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Arthritis and Influenza Update

How does arthritis affect how I respond to the flu?

  • People with certain types of arthritis, called inflammatory rheumatic disease or autoimmune rheumatic disease, have a higher risk of getting respiratory infections as well as flu-related complications, such as pneumonia.
  • Inflammatory arthritis affects the immune system which controls how well your body fights off infections. Also, many medications given to treat inflammatory arthritis can weaken the immune system. People with weakened immune systems are at high risk for getting more severe illness and complications such as pneumonia or hospitalization with the flu. Rheumatoid arthritis and lupus are the most common types of inflammatory arthritis.
  • Older adults with osteoarthritis, also called degenerative arthritis, are likely not at increased risk of complications from the flu unless they also have other high-risk conditions for flu such as asthma, diabetes, heart disease, or cancer.
  • The best way to prevent the flu is to get vaccinated every year.

Persons who have the following types of inflammatory arthritis or rheumatic disease or take certain medications may be at high risk for influenza and its complications. You should discuss your risk for complications from the flu with your healthcare provider.

  • Rheumatoid arthritis (RA)
  • Systemic lupus erythematosus (SLE)
  • Psoriatic arthritis
  • Anti-phospholipid syndrome
  • Polymyalgia rheumatica
  • Systemic sclerosis/scleroderma
  • Spondyloarthropathies
  • Sjögren’s syndrome
  • Polymyositis/dermatomyositis
  • Vasculitis (e.g giant cell arteritis)
  • Necrotising arteritis
  • Sarcoidosis
  • Polyarteritis nodosa

Steroids (corticosteroids) taken by mouth or intravenously, not applied to the skin or injected into a joint.

  • prednisone (Deltasone, Orasone, Prednicin-M, Sterapred)
  • prednisolone (Prelone)
  • methlyprednisone (Medrol)
  • hydrocortisone (Cortef, Hydrocortone)
  • dexamethasone (Decadron, Hexadrol)
  • cortisone acetate (Cortone)
  • betamethasone (Celestone)

DMARDs (disease-modifying antirheumatic drugs)

  • methotrexate (Rheumatrex, Trexall)
  • azathioprine (Imuran, Azasan)
  • hydroxychloroquine (Plaquenil)
  • leflunomide (Arava)
  • sulfasalazine (Azulfidine)

Biological response modifiers (biologics)

  • etanercept (Enbrel)
  • infliximab (Remicade)
  • adalimumab (Humira)
  • anakinra (Kineret)
  • abatacept (Orencia)
  • rituximab (Rituxan)
  • tacrolimus (Prograf, FK-506, fujimycin)

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CDC influenza vaccination recommendations 

For the flu season, the Centers for Disease Control and Prevention recommends all persons age 6 months and older get the seasonal flu vaccine.

Do I need to get a flu shot?

Yes, CDC recommends certain persons with weakened immune systems, which includes people with inflammatory arthritis, get a flu shot every year.

  • People living with inflammatory arthritis should get the "flu shot"— an inactivated vaccine (containing fragments of killed influenza virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people inflammatory arthritis.
  • The other type of flu vaccine — nasal-spray flu vaccine (sometimes called LAIV for “live attenuated influenza vaccine)—is not recommended for people with inflammatory arthritis. This vaccine is made with live, weakened flu viruses that do not cause the flu. LAIV (FluMist®) is approved for use in healthy people 2-49 years of age.

What are the symptoms of the flu?

  • The symptoms of the flu include:
    • Fever/Chills
    • Cough
    • Sore throat,
    • Runny or stuffy nose
    • Body aches,
    • Headache
    • Fatigue.

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How can I avoid getting the flu or giving the flu to others?

The flu is spread from person-to-person by coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose. You can take simple actions to protect yourself and others from getting the flu:

  • Get a seasonal flu shot every year.
  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. If soap and water are not available, use an alcohol-based hand rub.
  • Avoid touching your eyes, nose, or mouth. Germs spread this way.
  • Try to avoid close contact with sick people.
  • If you are sick with flu-like illness, seek medical care early. Your health care provider can determine if you need to be treated with antiviral medication.
  • Keep away from others as much as possible to keep from making others sick.

What should I do when I am sick?

  • If you develop flu-like symptoms contact your healthcare provider.
  • Avoid contact with others. You should stay home and avoid travel, including not going to work or school, until at least 24 hours after your fever is gone except to get medical care or necessities. Your fever should be gone without using fever-reducing medications.
  • Do not stop taking any medicine you take for your arthritis unless told to do so by your physician.
  • Seek medical attention early if you develop symptoms of the flu. Treatment is available for persons with severe disease and those at high risk for complications. Persons with inflammatory arthritis are considered high risk for complications from the flu; therefore, your health care provider may choose to prescribe antiviral medications for you if you get the flu.
  • If you are exposed to someone who has flu, consult your health care provider. They may prescribe medication to help prevent you from getting the flu or watch you closely to see if you develop flu symptoms.

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Additional Facts:

  • The flu vaccine contains an inactivated (killed) influenza virus; the vaccine cannot cause the flu.
  • The flu vaccine does not make arthritis symptoms worse.
  • Some persons taking biologic response modifying drugs (e.g. rituximab) may have a lower immune response to the flu vaccine. However, most experts agree that the immune response is sufficient to protect against the disease or shorten the course of the disease. The timing of treatment and vaccination may be important; talk to your health care provider about the best time that you should get the flu vaccine.
  • The flu vaccine approved by the FDA each year has a long record of safety and effectiveness.
This year, only 1 vaccination is needed for most people.

Additional Flu Resources

Centers for Disease Control and Prevention – Seasonal Flu

CDC’s Advisory Committee on Immunization Practices – Prevention and Control of Influenza with Vaccines

Food and Drug Administration – Influenza Virus vaccine safety and availability


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