Adverse Events - RA immunosuppresant meds & opportunistic infections

You understand more about these things than I do, @Arthuritis , but, for the record, I've always been told to avoid all live vaccines on any dose of methotrexate. but to have the flu jab each years. I've done that and my only problem was one year when, actually, I was on leflunomide not meth, and I did almost end up in hospital with breathing problems. However, I suspect I was starting with a cóld when I had the jab. Not made that mistake since!

In my earlier RA life, I did find that anything that raised my temperature (cold/flu) set off the joints. I wouldn't call these flares as they settled down with the temperature. Now I just skip the meth if I have a hint of a sore throat etc and that seems to avert both cold and RA problems.

I have wondered if covid transmission will actually go up in summer as people's 'vaccination life' comes to an end and, in any case, I think people are less concerned now. I do go out for walks and ,in the summer, we did have friends for coffee or meals in the garden, but anyone coming into the house (only vaxed people) know to do an LFT first. But Mr SW does go into shops occasionally. In summer, I might actually eat out - literally - at a restaurant.

Hi @Arthuritis

I think I might have got things the wrong way round here😯. I actually started getting recurring chest infections almost every month from March 2020 - only to then be diagnosed with PsA in October 2020 and put on 3gms daily sulfasalazine. I turned 65 in September 2020 and received my pneumonia and flu vaccine then - only to be hospitalised with community acquired pneumonia in November 2020, December 2020 and March 2021. I was only put on MTX in February 2021 - firstly 15mg, then upped to 20mg in March 2021. It didn't seem to work though and I was put on Amgevita biosimilar in July 2021. I was hospitalised with a chest infection in October 2021 and one of the consultants I saw was a rheumatologist who all but said he thought MTX might have caused it and reduced my MTX from 20mg to 10mg per week. I've noticed a slight difference since the reduction - my joints are more achy now but nothing in comparison to the pre Amgevita period.

So the short answer is I've actually had less infections since I've been on MTX, however the devil is in the detail. Getting diagnosed with PsA during the period of covid has altered my life considerably. I was on high dose prednisolone for 4 months when I got my 1st covid vaccination, then 20mg MTX for my 2nd, then Amgevita and MTX for my 3rd and booster. So I've been - and I'm being - careful. Regular lateral flow tests, home grocery deliveries and Amazon purchases, gazebo garden meetings with friends and family and avoiding going to social gatherings where there are multiple households, pubs, restaurants etc. My best friend was diagnosed with cancer just pre-covid times and has gone through chemo and radio therapy so we haven't seen each other in the flesh for two years.

A few of the rheumatology staff I've seen have suggested my PsA could have been triggered by a virus. It was also suggested my first March 2020 chest infection was covid - but testing was withdrawn at the time if you remember.

So the 'new normal' is certainly significantly different that what I was used to.

I've been into a supermarket probably 4-5 times in the last 15 months when I've needed to. I've a small, local Sainsbury's and I've ensured I've gone at a quiet time and used the auto checkout and paid contactless. I've been to very few other shops - Jeff Bezos rocket contributions have been significant😉.

Pre - covid we got a supermarket delivery weekly as we're in a semi- rural area. Mr SW sometimes goes to a local shop if necessary. I don't.

I think, but I'm not sure as it was over 20 years ago, I was started on 10mgs then it was gradually pushed up as necessary. I've always believed in as few meds as possible so asked if I could reduce from time to time. The answers varied but I've been back on 10mgs for some years now.. I did try 7.5mgs but it didn't work out.

My NHS dentist, since lockdown, keeps me regularly updated. All routine appts stopped but emphasis that they are there if needed.

Haven't really done public transport for years. Covid stopped our annual flights to stay with son and grandson in LA. He came here before Xmas. Many PCR tests involved!

Hi @Arthuritis

I've not found any food that has caused me any more issues. I have given up alcohol - I didn't drink much, only red wine - but I've found my taste for it has gone. I've always only eaten a small amount of red meat but I was diagnosed with anaemia just before the end of last year so I've upped my intake of red meat. and I'm eating more bran. It's something to watch out for as it turns out Omeprazole can cause anaemia. If you are on NSAIDs there's a chance you are also on Omeprazole to counter the damage NSAIDs can do to your stomach lining. In my case I'd been un-prescribed NSAIDs last June but nobody had picked up on the fact I was still prescribed Omeprazole - and I didn't know any better.

Before I was put on Amgevita my really major flares coincided with my pneumonia/chest infections. I've had one bad chest infection since being put on Amgevita but it didn't cause a flare.

Regarding my time in BA I didn't jump but was pushed. After 27 years service they outsourced my job - to Chennai in India. Initially they didn't offer any type of redundancy but simply said my job would be in Chennai in 3 months and it was down to me to decide whether to take it or not. Luckily most of the workforce was unionised so a redundancy package was finally offered and I retired at 61. There was little chance of a 61 year old IT professional getting a relevant position elsewhere. In some ways the timing was lucky as my work pension is now almost wholly protected since I'm drawing it now.