I have to withhold my tocilizumab

[Teekay2]

I was taken into hospital again with cellulitis on my leg put on intravenous antibiotics and am now at home on antibiotic tablets. This means that I have to withhold my tocilizumab. My concern is that if I have a flare what should I do. Increase my pred and by how much? I am now on 8mgms. Tried to reduce to 7mgms a couple of weeks ago but had to go back to 8 and seems settled now. Rheumatology is aware of what happened and normally my excellent consultant would have contacted me but she hasn’t. I know she has been off with a family emergency. Any ideas?

[PMRpro Ambassador]

What did they do last time? No-one here with the requisite expertise I fear.

[Teekay2 in reply to PMRpro]

Good thinking PMRpro. I dug out my discharge papers from 2 years ago. Said to continue tocilizumab when antibiotics finished which is next week.

[Hidden]

You really need an expert in this case to be honest, so l would ring the Medical Secretary again.

[Jackoh]

Do you have a rheumatology nurse in the department that you could contact for specialist advice?

[Blearyeyed]

You don't need to speak to your usual Rheumatologist to just double check on this advice , you can ring the Department and give your details to the Secretary to check what is written in your notes , or ask another Doctor with experience of what to do with Tocilizumab in this situation to give the advice to them to ring back with straight away for you tomorrow. If you don't hear back from them after a few hours , ring back in case they are backed up .

Ask them when you are allowed to begin the Biologic again?

Ask if you can take an increase of Pred for a few weeks if you Flare and their recommendation of how much?

In the meantime , follow the usual guidelines on recovering from an infection and taking your antibiotics.

Don't do to much activity , rest and relax as much as possible.

Eat light , plenty of fluids , keep up your vitamin supplements , keep your legs raised when possible and don't forget to apply any creams you have been given.

Take paracetamol if you need to for pain associated with your infection , increase vitamin C , the calmer and more rested you are during recovery from your infection the less likely a Flare will be and you may not need to increase your Steroids to deal with it.

Hope you feel better soon

[Teekay2]

Thanks , very helpfull.

[Teekay2]

No one has suggested a cause for the cellulitis. A&E just asked if I had any insect bites or scratches .I wasn't aware of any. Last time I had it I was on etanercept and leflunomide.

[Chrisellie]

Yes Tocilizumab must be stopped when taking antibiotics otherwise they won’t work properly . I had 1 episode due to a tooth abscess and just restarted after I stopped antibiotics. All should be fine. But call the rheumy nurse helpline, if in the uk, or your consultants secretary should be able to help if you need some reassurance .