NRAS
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Flu jab and methotrexate?

Anyone know if there is a guideline about taking methotrexate the week of my flu jab? I usually have my injection tomorrow morning but am having my flu jab tomorrow afternoon. Should I take the methotrexate as normal?

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There seemes to be more efficacy when stopping mtx two weeks after flu shot. Those who stopped had 75,5% whereas those who didn't had 54,5%

rheumatology.org/About-Us/N...

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Hmm. Its an interesting article. It begs the question what about about drugs ie other dmards, biologics and jak inhibitors. (Trying to get the letter required to have the flu jab seems a mission in itself locally. OH green flagged but can't have it without the magic letter. Apparently lots of letters haven't arrived...)

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You shouldn’t need a letter at all... your gp will fast track the jab as we’re in the “at risk” group.

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He's in the under 65yrs vulnerable group but it is given in an open access clinic requiring said letter. Will make further request tomorrow.

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Two weeks after? Do you mean stopping it for 2 weeks or stopping it for a week 2 weeks after jab?

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Here is an other study.

ard.bmj.com/content/early/2...

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I’ve read it and still don’t get it. NRAS itself says to continue the methotrexate. So it’s uk vs us. They say as long as it’s a not a live virus that’s injected you should continue. The flu jab here is a dead virus. Arghhhh

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Interesting question I hadn't thought of....

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It's not a live virus so it shouldn't affect your dmard. In fact protecting yourself and your family from flu seems the more beneficial way.

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Yes I know it’s a dead virus. So it’s ok to take my methotrexate as well?

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Has nothing to do with if it's dead or alive, as far as I understand, only that stopping Mtx for two weeks after flu jab gives you significantly better protection against the flu and this does not make your RA symptoms worse. I find it quite curious that your rheumies have not taken this up to discussion.🤔

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I think Jules is right. It's UK v US guidelines. I'd rather keep with the UK's guidelines, don't halt MTX & have flu jab as normal. In 11 years of having the flu jab, 9 on MTX, I've not had flu. Unless you know different Simba & UK guidelines have changed & I've not seen it?

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I think it takes time for guidelines to change, but this does not necessarily mean that following guidlines is the best option. You can always talk to your doc about new research and findings and perhaps make better choices.

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No, sorry. A UK GP will always advise from UK guidelines, or should.

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Look at Lisaj42 post. Seemes like new regulations are in fact put into place. I assume that Lisaj42 is from UK (?)

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Told it was fine to carry on taking by rheumatology: had flu and pneumonia last year on MTX and flu this year on benepali, no adverse effects. Just to throw spanner in the works there, sorry 😐, maybe ring advice line if worried? X

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I was told the same as Kareena by rheumy. I can have my RA dmard and flu jab at same time span. Call your go for advice if you not sure of course

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The different advice between hospitals, consultants and countries is quite interesting. My french rheumy suggested I stop for a week before and a week after to give the vaccine the best chance of taking effect. Go figure.

Basically get the jab as that could be important. And apart from that put your finger in the wimd and choose....

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I always have for 9 years, never been told otherwise & other than an achy arm which is quite a normal reaction I've not had any problems. There is word about that if you take MTX the same week it reduces the effectiveness but I've never had flu. That could be pure coincidence but I'm still going to do as normal when I have my jab next month.

You could always ask your Rheumy nurses advice, call the helpline if you have one.

Everything else ok Jules? Not seen you around much. Hope you're now settled in your new home.

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I haven’t been around much as all the work still continues at my house so juggling workmen while trying to work enough to pay for it. Very hard still. But I’m myself I feel so much better.

So I’m going to talk to the nurse tomorrow and see what they say. But as far as I can tell from googling, 90% of medical sites say to have it, especially the NRAS guidelines and also UK Arthritis research. X

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As long as it's ongoing & not come to a grinding halt. That's what's worrying me the closer we get to Christmas & tradesmen start winding down work-wise.

Pleased you're doing so much better. I think it's wise asking your nurse. There have been some trials but they're all US based. I'm not stopping it unless I'm specifically told I must. If it's not broken I'm not fixing it.

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Hope your house stuff goes smoothly. My new neighbours have had work done and lived without curtains, carpets etc for months with a baby and toddler. They love it now and I hope you are really pleased when yours is done. Its never easy having workman loitering. Well done for remaining upbeat despite whats happening around you.

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I got mine on a different day. No problem at all. And I am in the US too.

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Same...I’m in the US and rheumy said to continue with mtx has normal.

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As long as you are well when having flu jab I see no reason not to carry on as usual. That's advice I have always been given and been on Enbrel since early 2005 and mtx before that.

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I took mtx last Wednesday and was told by the nurse when I went for my flu jab on Thursday afternoon that they had had new guidance that morning and I was advised to skip mtx for 2 weeks after the jab which essentially means skipping a week and then taking it on the Thursday of the following week. This increases the effectiveness of the jab I was told .

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Well I’ve decided not to take my methotrexate this week.

I’ve been feeling slightly u set the weather anyway and usually that means a virus is hanging about a bit. I had a throat infection a few months ago and stopped my metho for a week. Got better much quicker. So because I always feel a bit rubbish after my flu jab and feeling slightly ugh this morning, and I’m not currently in flare... I’m skipping until next Monday. X

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I'm in the US, California to be exact, had my flu shot 2 weeks ago, and was told NOT to stop my med intake, there would be no problem, but another weird thing I noticed on here, is that a lot of People take Ibuprofen with Methotrexate, I was prescribed it as well, but a few months ago, pharmacist told me to stop because the two together is toxic. so I stopped taking ibuprofen. Has anyone else been told that?

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Yes methotrexate doesn’t get on with NSAIDs at all. So anything from ibuprofen to diclofenic. However, sometimes it’s the only painkiller that works for me. I try and not take it daily but if I’m great pain then I will.

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I take 150 mgs voltarol every day and MTX. Voltarol is the only NSAID that works for me.

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I'm new to RA this year, gp said was okay, and had flu jab, on same day as methotrexate. Tired for 2 days after, apart from that all good.

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So when it comes down to it you can choose eather to be less protected or more. You can follow new research or not. Here are some numbers that tell how much more efficient waiting with mtx is.

medscape.com/viewarticle/88...

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I'm a bit late replying but I had my flu jab last Monday morning and took my mtx, albeit I'm on a low dose of 10mg, in the evening after tea. I did the same with my pneumonia jab too - had that and mtx on the same day. I never thought to ask if it was ok or not. Can only hope the flu and pneumonia jab will still protect me.

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I have never stopped my mtx when having flu jab I had my mtx last night n I’ve got my flu jab this afternoon n I’ve always been fine before no problems

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Hi

I had the flu jab two weeks ago and continued with methotrexate so should be fine. Having pneumonia jab on Wednesday and plan to take Methotrexate as normal on Friday.

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UPDATE.

So my RA specialist ranf me just before I had my flu jab and said not to take my methotrexate this week. Reason was that currently I’m not in flare so missing my methotrexate for a week won’t be a problem and the flu jab will work better.

If you are in flare, they wouldn’t suggest stopping the methotrexate.

But interestingly whilst I was in the nurses office it also flagged up that I needed a Pneumonia jab. This is a one shot wonder. A jab for life. I’d never heard of it but because I was immune suppressed, I was given one. And a blood test. So a bit of a pin cushion and rather sore arms but hope that helps a bit.

I would talk to your GP about getting the pneumonia jab too if you haven’t had one.

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Yes, there is new guidance that advises 2wk pause of MTX, percentage rate of protection rises considerably. I have never done it before, but had flu last year despite the jab, so I am doing it. Anything that makes the flu jab more effective is worth a try

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I take methotrexate and have just had my flu jab with no ill effects.

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Not a question of getting ill effects, just less efficacy when taken the two too close.

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Update... have had no reaction to flu jab whatsoever... but my god, the pneumonia jab has made me have a red swollen arm, awful headaches and slight temperature. But apparently that’s normal for 3 days afterwards. So don’t panic if you get the same. Keep an eye on it and if it continues longer than 3-4 days then give your gp a call.

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Pleased it's all done Jules & you should find the pneumonia one will ease within days.

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Well the CDC says if you have an autoimmune disease you should not be vaccinated. Google "who should not be vaccinated" and look at what the CDC says about it...which is don't do it.

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The CDC says under the heading "Who should be prioritised for flu vaccination during a vaccine shortage - people who are immunosuppressed due to any cause (including immunosuppression caused by medications or by HIV infection)." cdc.gov/flu/protect/whoshou...

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So my doctor says the complete opposite. It flagged up that anyone with auto immune disease should have the pneumonia jab. So here we go again, different people say different things. No wonder we’re all so confused.

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It's your doctor who's correct Jules. Seems Erica has misunderstood that because the CDC (US) guideline specifies we've not to have the live version of the flu vaccine that we shouldn't have the inactivated one either. I think it's because it doesn't specifically say so as it does in the listings for the live version. As you know it is recommended we have it (the inactivated version) because we're higher risk. I just hope she talks to her doctor, nurse or another medical professional to clarify & isn't compromised because she doesn't have the jab.

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Got to just LOVE how doctors follow the CDC guidelines......

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If they are they're not following it correctly. If we get flu we're at greater risk of complications, maybe even needing hospitalisation. This is why it's recommended we have it & are given the inactivated vaccine, it's just the live one we shouldn't be be given.

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You are still sick and on meds, I am not, again, my lupus has been quiescent for almost a year. You should ask yourself why that is. Perhaps take my advice. Or not. It's whatever.

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Actually I took the methotrexate as normal when I had my vaccinations, and I am not ill, in fact quite fit, so even ignoring your advice I have no trouble with my RA, still cycle when I can and walked around the imperial war museum in London, climbing up and down all the steps.

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I don't miss out my mtx when taking flu jab Only once I had bad flu in spite of taking flu jab l suppose that could have happened any way.

Thanks for your query.

Joya

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I just took the methotrexate as normal when I had my flue jab, no repercussions since. So don't worry

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