Because our doctors "disagree" on when to withhold the biologic regarding an illness, I'm so confused about what to do. We've talked about this a few times already, but I thought I'd bring it up because I've delayed my injection for four days now and I'm worried that if I don't hurry up and take it I'll be battling PsA symptoms. I've had the WORST chest/head cold for 6 days now that I've had in at least 20 years. (And I thought the 5-week cough I had was annoying!)
My symptoms had improved yesterday somewhat, but not all the way better. I haven't had a fever that I'm aware of, but a lot of that sweaty, clammy feeling comes and goes--especially during the night. I talked with the online pharmacist from where they ship my Enbrel yesterday and she said usually it's not suggested to delay the injection unless you have a fever. Other doctors and pharmacists say to delay as soon as you have a virus, whether or not there's a fever.
This morning I feel more fatigued than I have for awhile, even though I tried to get a good night's sleep. I don't know if that's a symptom of PsA trying to creep up on me or my cough is developing into something worse.
Can anyone share experiences you've had with bad viruses/infections and still continued to take Enbrel or another biologic and were able to fight the virus off anyway?
I've only been on a biologic a bit longer than you, a year next month. And yes, I've noticed that the advice seems to vary. I go with what my rheumatologist tells me. Mine wants me to call if I'm even sickish, and likely delay. Part of the caution is that I am fairly new on a biologic, and we just don't know if I'm one of those people who will be more prone to infections. Over time, the guidelines may shift to fever only. I don't know. In the meantime, I follow my rheumy's rules, as she is very clear with them.
In other words, I have not continued to take a biologic (Enbrel) while sick at all. I have delayed the few times that I have caught something.
She was actually a bit alarmed last time she saw me because my lower legs were covered with kitten scratches. The kitten liked to scale my legs and use them as a bridge from the coffee table to the couch. She pointed out the need to treat any scratches/wounds carefully, and make sure to clean and use antibiotic ointment.
I'm glad you point out that there's a lot of variation on this. And I think Stoney is correct that the answer is a clear "it depends" based on the patient and their ability to fight off minor infection, the drug, the longevity of treatment and the severity of the other ailment.
My doc has insisted that two instances are cause to withhold the shot. They are on an and/or basis: a) fever b) infection. So if I have a head cold, no fever and no nasty discharge I can take the shot. But if that head cold becomes bronchial and brings on nasty phleghm then no shot. Or if I have a fever but am not sneezing and sniffling then, you guessed it, no shot.
My rheumatologist says if I have symptoms of an infection- including a cold- that I need to hold the meds (not the prednisone, which I'm on a low maintenance dose of at the moment- it's dangerous to suddenly stop pred like that.) I had URIs and pneumonia repeatedly when I was younger, so that might be part of why I am told to stop if I just have a cold, but I don't think so. I think he's just cautious.
I've been off of my MTX and Humira since just before Christmas at this point, because of that flu that ultimately turned into pneumonia, and it's starting to become apparent just how much those meds have been doing... my hip misses that Humira desperately!
Well, I held off taking it for four days and then I just couldn't delay it any longer. I am so afraid if my PsA symptoms come back that the PsA will "win" and Enbrel won't work anymore! My cold symptoms are still lingering, but by Tuesday I had felt enough better that hopefully I gave my body adequate time to overcome the virus. If things start getting worse again, I'll just to have to delay my next shot. I don't take MTX or anything else besides Enbrel that would additionally weaken my immune system. My back, I think SI joint, but it could be my protruding disc, has been so painful, I can hardly stand it sometimes. I have a very weak thorasic spine and yesterday at work I wasn't able to straighten up due to the severe pain in my butt/leg. Just hoping things settle down.
A little over a month ago I was faced with the question, "is this minor sniffle" something I should hold off my injection on? I called the folks at Enbrel support and was told not unless it was a "serious infection" or "fever". I had no fever and had only been a little sick, no missed work. I took the injection and was in the hospital with pneumonia 2 days later.
My family Doctor knows nothing about Enbrel and suggests asking the rheumatologist - who is almost impossible to reach by phone in a hurry. Pharmacist has no clue - goes with the infection or fever story. Just covering their asses and say "consult your Doctor"
Know your body is all I can suggest. I have a history of weak lungs - so I will never take a chance again, skip it. PsA hurts but pneumonia kills. I think consulting your Doctor at your next regular appointment about your overall health and risks could help many of us know how "scared" we should be.
This said - you said it is the worst cold you have had in 20 years - Don't risk it! Might be an infection, or a bad flu and your immune system sounds like it is working on overdrive - night sweats etc. Miss a week - then see if you are strong enough.
After my pneumonia in December - I got SCARED - didn't take it again until last week. I am in the midst of flare today - my fault, but nothing new that I can't handle.
Thanks Seenie and Nic.Pat…I did my shot on tuesday. It seems like I’m slowly getting over this. I’ve been asking my friend at work who seems to have the same thing how it’s been going for her. A lot of ppl are getting a sinus infection with this. I’ve only had one sinus infection in my life. I’m not prone to infections. So every day I debate whether to call my dr!!! Remember last cough I had my dr wanted me to take prednisone and other stuff but I decided not to??? So, I feel like it’s pointless for me to see the dr unless I’m ready to do what they prescribe. I’m not quick to take anything, as you all have probably noticed by now!
Wow, that IS scary, Nic.Pat.....I had replied earlier but was in a hurry to get ready for work. You are right, we need to know our body--and I'm often better off if I just go with my gut. When I begged my doctors for a a prednisone taper for horrible PsA symptoms (before I went on Enbrel) they turned me down, but when I had a cough in November, they wanted me to take prednisone! So, I was already on Enbrel by that time and I worried that prednisone would, if anything, further weaken my immune system and possibly cause pneumonia.
I'm not afraid to use antibiotics but just don't like to jump into taking them for things that can resolve themselves.
And, this is a bad cold for me--but that's because I usually don't get a sick as other people do. So, when I said it's the worst cold I've had in 20 years it's because if I had a cold over the past 20 years it was more like as sniffle, sneeze and cough for 2 days and I was over it.
I hope you are back on Enbrel and feeling normal again! That's weird the Enbrel nurse told you to keep up the injections. The first cough I had, my Enbrel nurse told me to stop injections at the first sign of a virus!
Nic.Pat said:
Hi Grandma J,
A little over a month ago I was faced with the question, "is this minor sniffle" something I should hold off my injection on? I called the folks at Enbrel support and was told not unless it was a "serious infection" or "fever". I had no fever and had only been a little sick, no missed work. I took the injection and was in the hospital with pneumonia 2 days later.
My family Doctor knows nothing about Enbrel and suggests asking the rheumatologist - who is almost impossible to reach by phone in a hurry. Pharmacist has no clue - goes with the infection or fever story. Just covering their asses and say "consult your Doctor"
Know your body is all I can suggest. I have a history of weak lungs - so I will never take a chance again, skip it. PsA hurts but pneumonia kills. I think consulting your Doctor at your next regular appointment about your overall health and risks could help many of us know how "scared" we should be.
This said - you said it is the worst cold you have had in 20 years - Don't risk it! Might be an infection, or a bad flu and your immune system sounds like it is working on overdrive - night sweats etc. Miss a week - then see if you are strong enough.
After my pneumonia in December - I got SCARED - didn't take it again until last week. I am in the midst of flare today - my fault, but nothing new that I can't handle.
I put "antibiotics and biologics" in the search box to see what I could learn from past discussions. I just got more confused. Some people stopped biologics while on antibiotics and others continued the biologics, all with varying results! I always try to go with my gut--we all know our own bodies the best. I finally contacted my doctor because I'm concerned a cold/stuffy nose/cough I have has turned into a little sinus infection and maybe won't go away without antibiotics. But, then, I'm not sure because a lot of people I know have had this same stuff and it finally goes away--some took antibiotics and some didn't. Anyway, she prescribed Bactrim. First, she prescribed Levaquin, but I told her I wouldn't take that due to my PsA and previous pain in my achilles tendons and other tendonitis. (I asked her for Omnicef, because that's what a couple of our grandkids took for this and it worked well. But I have a past bad experience of confusion, etc., from Keflex and it's in the same family as Omnicef, so she didn't want to give me that.) I had delayed my Enbrel during the last cough/cold I had which was only a couple months ago, and a couple weeks later I had some very minor PsA pain (in my knuckles and feet) which didn't last very long. I just worry so much about Enbrel not working anymore and don't want to mess with a good thing. On the other hand, when I googled "antibiotics and Enbrel" on the internet, many people said they had trouble with ongoing sinusitis while on Enbrel.....I could see that happening if they never stopped the Enbrel temporarily while taking antibiotics, thus not allowing their immune system along with the antibiotic to kick the infection.
I keep thinking I'm getting over this "thing" but today I had a headache along with the stuffiness and I have occasional "cold sweats". It hasn't been fun considering this has all happened along with my painful back. Try blowing your nose for five minutes straight while having acute back pain. It's tricky!!!! *sorry for the visual* (At least my back has settled down over the past couple of days.)
Anyway, I guess I'll just do what I usually do and stress out over it, only for everything to turn out just fine no matter what I decide to do. Just nice to put it in writing here and to see if anybody wanted to share their knowledge and experiences.
