Rheumatoid Arthritis – Should I take my biological when I’m sick?

One of the most common questions people ask is whether or not they should take their biological when they are sick.

As you probably know, treatment for Rheumatoid Arthritis and many other Autoimmune diseases is based around suppressing a haywire immune system which, left unchecked, is mistakenly attacking healthy tissue.  By suppressing the immune system, the disease process is slowed or even halted completely.  Unfortunately suppressing your immune system comes with risks, the most common of which is making you more susceptible to every bug going around.

While some infections, viral, bacterial or fungal, can be very serious, some are not.  So where do you draw the line?  When do you continue taking your immunosuppressing medication and when do you need to stop?

The decision is complicated in the case of biological medications, because sometimes when you stop taking the medication, you develop antibodies to it, and when you restart it, it is no longer as effective as before.  So you don’t skip doses lightly.

So when should you not take your biological?

This is a guide only, and not medical advice.  As with everything, if you are in doubt, call your rheumatologist or primary care doctor for advice.

According to my rheumatologist, stop your biological medication if:

1. You have fever. Fever is the bodies way of dealing with illness and infection, so if you have a temperature, stop taking your biological at least until the fever resolves.
2. You have obvious signs of infection. If you are coughing up mucus from your lungs, you have a lung infection, and should stop your biological until your chest is clear.  Similarly, if you have a wound that is pus filled, red and warm, and not healing stop your biological.  In reality, in either of these situations you should see your doctor anyway because you may need antibiotics.
3. You are on antibiotics. If you have been prescribed antibiotics, you should stop your biological until you have finished the course, even if your doctor didn’t explicitly say so.

When can you keep taking your biological?

You can keep taking your biological if you have the sniffles or a bit of a head cold or a sore throat.  But be guided by past experience.  If every time you get the sniffles, it turns into pneumonia, at the first sign see your doctor, get antibiotic cover and don’t take your biological medication.

I used to keep a script for strong antibiotics in the cupboard, because a few years ago I was winding up with walking pneumonia every time I caught a cold.  My GP was happy to write the script at the beginning of winter, so that if I came down with anything I could get antibiotics immediately and not have to wait for an appointment with him. He trusted me, however, to be sensible.  I don’t get antibiotics for a head cold.  I only get them when my chest starts to hurt and I am coughing up rubbish.

Last winter, when I wasn’t on a biological, I didn’t catch anything, despite my kids getting sick several times.  This year I became blasé, and became lax.  I’ve paid for it with a nasty chest infection.  I should have taken more care.

How do you avoid getting sick?

Hand washing.  The single most important thing to prevent infection and staying well is frequent hand washing.  Some viruses can survive for several hours on a solid surface, and if you touch that surface and then touch your mouth or nose, you might become sick.  So wash your hands often and try not to touch your face.

Keep your distance.  Obviously you don’t want to get too close to other sick people.  Colds and flus are spread by droplets.  When someone sneezes, the droplets travel through the air, and if they land on your mouth or nose, and are inhaled into the lungs, the infection can take hold and you’ll become sick. In the flu season, if I need to go to the doctor and the waiting room is full of sneezing, coughing people, they usually put me in a separate room to wait my turn.  If you go to the doctor tell them that you are immunosuppressed and ask to wait away from obviously sick people.

Ask others to keep their distance.  Send the ‘heroes’ who come to work sick home!  Remind them they aren’t helping anyone if they spread their illness and tell them to go home and rest.  Explain to all your friends about your immunocompromised status, and ask them to not come and visit when they (or they’re children!) are sick.  I have gotten the eye roll a few times from a friend who thought I was being a hypochondriac when I asked her to take her sick child home.  Only for me to spend the next two weeks sick as a dog and ultimately getting pneumonia.  People won’t understand.  They will judge.  Too bad.  Your health is more important than their feelings. Their ignorance might cost you two weeks of misery at best, and a potentially life threatening infection at worst.

Wear a face mask.  If you have to care for someone who is sick, consider wearing a face mask.  Studies show that masks aren’t that helpful, but when you are in close quarters to a sick, sneezing child, blocking your mouth and nose has to help.  Bear in mind that it has to be a medical grade mask. Some of the paper ones do nothing to prevent infection.  You might feel silly but it beats a trip to hospital.

If you have any other tips to avoid getting sick, please put them in the comments!  And stay well.