact with someone with the disease
d) Temporarily holding your self-administered medication (including methotrexate, leflunomide, Arava, Otezla, Enbrel, Humira, CellCept, Actemra, Simponi, Orencia, Cimzia, Kevzarra, Taltz, Cosentyx, Stelara, Rinvoq, Xeljanz and Olumiant) ONLY if you experience symptoms.
e) Avoid coming into the office if you are having any symptoms such as fever, cough or shortness of breath and please go to your local ER if you suspect you may have Coronavirus.
f) Please do not bring anyone who does not absolutely need to be with you to your appointments, especially children and elderly parents. This is to decrease the risk of potentially spreading the virus to either yourself and others. Spouses or drivers must wait in the waiting room
g) Minimize unnecessary calls to the office, as we need to make sure the phone lines are open for patients with urgent symptoms related to their diseases.
h) Please minimize all unnecessary travel and practice social distancing.

We value the relationships that we have developed with all of our patients, and we appreciate your trust in our ability to partner with you in your ongoing healthcare management. Together we will work closely to meet any challenges along our mutual journey.

For up-to-date general information about Coronavirus Disease 2019 (COVID-19), please visit the official Centers for Disease Control and Prevention (CDC) website at:
https://www.cdc.gov/coronavirus/2019-nCoV/index.html

For arthritis-related coronavirus information provided by the Arthritis Foundation, please visit:
https://tinyurl.com/AFCoronaVirusInfo


Arizona Arthritis & Rheumatology Associated (AARA) and Coronavirus Frequently Asked Questions

Q: Can I get the COVID vaccine?

A: Based on limited data in patients with autoimmune disorders or in patients who take immunosuppressive medications or therapies, we recommend COVID-19 vaccination to all our patients unless they have any other contraindication. This would include patients who have had a serious allergic reaction to their 1st COVID-19 vaccine or are known to be allergic to any specific components of the vaccine (listed on the CDC website).

Patients with any severe allergic reaction to any other vaccine or injectable therapy (i.e., intramuscular, intravenous, or subcutaneous vaccines or therapies) should consult with their PCP or allergist for individual recommendations.

Allergic reactions to other products such as food, pet, venom, or environmental allergies, or allergies to oral medications are not a contraindication to vaccination with either mRNA COVID-19 vaccine. In addition, there is no contraindication to patients with allergies to latex, eggs or gelatin.
There is also no contraindication if you have already had COVID-19. However, re-infection is uncommon in the 90 days after initial infection. These patients may consider delaying their vaccination until the end of this period.

Q: Are you providing the vaccine in your office?

A: AARA is currently not a designated vaccine site. Please go to your local County website for information on priority levels and how to sign up for your vaccine.

Q: Do I need to hold my medications before or after the vaccine?

A: There is no specific data but based on previous experience with other vaccines, we recommend holding methotrexate for 2 weeks after each dose of your COVID vaccine. There is no need to hold any other biologic or medication. If you are on Rituxan, then you need to talk to your rheumatologist.

Q: What happens if I cancel an appointment at the last minute due to respiratory illness
symptoms?

A: There will be no penalties for cancellations and missed appointments related to respiratory illnesses until further notice. Please be sure you call the office to cancel so your appointment time can be used by someone else.

Q: How do you know if other patients have it? I don’t want to be exposed to the virus.

A: At the time of scheduling and any reminder calls, we are asking all patients to cancel their appointment if they have signs of illness and if they have traveled recently. Patients who exhibit the criteria will not be scheduled until they are the past the two-week incubation period. We also require everyone to wear masks and to distance themselves. Except for a translator, do not bring anyone else with you to your appointment.

Q: What steps are you taking to make sure the clinic is germ free?

A: We always have patient safety in mind and disinfect all surfaces on a regular basis, regardless of the coronavirus outbreak. We perform a complete deep cleaning every night as well. All staff wash their hands with soap and water regularly and use hand sanitizer in between treating patients. This is being reinforced daily. Our staff wear gloves during specific procedures, such as trigger point dry needling. We request that all patients and staff wash their hands frequently, refrain from touching their face, and use hand sanitizer between patients.

We are taking all cleaning and hygiene precautions recommended by the CDC.

Q: If I have a cough can I come in for my appointment?

A: If you have fever or respiratory symptoms such as cough or shortness of breath and have either traveled in the past 14 days or had close contact with someone who is suspected or confirmed to have coronavirus, please consult with your primary healthcare provider prior to scheduling or attending an appointment. If you are experiencing any sickness, please wait to schedule an appointment until you are fever-free, without the use of fever reducing medication or other symptom reducing medication for 24 hours.

Q: What if I traveled outside of the country lately – can I still come in for my appointment?

A: If you have traveled to a country with a COVID-19 outbreak, please wait until 14 days after you have potentially been exposed to the virus to schedule an appointment.

Additional information is available on the AARA and CDC websites.
Your health, safety and well-being are our greatest concern.
Please let us know if you have additional questions.