After posting yesterday about my ongoing problem with Hidradenitis and Pilonidal Sinus, I thought it might be worth discussing the relationship between Still’s Disease, it’s treatments and infection, because I’m sure it is something we all worry about at one time or another.
Early on in my diagnosis, I remember a GP assuring me that, due to the overactive nature of the immune system in autoimmune diseases, I would be less likely to suffer from every day bugs such as the common cold – the logic being that my body would fight those off along with everything else. It is true that I’ve never had a major problems with coughs, colds and the like, but I’ve always wondered how much truth there was in this suggestion. Every other doctor I have come across since has suggested that I am more at risk of infection, but is this purely due to all the immuno-suppressant medications I take, or is the Still’s itself a factor?
Trawling through the internet I couldn’t find any article that specifically addressed the relationship between Still’s Disease and an increased/decreased risk of infection -but the general consesus of what I did read seemed to be that Still’s Disease in itself did not increase susceptability to infection. It seems likely then that it is our medications to blame for any increased risk; but unfortnately, the more severe the disease activity, the stronger these drugs are and the greater the risk of infection.
One particular study I found, on the relationship between RA and infection, claimed that even with immuno-suppressant DMARDs, there was only a sight increase in risk of infection and this was mainly found in patients taking Methotrexate or Cyclosporin. Only Corticosteroids such as Prednisolone presented evidence of a substantial risk, with the level of this risk related to the dose. As for the newer, Biologic treatments, it is still early days and more research is needed, but there does seem to be some concern surrounding them:
“…most doctors feel that the TNF blockers are more likely to cause serious infections when compared to patients who are not on these medications.”
This may seem like a mixture of findings but the conclusion is that we still have to be extra careful; why?
- The majority of patients being treated for Still’s Disease will be taking at least one immuno-suppressant drug, maybe more; these include Corticosteroids, DMARDs and Biological Therapy. In dampening down the immune system these drugs also lower your resistance to infection, meaning your body is at greater risk of being overwhelmed by any infection you do pick up. This is why a common cold or flu virus can quickly develop into Pneumonia.
- As I have discovered, prolonged use of these medications can also lead to chronic infections, such as skin infections, sinus infections and upper respiratory tract infections… which are plain stubborn to treat.
- If you were to develop a serious infection, you may have to stop taking these medications to allow your body to recover more efficiently, which leaves you at risk of a major flare in Still’s symptoms.
- Many people with Still’s Disease will agree that catching an infection in itself can lead to an increase in Still’s symptoms. A common cold no longer feels so ‘common’ when accompanied by fevers, rash and joint pain. In some cases this is only short-lived but, for others, it can be a major setback.
So, what can we do to protect outselves from this increased risk of infection? Of course, the easiest thing to suggest is to stay away from people that you know are sick, but this isn’t always possible – trains, buses, shops and restaurants are full of strangers unwittingly sharing their germs with us. I only have to watch a film at the cinema and I’m plagued with swollen glands and sore throat for the next couple of days. But there are some things we can do to improve our chances:
- Stay uptodate with vaccinations – make sure you get your annual flu jab, the pneumococcol booster when necessary and any others that are deemed important at the time – eg. Meningitis, Swine flu..
- If you do develop an infection, get it treated by a doctor as soon as possible.
- Before surgical procedures, you may need to stop certain medications temporarily and /or take a course of antibiotics beforehand.
- Make sure any open infection – wounds, abscesses etc are covered and always wash your hands after handling dressings.
- Keep your hands clean, especially in public places. Try and carry a small bottle of hand sanitizer with you and use after touching things like bus poles, money, tables and other people (discreetly in this case!).
- Don’t use air hand-driers in public toilets as apparently these just blow germs floating around from the toilets straight on to your hands; use tissue or paper towels instead.
- Don’t share foods, drinks or cutlery with others.
- Boost your immunity by eating a diet full of fresh fruit and vegetables, taking gentle exercise and with certain supplements.
- Keep your maintainence dose of steroids as low as possible – easier said than done sometimes.
Here’s to keeping happy, healthy and infection free 🙂
Is infection a side effect of Dmards and Biologic Drugs?
Infection Risk with Biologic Drugs
Rates of Serious Infection in Patients Receiving Anti-TNF Therapy
Immunisation For Rheumatoid Arthritis Patients (NRAS)
Infections, Drugs and Rheumatoid Arthritis (JRheum)
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