Please enable JS

Are Coronavirus Symptoms Different If You Have an Autoimmune Condition or Chronic Illness?

When you live with a rheumatic disease, you likely have daily symptoms that can mimic those of COVID-19, including shortness of breath, chronic, dry cough, muscles aches, fatigue, gastrointestinal woes, temperature spikes.

Learn more about our FREE COVID-19 Patient Support Program for chronic illness patients and their loved ones.

Fever. Fatigue. Dry cough. Difficulty breathing. Diarrhea. Loss of sense of smell and taste. Vision changes. As the list of potential COVID-19 symptoms seem to grow, so does our anxiety about whether we could have it. Many concerns are specific to people with certain chronic conditions. Over the past few weeks, we at the Global Healthy Living Foundation have heard such concerns as:

  • I take methotrexate every day and tend not to get fevers — what if they won’t test me?
  • I have chronic fatigue syndrome — how can I tell if my fatigue is from my condition, extra stress, or the actual coronavirus?
  • I have ankylosing spondylitis and shortness of breath and chest pain — is it from costochondritis, ramped-up anxiety, or could it be COVID-19?

Sound familiar? When you live with a rheumatic disease, you likely have daily symptoms that can mimic those of COVID-19, including shortness of breath, chronic, dry cough, muscles aches, fatigue, gastrointestinal woes, temperature spikes.

“The body has a limited number of ways to demonstrate illness, so many of the signs and symptoms are the same as those of rheumatic diseases,” says Susan M. Goodman, MD, a rheumatologist at Hospital for Special Surgery in New York City.

COVID-19 Symptoms in People with Autoimmune Conditions

So, what exactly should you be looking for?

“Unfortunately, I can’t say if you have symptoms one, two, and three you likely have COVID-19 and if you have four, five, and six, you have a bad cold,” says Uzma Haque, MD, assistant professor of medicine at the John Hopkins Arthritis Center. “We just don’t have enough data yet to say that our patients don’t present with fever, or our patients present with one core symptom, or our patients present with one symptom over another,” says Dr. Haque.

The Global Healthy Living Foundation spoke with multiple rheumatologists to help you better understand and navigate your symptoms. Here’s what we know now — and what you need to know about COVD-19 symptoms when you’re living with an autoimmune condition.

Defining the Symptoms of COVID-19

The three main symptoms of coronavirus are:

  • Fever (100.4 or higher)
  • Cough (dry)
  • Shortness of breath

These symptoms can appear two to 14 days after exposure, according the U.S. Centers for Disease Control and Prevention (CDC).

Less common COVID-19 symptoms include:

  • Cold and flu symptoms
  • Gastrointestinal symptoms (nausea and diarrhea)
  • Anecdotal reports of loss of taste, visual changes, and alteration of hearing

What you need to know: “To the best of our knowledge, COVID-19 symptoms are the same in patients with autoimmune disease,” says Dr. Goodman. “Rheumatologists have started to report cases among their patients, so we will be learning more over time.” In fact, certain groups of specialists — including gastroenterologists and rheumatologists — have launched new research registries to track coronavirus cases among specific high-risk patient populations, such as people with inflammatory bowel disease and inflammatory or autoimmune arthritis.

While you may be high-risk for COVID-19 complications, the data so far is reassuring. “In these difficult times, I understand that everyone is anxious but there is some good news: We are not seeing clusters of patients with rheumatic disease [getting the coronavirus at increased rates compared to the general population] and those who are getting infections are recovering,” says Dr. Haque.

1. Fever

Fever — defined as 100.4 F (38C) or higher —  is a key symptom of COVID-19. The virus typically causes your fever to rise in the late afternoon and evening, which is why experts recommend taking your temperature twice a day.

What you need to know: Again, since this is all new — to patients, to medical professionals, and to researchers — we can’t know for sure how each medication and each rheumatic disease will impact fever if you do have COVID-19. “There’s just not enough data, and we can’t hinge on one symptom,” say Dr. Haque.

In inflammatory arthritis and other conditions, fever can also be a sign of a flare or part of your normal disease activity.

Fever can also be blocked by or caused by certain medications.

Prednisone and non-steroidal anti-inflammatory drugs, or NSAIDs (aspirin, ibuprofen, diclofenac sodium, celecoxic, meloxicam) both block fever. Someone who is infected with COVID-19 may not have a fever if they are taking these drugs regularly, notes Dr. Goodman.

However, according to Brett Smith, DO, a rheumatologist with Blount Memorial Physicians Group in Alcoa, Tennessee, most patients on disease-modifying antirheumatic drugs, or DMARDs (methotrexate, sulfasalazine, leflunomide) and biologics and targeted therapies (TNF inhibitors, JAK inhibitors, abatacept) will mount fevers if they develop COVID-19.

Certain drugs can even cause low-grade fevers.

“Rheumatoid arthritis can be treated by a drug that blocks IL-6 — a protein that acts as a messenger in the body and directs the body to develop fever as well as other signs of inflammation,” Dr. Goodman notes. “There are now trials to see if blocking IL-6 in severely ill patients with COVID 19 is beneficial,” she says, “[but] there is no evidence that people taking Il-6 blockers are protected from the virus.”

While there’s no simple way to determine what’s causing a fever, you can take comfort in the fact that if it’s caused by a flare there is also a pattern of symptoms — not just fever alone — that you’ll be able to recognize, says Dr. Goodman.

For now, rheumatologist want to know if you’re feeling feverish, especially if it’s something different than how you normally feel. If you have a fever of 100.4 F or greater, presume it’s infectious and call your rheumatologist or physician, says Dr. Smith.

“Do not go straight to an emergency room,” adds Dr. Goodman. “If you have a mild case [of coronavirus], there is no treatment except fluids, rest, and acetaminophen. And if you’re not infected, you’ll risk being exposed to the virus when you go in.”

2. Cough and Shortness of Breath

A dry cough — one that you feel in your chest — is another key COVID-19 symptom. You’ll feel like your bronchial tubes are inflamed and you won’t cough anything up, William Schaffner, MD, a professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine in Nashville, Tennessee, told CNN.

Shortness of breath can occur with or without a cough and your symptoms won’t improve (and may worsen) after a week or so. If shortness of breath is severe and you experience any of the following signs, call 911:

  • Trouble breathing
  • Persistent pain or pressure in the chest
  • Sudden mental confusion or inability to arouse
  • Bluish lips or face (from a lack of oxygen)

What you need to know: Chest pain, shortness of breath, and even a dry cough can also be part of your chronic condition. Many people living with rheumatic diseases are also living with asthma or COPD. The same chronic, systemic inflammation that targets your joints can also affect your lungs and chest wall.

“Any systemic inflammatory disease can inflame the structures that comprise the chest wall, as muscles connect to tendons and bones to expand the chest wall in normal respiration, and all of those structures can become inflamed,” says Dr. Goodman. “For some systemic inflammatory diseases like lupus, the inflammation may be in the lining of the lungs, which is called pleurisy.”

Costochondritis, an inflammation in the costosternal joints — the segments of cartilage that connect the ribs to the breastbone — is common in inflammatory arthritis like rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis. However, a patient with a flare or costochondritis will typically not report cough or shortness of breath, says Dr. Goodman.

“Patients should be alert to progressive shortness of breath, as this appears to be the harbinger of the moderate to severe COVID-19 cases,” says Dr. Smith. “The shortness of breath is very rapid in individuals with coronavirus, with progression over one to two days typically, which is highly atypical for [inflammatory arthritis].”

Any time you experience chest pain, especially if it’s accompanied by a dry cough and shortness of breath, you should call your rheumatologist or primary care physician.

Do not try to assess for yourself whether this symptom is from asthma, anxiety, heart attack, costochondritis, COVID-19, or something else.

3. Fatigue and Body Aches

While cold and flu symptoms don’t top the list of common COVID-19 symptoms, there have been reports of body aches and fatigue as well as headaches, digestive issues (nausea and diarrhea), runny nose, sore throat, and sneezing.

Most likely, however, experts say these symptoms alone — without fever and cough or shortness of breath — indicate cold, flu, seasonal allergies, or something else, not COVID-19.

What you need to know: “When you’re living with a chronic illness, there are innumerable reasons for chronic fatigue, so no one should assume they have COVID-19 due to only fatigue or body aches,” says Dr. Smith.

Instead, it’s best to just listen to your body. “Our patients are very savvy in recognizing their symptoms and being able to tease apart an arthritis flare or fibromyalgia flare [from other body aches],” says Dr. Haque. “I tell my patients if you have fatigue in a way that’s not common for you, or body aches that you’re not used to, or a little bit of a cough and feel down and awful, then reach out to your rheumatologist and primary care physician.”

There’s no such thing as being too vigilant about your health right now. “If you feel that anything is unusual — or different than your typical underlying chronic disease — bring it up to your doctor,” says Dr. Haque.

Monitoring Your Symptoms

If you feel anxious about your symptoms, consider tracking and monitoring them in a journal. Dr. Smith recommends documenting the following:

  • Temperature check (oral, axillary, forehead)
  • Time taken
  • Symptoms
  • Progressive symptoms (cough or shortness breath)

“If your symptoms haven’t budged in a few days, you may be reassured,” says Dr. Haque. Still, this approach isn’t for everyone and may make you feel more stressed out.  “I have patients who keep diaries and journals and others who don’t because it makes them more anxious,” she says. “Do what will make you feel comfortable and in control of your body and your disease.”

Get Free Coronavirus Support for Chronic Illness Patients

Join the Global Healthy Living Foundation’s free COVID-19 Support Program for chronic illness patients and their families. We will be providing updated information, community support, and other resources tailored specifically to your health and safety. Join now.


Sources:

Interview with Brett Smith, DO, a rheumatologist with Blount Memorial Physicians Group in Alcoa, Tennessee

Interview with Susan M. Goodman, MD, rheumatologist at Hospital for Special Surgery in New York City

Interview with Uzma Haque, MD, assistant professor of medicine at the John Hopkins Arthritis Center

Symptoms of Coronavirus. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html.

BY: Susan Jara

March 29, 2020