Ask the Express doctor

Q

I’m on methotrexate 15mg weekly for rheumatoid arthritis and am confused as to whether I should be shielding or not. I thought I should but I received a letter from my GP in April saying I did not meet the current shielding guidelines.

Yet you published a letter from someone on methotrexate who was receiving regular texts from the NHS reminding them to shield. I am 63, and have Type 2 diabetes. So do I need to shield or not? I’m confused.

AThe guidance about shielding first came out on March 23, advising people at extremely high risk of a severe outcome from Covid-19 to stay at home for the next 12 weeks. I sense the list of those who needed to be included in this group was put together in quite a hurry.And since then there has been a lot of further guidance, especially from specialists. It has been difficult for everyone, including GPs, to keep up to date. So I’m not surprised you are confused.

Methotrexate suppresses the action of the immune system and is used to treat conditions where the immune system attacks healthy tissues such as rheumatoid arthritis or giant cell arthritis. But this also means the immune system cannot fight off invading bacteria or viruses and this does put you at increased risk of severe Covid infection.There is some debate as to whether those on methotrexate alone need to shield (some doctors say yes, others no) but you have the additional risk factor of Type 2 diabetes which has been linked with an increased risk of a poor outcome from Covid-19 infection. So the more precautions you take, the better.

● If you have a health question for Dr Leonard, write to her in confidence at the Daily Express, One Canada Square, CanaryWharf, London E14 5AP, or email yourhealth@express.co.uk. Dr Leonard regrets she cannot enter into personal correspondence or reply to everyone.