Living with rheumatoid arthritis is a complicated business, to say the least. This chronic condition causes pain, inflammation, and fatigue, the severity of which can fluctuate from day to day. On top of that, the treatments for this autoimmune condition have a variety of side effects and typically involve suppressing the immune system. This is because rheumatoid arthritis is caused by the very system that is supposed to keep our bodies healthy and well. When our immune systems are confused and fighting against joints and tissues instead of germs and viruses, we face problems on two fronts: the points of the immune system’s attacks and the areas left undefended.
The past month, I’ve been hyperaware of the complexity of the interplay between rheumatoid arthritis and the immune system. Since I was a small child, I’ve been more prone to colds and infections than the average American. In the 15 years since being diagnosed with RA, my rate of illness has only increased when I’m on immunosuppressant drugs. While these treatments are often effective in decreasing my RA symptoms, they leave me at greater risk for contracting infections. I am not alone, as most RA patients experience such impacts of having suppressed immune systems. Dr. Clifton Bingham, director of the Johns Hopkins Arthritis Center, sums it up, “We know that patients with diseases such as rheumatoid arthritis [RA] and lupus have an increased risk of usual infections as well as atypical infections. We also understand that corticosteroids and immunomodulators may increase this risk and that outcomes can be more severe in this population.”
Right now, I feel like a poster child for that statement. This cold and flu season I’ve had a series of upper respiratory infections, the most recent of which led me to my primary care doctor due to the intense coughing and shortness of breath I was experiencing. She said I was wheezing due to asthma brought on by an upper respiratory infection (to which I thought, “oh great, asthma: another diagnosis.”). A few days later as the coughing fits increased in intensity, I went to an urgent care doctor, who said I had bronchitis. Although both doctors prescribed antibiotics and steroids, I wasn’t improving. Fortunately, I was able to get in with a pulmonologist within a couple of weeks, and he performed a wide array of laboratory and breathing tests in addition to a physical exam. A few days later his nurse called to inform me that I tested positive for pertussis. For those of you who are like me and don’t know the formal names of many illnesses, pertussis is whooping cough.
“Whooping cough? Are you kidding me? In 2016?” These were the thoughts that went through my head as news of this most recent diagnosis set in. When I hung up the phone, the first thing I did before leaving early from work to go pick up yet another antibiotic prescription was to perform an online search for pertussis. The Centers for Disease Control and Prevention describes the condition as “a highly contagious respiratory disease . . . known for uncontrollable, violent coughing which often makes it hard to breathe.” The CDC added, “The best way to protect against pertussis is by getting vaccinated.”
For the next week I pondered how I’d ended up contracting a disease that is generally associated with infants and the pre-vaccine era prior to the 1940s. My research led me to a few interesting insights: 1) whooping cough has been on the rise nationally in the past decade, 2) those of us with inflammatory autoimmune diseases are at a higher risk of pertussis infection, both because these conditions themselves and the immunosuppressant drugs used to treat them lower our immunity to the disease, and 3) a pertussis vaccine booster is recommended for all adults over the age of 19, and especially for those with autoimmune conditions.
When the topic of vaccination comes up in the RA community, there is generally controversy. Experts recommend that patients with immune systems suppressed by autoimmune conditions and/or immunosuppressant drugs receive annual flu shots and the pneumonia vaccine. However, those of us living with RA sometimes worry about whether introducing small doses of a virus into our systems is a wise move, given how hard a time our systems have fighting illness. Yet, there is a preponderance of research that indicates that introduction of “killed vaccines” into RA patients is safe and effective (although there can be complicating factors, so this should always be discussed with your rheumatologist). Some vaccines, such as the flu nasal spray, contain live viruses, which are not recommended for patients with autoimmune conditions. The pertussis vaccine contains a dead virus, and is therefore considered safe and is recommended for RA patients. 
In the past, I have been on both sides of the vaccine debate. Some years I have felt that introducing any viruses into my immune-compromised system was asking for trouble, and other years I’ve trusted my doctors and put faith in their recommendations that vaccination was the best course of action. That being said, I was never encouraged to get a pertussis booster. My bout with whooping cough, which ended up taking weeks to get over and required eight sick days from work and the suspension of my RA treatment, has left me siding with the medical experts. Having RA is hard enough on its own, so I now feel I’d best take advantage of vaccines that can help my weakened immune system ward off disease.
When was your last flare?