Flu or Flare or Neither?

Flu or Flare or Neither?

I saw a report on a study the other day that indicates stopping methotrexate (MTX) for two weeks after getting the flu vaccine makes the vaccine more effective – by as much as 15 to 20 percent.

How the flu vaccine works

My first reaction was that this makes sense. The flu vaccine works by introducing the inactive (dead) flu virus strains into your system which then responds by building antibodies. Later, when you encounter the live versions of the virus (generally from people around you), these antibodies make you more resistant to catching the flu.

Since methotrexate suppresses your immune system, your system is less able to make flu antibodies (which is one reason that catching the flu is so serious for RA patients). Stopping MTX after getting your flu shot therefore allows your body a more normal response to the vaccine and it makes more of the antibodies.

Getting the flu seems similar to having a flare

I have had the flu. The real flu – not just a really bad cold. And I had it when I was much younger and much healthier. Now as an RA patient, I really don’t want to risk an even worse case of it, which is why I get my flu shot every year.

The closest I’ve come to feeling as bad as I did with the flu is when I’ve had really bad flares. The flares where it hurts all over. Where it hurts even to breath and you don’t even want to think about getting out of bed.

This brings me to my second reaction when I read the headline about stopping MTX after getting the flu vaccine. Missing two weeks of MTX might be enough to put some people into a flare. Apparently this wasn’t the case in the trial which included 199 patients. There were no noticeable increases in flares among the RA patients. That being said, based on personal experience, I’m not sure I’d want to take that chance.

It’s unclear from what I’ve read whether the patients were on other medications besides MTX, such as other DMARDs or biologics. If they continued on with these treatments, that would add some protection against flaring.

In addition to being presented at the national American College of Rheumatology Conference, the study was also published in the Annals of Rheumatic Diseases.

A couple of things:

First, you should never change or discontinue any part of your treatment plan without discussing it first with your doctor. Hopefully that goes without saying.

Second, you should never get any vaccine without also talking with your doctor. Some vaccines like that for the flu and pneumonia are inert/dead vaccines. That is, you can’t get the disease from the vaccination. However, other vaccines, like those for shingles, contain live virus strains (although they have been weakened). It’s possible, and sometimes recommended, for people with suppressed immune system to get those vaccinations, but only under a doctor’s guidance because there are risks of actually developing the disease involved.

After having the flu those many years ago, I always, always get my flu shot every year. While there’s no guarantee that it will keep me from getting it, it’s definitely the best chance I have of avoiding a very serious situation.

Remember that it takes from two to four weeks for the full effects of the vaccination to kick in, so you might want to consider getting it in advance of time where you’ll have a lot of exposure – like holiday gatherings and travel.

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