Flu Risks for People with Arthritis and/or Rheumatic Disease

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People with certain types of arthritis, called inflammatory or systemic arthritis or autoimmune rheumatic disease, have a higher risk of getting 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 hospitalization with the flu. Rheumatoid arthritis and lupus are the most common types of inflammatory arthritis.

People 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.

If you have one of these types of inflammatory arthritis, you may be at high risk for complications from the flu. You should discuss your risk for complications from the flu with your healthcare provider.

Types of Inflammatory Arthritis:

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

If you are taking one or more of these medications for your arthritis, you may be at high risk for getting the flu or complications from the flu. Note: This list applies to medications that are ingested or injected and does NOT include medications that are applied to the skin such as creams and ointments. Your healthcare provider can clarify if the medications that you take weaken the immune system.

Arthritis medications that weaken the immune system:

• 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 )
• minocycline ( Minocin, Dynacin )
• cyclosporine ( Sandimmune, Neoral, Gengraf )
• mycophenolate mofetil ( Cellcept )
• gold ( Auranofin, Ridaura, Myochrysine )
• chlorambucil ( Leukeran )
• cyclcophosphamide ( Cytoxan )
• Biological response modifiers ( biologics )
• etanercept ( Enbrel )
• infliximab ( Remicade )
• adalimumab ( Humira )
• anakinra ( Kineret )
• abatacept ( Orencia )
• rituximab ( Rituxan )
• tacrolimus ( Prograf, FK-506, fujimycin )

What Are the Symptoms of the Flu?

The symptoms of 2009 H1N1 flu virus in people are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1, and have respiratory symptoms without a fever.

How can I avoid getting and 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 now and the 2009 H1N1 flu shot when it becomes available.
• 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.
• Alcohol-based hand cleaners are also effective.
• 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. CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. Your fever should be gone without the use of a fever-reducing medicine.

Is There a Vaccine Against H1N1 Flu Virus?

• Yes. A vaccine for the 2009 H1N1 flu has been developed and will be available beginning mid-October 2009. People with inflammatory arthritis within any of the following prioritized groups are recommended to receive the 2009 H1N1 vaccine when it first becomes available:
• Pregnant women
• People who live with or care for children younger than 6 months of age
• Healthcare and emergency medical services personnel
• Persons between the ages of 6 months and 24 years old
• Persons between the ages of 25 and 64 years old who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems ( including with inflammatory arthritis )
• Persons age 65 or older ( including those with inflammatory arthritis ) are not included in these prioritized groups because current studies indicate that the risk for 2009 H1N1 flu infection among persons age 65 or older is less than the risk for younger age groups. We do not expect that there will be a shortage of 2009 H1N1 vaccine, but availability and demand can be unpredictable. Once the demand for vaccine among the younger groups has been met, however, people age 65 or older with inflammatory arthritis should receive the 2009 H1N1 flu shot.

Do I Need to Get a Flu Shot?

• Yes, CDC recommends certain persons with weakened immune systems, which includes people with inflammatory arthritis, get flu shots.
• People with inflammatory arthritis should get:
• A seasonal flu shot every year. These are available beginning in September.
• The new 2009 H1N1 flu shot when available. These will begin to be available in mid-October 2009.
• 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 currently approved for use in 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 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.
• If you leave the house to seek medical care, wear a face-mask, if available and tolerable, and cover your coughs and sneezes with a tissue.
• 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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