Infection-fighting Tips for People With RA

It’s important for everyone to keep up with immunizations, but that’s even more true if you’re on an immunosuppressant. “One of the best ways to prevent infections is to get vaccinated against common viruses and bacteria. For example, I recommend that my patients with rheumatoid arthritis get an annual flu vaccine as well as, depending on the age of the patient, herpes zoster (shingles), pneumonia, and hepatitis,” says Orrin Troum, M.D., a rheumatologist at Providence Saint John’s Health Center in Santa Monica, CA. Your doctor can help you figure out which ones you need.

Your mom’s advice was right—many infections can be avoided simply by washing your hands. People touch their face every three to four minutes without realizing it (aka the germ superhighway to your eyes and mouth). According to the Centers for Disease Control and Prevention, scrubbing should last for 20 seconds and happen before, during, and after cooking, after using the toilet, after blowing your nose, and before treating a cut. It’s not a bad idea to do it after you come in from being out and about, too. Washing with soap and water is ideal, but sanitizer works in a pinch.

Raw or undercooked meat, chicken, fish, and vegetables can all transmit infectious bacteria, and the Arthritis Foundation reports that anyone with an autoimmune arthritis is at a higher risk for getting food poisoning. So take precautions. Before even starting to cook, make sure to wash your hands. Once you’re busy chef-ing, pay detailed attention to expiration dates, check for “off” smells, wash raw produce thoroughly, and use a meat thermometer to ensure foods reach a safe internal temperature. Don’t reuse knives and clean each surface before another food is placed on it.

As with some RA medicines, stress can act as an immunosuppressant, further increasing your chances of getting sick. Admittedly, there’s nothing more stressful than actively trying not be stressed, but the calmer you are, the easier it is to fight off those germs. The Cleveland Clinic recommends integrating practices such as meditation and deep breathing into your regular routine to keep those panicky responses in check.

While it’s often thought that medical masks should be worn when you’re sick, they’re a great preventative option as well. If you’re traveling a lot during flu season or interacting with someone sick, a medical mask can stop infected germs from entering your system, the Food and Drug Administration reports. The agency recommends using disposable masks (look for one that is FDA-approved) to prevent extended wearing of a soiled one. Always wash up after removing a mask to prevent germs from staying on your hands.

It’s important for anyone with rheumatoid arthritis to avoid contact with others who are sick, stresses Anca Askanase, M.D., a rheumatologist at ColumbiaDoctors and associate professor of medicine at Columbia University Medical Center in New York City. Explain to friends and family that with a weakened immune system, you need to be extra cautious. If you are forced to interact with sick people, wear that face mask during the interaction and discard it once you are away from the affected individual.

Follow-up lab work after diagnosis can help you and your doctor better assess your susceptibility to disease, Dr. Askanase explains. Because RA can impact your whole body, including kidneys, lungs, eyes, and bone marrow, your doctor may want to monitor each of these to see if they might be compromised and at higher risk for infection. Your age, any other health conditions, and your mix of medications may also inform your risk. For example, standard-dose and high-dose biologics taken for RA are associated with an increase in serious infections, while low-dose biologics may not be, according to a review of research in Lancet.

You’ll want to discuss with your doctor what to do if you start showing signs of an infection—well before you ever get sick. Find out exactly what to watch for and what potential symptoms might feel like. This preparation can go a long way towards heading off potential infections before they grow into something more dangerous for you.

Stay in tune with how your body is feeling day to day, and if you're on a biologic, know which infections are most common. According to a 2018 study, they include: respiratory illness (such as colds, bronchitis, and pneumonia); skin infections (often marked by redness, rash, tenderness, or pus); genitourinary conditions such as UTIs (marked by frequent, painful urination); and bone/joint infections (often caused by bacteria and marked by red, hot, and painful joints). Watch out for early signs and never ignore fevers, advises Linda Lee, M.D., a rheumatologist with the Summit Medical Group in Berkeley Heights, NJ.

If your body is doing something out of the ordinary, and especially if you feel an antibiotic might be called for, check in with your doctor right away, says Dr. Lee. Your physician may direct you to stop taking some medications, including biologics or disease modifying anti-rheumatic drugs (DMARDs). “Patients taking DMARDs should notify their healthcare provider as soon as they develop signs of an infection so those medicines can be held and appropriate treatment started as soon as possible,” Dr. Troum says.