Flu - Metrotrexate and Arava

[Amy_Lee]

Since Jun 2014 after I was diagnosed RA, this is the second time I had flu during my holiday in China. I had fever but I did not see any doctor there, I merely had the panadol to control my fever.

I came back home and had my appointment to see my rheumy 2 days ago, I had no further fever but I still cough badly. I told my rheumy of my situation. He gave me antibiotic and advised me to stop both metrotrexate and arava temporary until I finish the antibiotic.

I told him that I did stop metrotrexate while I had fever but I did not stop arava. He said that I should stop both and see a doctor immediately. The reason was because my immune system has been suppressed for a long time and I would be vulnerable to disease .

I learn my lesson and I would like to share as this could happen to any RA patient around. That is to stop DMARDs all together when we are sick!!

[Hessie5]

Hi Amy_Lee - thanks for the post. Just wondered if you have the flu jab?

[Amy_Lee in reply to Hessie5]

Dear Hessie,

No, I did not have the flu jab. In fact, I only had panadol and vit-C while I was in China. I don't feel comfortable to see the local doctor and after taking the panadol, I felt good again hence I just left it as it was until I came home.

[Hessie5 in reply to Amy_Lee]

Thank you - glad all good now. I have never had a flu jab but my Dr was insistent and booked me for Saturday - he said it is a must with RA.

[Amy_Lee in reply to Hessie5]

May I know why it is a must for RA patient? My rheumy has never suggested that to me at all!! I must ask him the next I see him then.

[Hessie5 in reply to Amy_Lee]

Apparently - I was told due to the compromised immune system and the biologics - I have never had one and feel somewhat pressured too to be honest.

[Amy_Lee in reply to Hessie5]

It is never a must over here. I think may be over there people get flu easily due to the weather. I am not sure. Just listen to our rheumy to avoid any problem then.

[AgedCrone in reply to Amy_Lee]

I just remembered you are not in the UK are you? That is probably why your rheumatologist hasn’t suggested you have the influenza vaccine.

Here in the UK we started having our influenza vaccinations back in early October.....No we just cross our fingers we escape the dreaded virus.

[Amy_Lee in reply to AgedCrone]

I am from Malaysia, a tropical country hence the situation is different.

[helixhelix in reply to Amy_Lee]

rappler.com/nation/220904-d...

I seem to remember you live in the philippines? The flu is just as bad there!

rappler.com/nation/220904-d...

[Amy_Lee in reply to helixhelix]

No, I am from Malaysia. So far I am okay, this is my 2nd flu since Jun 2014.

[helixhelix in reply to Amy_Lee]

Still applies! See this article...

But are you sure you had flu? What you describe doesn’t sound much like it. I’ve only had flu once, before I had RA, and it was very unpleasant. I was completely floored by it for 2 weeks, and then took a further 6 to recover. You basically feel as if you have been hit by a train.

jurcon.ums.edu.my/ojums/ind...

[nomoreheels in reply to Hessie5]

We're in at risk category Hessie, surprised you’ve not been flagged up by your GP Practice to be called for it before they start their flu clinic. As if flu itself wasn’t bad enough it could potentially turn into complications... bacterial chest infection that can turn into bronchitis or worse pneumonia (or worse still, meningitis & septic shock for two), possibly needing hospitalisation at the most busy months of the year, with Christmas bang in the middle. So being protected against the most virulent strains makes sense, or should you get it the likelihood is that it won’t be as bad as it could have been without building up the antibodies by having the jab. The more of us that have it the less likely we'd have an epidemic. Sorry for banging on about it, it's your choice of course.

[Hessie5 in reply to nomoreheels]

Thank you! Going tomorrow 😌

[nomoreheels in reply to Hessie5]

Good!

[Amy_Lee in reply to nomoreheels]

You are being concern, Nomoreheels. We all care about each other hence we share our experience.

[nomoreheels in reply to Amy_Lee]

It does concern me Amy. Full blown flu is a real knock-me-down illness when you don't have RD, when you do it's a whole different ball game. We have a 70% higher risk of developing any type of infection & an 83% higher risk of developing an infection that requires hospitalisation. Winter in the UK is when beds in our hospitals at at the highest premium. We have a 2.75-fold increased risk of having complications (such as pneumonia, heart attacks, strokes) related to flu regardless of whether or not we take DMARDs or biologics. We need to be as heart-healthy & lung-healthy as we can possibly be given RD itself can affect them, plus chronic bronchitis, just one possible risk of flu, is irreversible.

Sorry for banging on about it but a school friend of my brother in law's died last week aged 64, he was a healthy man for his age but still he died from complications of flu.

[Hidden in reply to nomoreheels]

I don't just have RA to worry about as far as flu is concerned, I also have Asthma and Bronchiectasis. So I certainly hope I get my jab. As I'm housebound I have to wait for the jab to come to me.

[Amy_Lee in reply to Hidden]

That put you more vulnerable to the infection of flu. Please take good care as winter is coming very soon.

[Amy_Lee in reply to nomoreheels]

I am very sorry to know about the death of the brother in law of your friend. 64 is indeed still young at this modern world. As a RA patient, we just have to be very careful about own health.

[AgedCrone in reply to Hessie5]

Believe me Hessie......it’s worth having a flu jab.

I had flu for the first time ever a couple of years ago.... thankfully I had had the vaccination and although I thought I was at death’s door I recovered pretty quickly as I had the protection provided by the jab.

Worst case scenario you may get a bit of a sniffle or a sore arm-but believe me that is definitely preferable to having influenza.

Speak to your medics...they will, advise you.

[Hessie5 in reply to AgedCrone]

Thank you - sounds stupid I am just apprehensive as it will make me hurt more. Didn't help when my colleague at work said she was hospitalised due to it 😬. That said you guys are giving me the confidence to just do it.

Thanks again and I hope all things are going well for you 😌 best always, Hessie

[AgedCrone in reply to Hessie5]

I didn’t get the flu jab last year when we had the 65+ vaccination introduced as nobody could give a positive answer as to whether you should have it when you are on Rituximab.... but I didn’t get the flu .....so I think it really is you are lucky or you’re not!

I read in the newspaper this morning they are cancelling lots of children’s live nasal flu vaccinations because they’ve run out again apparently lots of the vaccines haven’t yet been delivered.

[nomoreheels in reply to Hessie5]

I admit I usually get an achy arm that lasts a couple of days & the feeling you have a bit of a 'lump' just around where you're injected, but this year no reaction at all. I'm sure you'll be fine.

[Eiram50 in reply to Amy_Lee]

Presumably, due to the drugs we take that suppress the immune system? The flu is so readily spread and the impact in those of us more vulnerable, can be significant and severe x

[helixhelix]

That’s the right advice for you, but it might not be the right advise for other people. We should always follow our own doctor’s advice as they know our medical history. (For me I don’t have to stop all the drugs for mild infections.)

Hope you feel better now.

[Amy_Lee in reply to helixhelix]

Thank you, Helix. I am okay now though I am still having my antibiotic at this moment. I will check with my rheumy again on your information above then. A lot to learn for me.

[nomoreheels]

I'm with helix on this one Amy, this was the advice for you but we should each ask the advice of our Rheumy (or GP) should we fall ill. Maybe your last comment should be amended as we should each seek the advice of our own medical professional as this relates to your experience only for this particular illness.

Please do consider having the flu vaccine as recommended & I hope by now that you're fully recovered.

[Amy_Lee in reply to nomoreheels]

Dear Nomoreheels,

Thank you for highlighting this. I will take note of that. You may be right to say that this advice may be just for me. I do agree all of us should ask our rheumy for advice if we are sick to avoid any complication.

[AgedCrone]

In fact you may have such a nasty infection because bugs we pick up outside our normal environment in this country, always hit harder because our system is not used to coping with them .

When on Dmards, if we get sick we should always ask our rheumy nurse what action to take regarding which drugs we should stop taking.

Hope you feel better now!

[Amy_Lee in reply to AgedCrone]

If I was home, I would have asked. I was away hence I just waited to come home to see what to do next. You guys are right, it is always safer to ask our rheumy before we do anything. In fact, I am learning by reading through the exchanges.