As the SARS-CoV-2 coronavirus spread early in the year, the National Psoriasis Foundation (NPF) recognized the critical need for additional information for health care providers and individuals living with psoriatic disease on managing psoriasis and psoriatic arthritis during the COVID-19 pandemic. In March 2020 NPF released “NPF Medical Board COVID-19 Recommendations for Patients with Psoriatic Disease,” which provided early guidance for the community based on information available at that time.
To effectively serve the psoriatic disease community through this pandemic and to closely monitor evolving data and advances, NPF formed the NPF COVID-19 Task Force. This group, which is being chaired by dermatologist Joel M. Gelfand, MD, MSCE, FAAD and rheumatologist Christopher T. Ritchlin, M.D., M.P.H., is comprised of experts from both the NPF Medical Board and Scientific Advisory Committee and will include advisors in specialty areas such infectious diseases, as needed. The charge of the Task Force is to identify critical needs for the psoriasis and psoriatic arthritis community related to the pandemic and to serve as an expert resource to NPF in an advisory capacity. The group will address short-, mid- and long-term needs.
One of the first activities of the task force was to review and update the preliminary recommendations of NPF medical and scientific leaders. In early June, the NPF COVID-19 Task Force released updated recommendations for the community. At the end of June, the following version of the recommendations was updated.
Updated July 7, 2020
NPF COVID-19 Task Force Recommendations for Patients with Psoriatic Disease
Patients with psoriasis and/or psoriatic arthritis should take common sense measures to lowering their risk of becoming infected with SARS-CoV-2, the virus which causes COVID-19 illness.
- Pediatric and adult patients with psoriasis and/or psoriatic arthritis (collectively termed “patients”) are encouraged to follow CDC, WHO and federal/local guidelines and practices to protect themselves and others.
- Practice physical distancing (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html)
- Wear face coverings in public settings where physical distancing measures are difficult to maintain (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html)
- Wash hands regularly (https://www.cdc.gov/handwashing/when-how-handwashing.html)
- If a patient or someone with whom the patient has had close contact experiences signs or symptoms of COVID-19 infection, the patient is advised to stay home and telephone their healthcare provider immediately.
The major cause of serious health outcomes and death from COVID-19 illness are advanced age and certain underlying major medical conditions. It is not known if having psoriasis and/or psoriatic arthritis meaningfully alters the risks of contracting SARS-CoV-2 (the virus which causes COVID-19 illness) or having a worse course of COVID-19 illness.
- Based on current data, those at higher risk for having a more severe course of COVID-19 and/or worse outcome are:
- People 65 or older
- Patients with the following conditions: Chronic kidney disease, chronic obstructive pulmonary disease, solid organ transplant recipient, obesity (body mass index 30 or higher), serious heart problems such as heart failure, coronary artery disease, or cardiomyopathies, sickle cell disease, or type 2 diabetes. Additional conditions which might be at increased risk include, but are not limited to moderate to severe asthma, cerebrovascular disease, high blood pressure, liver disease, pregnancy, smoking, type 1 diabetes, use of immune compromising medications. (https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html)
- Most treatments for psoriasis do not cause a person to be defined as immunocompromised with the exception of prolonged use of systemic steroids (administered by mouth or injection), and cyclosporine.
- Given the increased risk for more severe illness from COVID-19 in individuals with certain underlying health conditions, it is strongly recommended that individuals continue treatments for these health conditions including hypertension, diabetes and elevated lipids (such as angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers).
At this time, the NPF COVID-19 Task Force does not recommend that patients stop their biologic or oral therapies for psoriasis and/or psoriatic arthritis.
- The decision to start or stop a biologic or oral systemic therapy is an individual decision that should be made in conjunction with a healthcare provider.
- While some uncertainties remain, initial data suggest that the benefit of continuing treatments for psoriatic diseases outweighs the hypothetical risks associated with immune modulating treatment of poor COVID-19-related outcomes for most patients. It is recommended that:
- Individuals in high risk groups should have a conversation with their healthcare provider about whether it is recommended to continue or alter therapy
- Clinical decisions should be guided by the health care providers’ consideration of the following factors and their discussion with the patient:
- Specific treatment(s) used for psoriasis and/or psoriatic arthritis
- Patient’s age, disease characteristics, and underlying medical conditions
- Patient concerns
If patients have COVID-19 infection, they should discuss with a health care provider whether they should stop a biologic or oral psoriasis treatment.
- While it is generally advised to hold immune-modulating treatment during an infection, in the case of COVID-19, several different immune modulating treatments used for psoriasis and other immune-mediated or autoimmune diseases are being studied in experimental placebo controlled trials to treat or prevent severe COVID-19 illness in those infected with SARS-CoV-2.
- If biologic or oral systemic medication is stopped, the decision to restart treatment should be made in conjunction with a healthcare provider. Restarting treatment may be informed by a symptom-based strategy or test-based strategy. (https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html)
- The impact of immune modulating psoriasis treatment on duration of a patient with COVID-19 being infectious is not known.
Individuals newly diagnosed with psoriasis and/or psoriatic arthritis or who are currently not receiving treatment should be aware that untreated psoriatic disease is associated with serious impact on physical and emotional health, and in the case of psoriatic arthritis, can lead to permanent joint damage and disability.
- Psoriatic disease may be further exacerbated by stress, which is of special concern given the difficult conditions brought on by the pandemic, and there are also reports of psoriasis flares associated with COVID-19 illness.
- Patients are advised to discuss the risks and benefits of available therapies for psoriasis and psoriatic arthritis with their healthcare provider.
Patients with concerns should contact their healthcare provider’s office.
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