2009 H1N1 Flu (referred to as “swine flu” early on) and Seasonal Flu Information for People with Inflammatory Arthritis or Rheumatic Disease

October 15, 2009, 11:00 AM ET

How does arthritis affect how I respond to the flu?

People with certain types of arthritis, called inflammatory or systemic arthritis or autoimmune rheumatic disease, have a higher risk of getting flu-related complications, such as pneumonia. Inflammatory arthritis affects the immune system which controls how well your body fights off infections. Also, many medications given to treat inflammatory arthritis can weaken the immune system. People with weakened immune systems are at high risk for getting more severe illness and complications such as hospitalization with the flu. Rheumatoid arthritis and lupus are the most common types of inflammatory arthritis.

People with osteoarthritis, also called degenerative arthritis, are likely not at increased risk of complications from the flu unless they also have other high-risk conditions for flu such as asthma, diabetes, heart disease, or cancer.

If you have one of these types of inflammatory arthritis, you may be at high risk for complications from the flu. You should discuss your risk for complications from the flu with your healthcare provider.

Types of Inflammatory Arthritis

Rheumatoid arthritis (RA) Systemic lupus erythematosus (SLE) Psoriatic arthritis Anti-phospholipid syndrome Polymyalgia rheumatica Systemic sclerosis/scleroderma Spondyloarthropathies Sjögren’s syndrome Polymyositis/dermatomyositis Vasculitis (e.g giant cell arteritis) Necrotising arteritis Sarcoidosis Polyarteritis nodosa

If you are taking one or more of these medications for your arthritis, you may be at high risk for getting the flu or complications from the flu. Note: This list applies to medications that are ingested or injected and does NOT include medications that are applied to the skin such as creams and ointments. Your healthcare provider can clarify if the medications that you take weaken the immune system.

Arthritis medications that weaken the immune system

Steroids (corticosteroids) taken by mouth or intravenously, not applied to the skin or injected into a joint. prednisone (Deltasone, Orasone, Prednicin-M, Sterapred) prednisolone (Prelone) methlyprednisone (Medrol) hydrocortisone (Cortef, Hydrocortone) dexamethasone (Decadron, Hexadrol)) cortisone acetate (Cortone) betamethasone (Celestone) DMARDs (disease-modifying antirheumatic drugs) methotrexate (Rheumatrex, Trexall) azathioprine (Imuran, Azasan) hydroxychloroquine (Plaquenil) leflunomide (Arava) sulfasalazine (Azulfidine) minocycline (Minocin, Dynacin) cyclosporine (Sandimmune, Neoral, Gengraf) mycophenolate mofetil (Cellcept) gold (Auranofin, Ridaura, Myochrysine) chlorambucil (Leukeran) cyclcophosphamide (Cytoxan) Biological response modifiers (biologics) etanercept (Enbrel) infliximab (Remicade) adalimumab (Humira) anakinra (Kineret) abatacept (Orencia) rituximab (Rituxan) tacrolimus (Prograf, FK-506, fujimycin)

What are the symptoms of the flu?

The symptoms of 2009 H1N1 flu virus in people are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1, and have respiratory symptoms without a fever.

How can I avoid getting and the flu or giving the flu to others?

The flu is spread from person-to-person by coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose. You can take simple actions to protect yourself and others from getting the flu:

• Get a seasonal flu shot now and the 2009 H1N1 flu shot when it becomes available.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
• Avoid touching your eyes, nose, or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu-like illness, seek medical care early. Your health care provider can determine if you need to be treated with antiviral medication.
• Keep away from others as much as possible to keep from making others sick. CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. Your fever should be gone without the use of a fever-reducing medicine.

Is there a vaccine against the 2009 H1N1 flu virus and who is it available for?

Yes. A vaccine for the 2009 H1N1 flu has been developed and will be available beginning mid-October 2009. People with inflammatory arthritis within any of the following prioritized groups are recommended to receive the 2009 H1N1 vaccine when it first becomes available:

• Pregnant women
• People who live with or care for children younger than 6 months of age
• Healthcare and emergency medical services personnel
• Persons between the ages of 6 months and 24 years old
• Persons between the ages of 25 and 64 years old who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems (including with inflammatory arthritis)

Persons age 65 or older (including those with inflammatory arthritis) are not included in these prioritized groups because current studies indicate that the risk for 2009 H1N1 flu infection among persons age 65 or older is less than the risk for younger age groups. We do not expect that there will be a shortage of 2009 H1N1 vaccine, but availability and demand can be unpredictable. Once the demand for vaccine among the younger groups has been met, however, people age 65 or older with inflammatory arthritis should receive the 2009 H1N1 flu shot.

Do I need to get a flu shot?

Yes, CDC recommends certain persons with weakened immune systems, which includes people with inflammatory arthritis, get flu shots.
People with inflammatory arthritis should get—

• A seasonal flu shot every year. These are available beginning in September.
• The new 2009 H1N1 flu shot when available (see question above). These will begin to be available in mid-October 2009.

People living with inflammatory arthritis should get the "flu shot"— an inactivated vaccine (containing fragments of killed influenza virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people inflammatory arthritis.

The other type of flu vaccine — nasal-spray flu vaccine (sometimes called LAIV for “live attenuated influenza vaccine)—is not currently approved for use in people with inflammatory arthritis. This vaccine is made with live, weakened flu viruses that do not cause the flu). LAIV (FluMist®) is approved for use in healthy people 2-49 years of age.

What should I do when I am sick?

• If you develop flu-like symptoms contact your healthcare provider.
• Avoid contact with others. You should stay home and avoid travel, including not going to work or school, until at least 24 hours after your fever is gone except to get medical care or necessities. Your fever should be gone without using fever-reducing medications.
• If you leave the house to seek medical care, wear a facemask, if available and tolerable, and cover your coughs and sneezes with a tissue.
• Do not stop taking any medicine you take for your arthritis unless told to do so by your physician.
• Seek medical attention early if you develop symptoms of the flu. Treatment is available for persons with severe disease and those at high risk for complications. Persons with inflammatory arthritis are considered high risk for complications from the flu; therefore, your health care provider may choose to prescribe antiviral medications for you if you get the flu.
• If you are exposed to someone who has flu, consult your health care provider. They may prescribe medication to help prevent you from getting the flu or watch you closely to see if you develop flu symptoms.

For more information:

H1N1 Flu: General information
http://www.cdc.gov/h1n1flu/general_info.htm

Arthritis Foundation Flu: What People with Arthritis Should Know*
http://www.arthritis.org/the-flu.php

H1N1 Advisory for People with Lupus*
http://www.lupus.org/webmodules/webarticlesnet/templates/new_empty.aspx?articleid=2681&zoneid=99

Lupus and Influenza Vaccines*
http://www.lupus.org/webmodules/webarticlesnet/templates/new_learnliving.aspx?articleid=2688&zoneid=527

* Links to non-Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at this link.

http://www.cdc.gov/h1n1flu/arthritis.htm


Keywords: APSFA, APS Foundation, antiphospholipid antibody syndrome, lupus, stroke, dvt, pe, thrombosis, clot, migraine, hughes syndrome, miscarriage, america, usa, anticoagulant, heart attack, APS, H1N1, flu, swine

Volume 14 of the APSFA Newsletter - "Antiphospho...What?"

Hello!!

The SUMMER/FALL 2009 volume of our quarterly newsletter, "Antiphospho...What??" is ready to be downloaded. You can download it at the following link: http://www.apsfa.org/docs/APSFAVol14SumFall09.pdf

The next volume will be coming out in late Fall, early Winter 2009.

Please let us know if there are any topics that you'd like our Medical Advisors to cover in their articles. We try to request topics that people are emailing about or that are discussed on our the forum. So if there's anything you'd like to see, please let us know and we'll pass it along to the medical advisors.

We are still in need of patient stories (esp about Pregnancy Loss, Men and Teens or Children), recipes, poems, related book reviews, and anything else you think would be of interest for upcoming newsletters. (book reviews, poems, recipes, articles written by family members, etc.) Please submit articles to the following email address: articles@apsfa.org.

If you have an idea and are not sure if it would fit, please feel free to contact us through our contact page on the website, or email us using the email address below. We are open to any suggestions. Without your help we would not be able to include an APS patient's story in each of our newsletters.

Thank you to those people who have submitted articles. If you have submitted an article and we have not used it yet, we will be using it in the near future.

We could also use articles written by medical professionals or medical students. Please contact us if you are interested.

Please remember to check our website for any changes at the following link: http://www.apsfa.org/new.htm

Thank you for your continued support!

Preventing Miscarriages

On June 25th, Judy Smith did an interview with Fox News in Tampa Bay. Judy has had several miscarriages and at one point thought she had MS. It wasn't until her Dr. did a simple blood test that revealed she had a potentially life threatening illness called APS.

She can not stress the importance of the APS Foundation of America, Inc (http://www.apsfa.org), and how it has played a part in helping her cope with this disease. Not only do they have a support group for others with APS, but they are the only "United States nonprofit health agency dedicated specifically to bringing national awareness to Antiphospholipid Antibody Syndrome (APS), the major cause of multiple miscarriages, thrombosis, and young strokes and heart attacks."

"Knowing more about APS can make all the difference. Get in the Know and Get in the Flow!"

Please watch this video as it may help someone you know.



http://www.myfoxtampabay.com/dpp/health/doctor_jo/Preventing_miscarriages_070809

Keywords: APSFA, APS Foundation, antiphospholipid antibody syndrome, lupus, stroke, dvt, pe, thrombosis, clot, migraine, hughes syndrome, miscarriage, america, usa, anticoagulant, heart attack, APS

Signs and Symptoms of Antiphospholipid Antibody Syndrome: Get in the Know and Get in the Flow!

FOR IMMEDIATE RELEASE

Date: 06/22/2009
Contact: Christina "Tina" Pohlman
Phone: 608-782-2626
Website Address: www.apsfa.org
Email Address: apsfa@apsfa.org

Signs and Symptoms of Antiphospholipid Antibody Syndrome: Get in the Know and Get in the Flow!

The Antiphospholipid (APS) Antibody Syndrome Foundation of America, Inc. (APSFA) urges the public, as well as the medical community, to learn more about this rare disease. APS Awareness Month runs throughout June.

APS is an autoimmune disorder. Such illnesses occur when the body’s tissues are attacked by its own substances. In APS, the body recognizes certain components of blood or cell membranes as foreign substances and produces antibodies--a specialized protein the body uses to prevent infection--against them. It is the major cause of strokes in persons under 40 years old, blood clots (thrombosis) – which can lead to heart attack or stroke – vision disturbances and repeated, otherwise unexplainable miscarriages.

While more general practitioners have become familiar with APS in the last few years, many physicians – and most of the public – are still unfamiliar with both its symptoms and the damage it can cause.

People who arrive at emergency rooms and doctor’s offices with the following issues should be tested for APS:

• Heart attacks and strokes in those under 50
• Transient ischemic attacks, known as “mini-strokes.” TIAs last 10 minutes or less and leave no permanent damage.
• Multiple miscarriages and stroke
• Blood clots in the lung (called pulmonary emboli) or deep veins in arms and legs (called deep vein thrombosis, or DVT)
• Diminishing mental alertness, such as loss of concentration, memory loss and difficulty with reading comprehension
• Migraine headaches
• Partial or total vision loss
• Dizziness
• Seizures

APS shares symptoms with more well-known disorders such as multiple sclerosis and lupus. Diagnosis and treatment delays can cause serious, sometimes fatal complications. A simple blood test can determine whether someone has APS.

The APS Foundation of America, Inc. is the only United States health agency dedicated specifically to bringing national awareness to APS. We are a volunteer-run, community-based, non-profit organization dedicated to spreading awareness and support to those with the disease.

Knowing more about APS can make all the difference. Get in the know and Get in the Flow!

For more information Contact: Christina "Tina" Pohlman at Phone: 608-782-2626 Website Address: www.apsfa.org. Email Address: apsfa@apsfa.org

###

Public Service Announcement for Week 4:
http://www.youtube.com/watch?v=GRiK_CncGyU



Keywords: APSFA, APS Foundation, antiphospholipid antibody syndrome, lupus, stroke, dvt, pe, thrombosis, clot, migraine, hughes syndrome, miscarriage, america, usa, anticoagulant, heart attack, APS, PSA

APS Often the Culprit Behind Heart Attack and Stroke in Younger Adults

FOR IMMEDIATE RELEASE

Date: 06/15/2009
Contact: Christina "Tina" Pohlman
Phone: 608-782-2626
Website Address: www.apsfa.org
Email Address: apsfa@apsfa.org

APS Often the Culprit Behind Heart Attack and Stroke in Younger Adults

The Antiphospholipid Antibody Syndrome Foundation of America, Inc. (APSFA) urges the public, as well as the medical community, to learn more about this rare disease. APS Awareness Month runs throughout June.

APS is an autoimmune disorder. Such illnesses occur when the body’s tissues are attacked by its own substances. In APS, the body recognizes certain components of blood or cell membranes as foreign substances and produces antibodies--a specialized protein the body uses to prevent infection--against them. It is the major cause of strokes in persons under 40 years old, blood clots (thrombosis) – which can lead to heart attack or stroke – vision disturbances and repeated, otherwise unexplainable miscarriages.

A heart attack generally occurs when a coronary artery clot blocks the supply of blood and oxygen to heart muscle. There are more than one million heart attack sufferers annually in the U.S.; about half of those stricken die. Unfortunately, many heart attack victims wait two hours or more after symptoms begin before they seek medical help. This delay can result in death or lasting heart damage.

A stroke, or "brain attack," occurs when blood circulation to the brain fails. Brain cells can die from decreased blood flow and the resulting lack of oxygen. There are two broad categories of stroke: those caused by a blockage of blood flow (called “ischemic” strokes) and those caused by bleeding. Ischemic strokes account for about 80 percent of all strokes. They usually are not fatal.

A transient ischemic attack, or TIA, is an ischemic stroke that occurs when the brain’s blood supply is interrupted briefly (10 minutes or less). There generally is no lasting damage, but recent research shows that about half of people who experience a TIA have a full-blown stroke within 24 hours.

APS is the leading cause of heart and brain attacks in people under 50. If you have a personal or family history of heart attack or stroke before age 50, ask your primary care physician to test you for APS. It requires only a simple blood test.

The APS Foundation of America is the only United States health agency dedicated specifically to bringing national awareness to APS. We are a volunteer-run, community-based, non-profit organization dedicated to spreading awareness and support to those with the disease.

Knowing more about APS can make all the difference. Get in the know and Get in the Flow!

For more information Contact: Christina "Tina" Pohlman at Phone: 608-782-2626 Website Address: www.apsfa.org Email Address: apsfa@apsfa.org

###

Public Service Announcement for Week 3:
http://www.youtube.com/watch?v=63-5f0G9CCA



Keywords: APSFA, APS Foundation, antiphospholipid antibody syndrome, lupus, stroke, dvt, pe, thrombosis, clot, migraine, hughes syndrome, miscarriage, america, usa, anticoagulant, heart attack, APS