The first thing to do is not to get to excited. Second thing is to contact you rheumy and let them know what's going on and look for guidance. Seems like these things always happen on the weekend or the worse possible times. Lol. Different drs have different advice on illness and what to do with the meds. The first time I got sick while on Mtx, I chose to put my meds off until I could get professional advice. I ended up skipping a couple weeks until I got to feeling better and then resumed my regular dosage. Later I had to stop Mtx all together because my liver didn't like it. He kept me on plaquenil for some time after that. Now with the plaquenil he wanted me to continue ta king it throughout my illness. Really just depends on your Dr recommendations and of course what the meds are. You also have the pred in the mix to. I think the right move for me would be to delay it for a couple days until you get professional advice.

I am now on Humira and have taken 3 shot so far and it seems to be helping. Doc told me ahead of time when I started it to delay the injections if I get sick. Wait until all antibiotics have been finished and I have no signs of any sickness before starting it back. My wife has been sick for the last week so I have been wearing a mask at home and using plenty of germx trying to avoid catching this crap. My anxiety goes out the roof when I get sick while on these immune suppressants. Sometimes this makes me a lot worse just worrying about it. Hope you get to feeling better and hope my expierence is helpful for you in some way. Get well!

We all go through this......over time I think we all become in tune with our bodies and the degree of seriousness of the issue at hand. With that experience comes - for me, at least - the best guess as to whether to discontinue the drug or not. It also helps to remember that the drugs we take, while they are immune suppressants, they are nowhere near as strong as those that [e.g.] a cancer patient takes.

For me, I'd have to be pretty doggone sick to go to an Urgent Care. And if I was that sick and the Urgent Center gave me a specific diagnosis ["infection" wouldn't be enough for me.....I'd want to know what KIND of infection}, I might stop my MTX until the rheumatologist got back to me in a few days to give me direction.

What kind of respiratory infection do you have?

I think you made a wise decision. Did urgent care take a chest x-ray? I had RA-related plural effusion once and had to have a lung drained for a week!

In Canada, we are never told to go off our RA meds for an infection. Even for surgery it is argued that the stats show that there is no more infection on the RA drugs than off of t;hem.

After what happened to me with my foot reconstruction, I would never go off my meds. I wasn't told to go off, but coincidently, only 2 weeks before surgery, my liver enzymes went crazy, and I had to go off mthx for that. And Kineret didn't work without a biologic, at all!

So first, I woke up the morning after the surgery in agony. I told the nurse, who asked, and she didn't understand why the IV drip wasn't blocking the pain from the surgery. I realized I had not made myself clear - I couldn't feel the pain of the foot reconstruction surgery at all. The problem was huge flares all over my body. I couldn't even roll myself a bit in bed, to take the pressure off my back, the flares were so big and bad.

That was when I learned that RA pain is a LOT worse than totally cutting off all the toes from the feet, cutting the whole bunion apart, and putting them back together with 6 pins that were over 4 inches long, to say nothing of the 50 or so stitches.

Then there was the RA nodule I got on my vocal fold. My throat became so swollen I could hardly breath. I had a cousin with RA who got a vocal fold nodule, and it was so big she could not breath, and died at the hospital. She was revived, but she has worn a permanent trache since then, which is not fun. I couldn't talk at all for months after I had this nodule, and it caused permanent voice damage to my singing voice. Which is something I regret to this day.

As for lung infections, I get them so much less than when I went onto biologics and DMARDS. I used to be so sick all the time, and adding all the vitamins and minerals as supplements to my life, seems to make my infection risk go down dramatically.

I probably should have gone off my biologic when I had shingles for 5 months, but in the end, a kind Doctor put me on Famvir, which actually targets Herpes Zoster, instead of just Valtrex. I got it post-op and then the next three years after. I am very careful to not get burned which seemed to be a trigger, and I have not had a recurrence for 4 years.

I truly believe that this going off your meds for an infection is all about litigation - in the off chance you might get really sick, and then the doctor would get sued. Or why else is this not a protocol in Canada?

Of course you have to make up your own mind, but going off my meds is not an option for me. I simply cannot take the pain and being totally bed ridden. Nor do I ever want to risk death by swollen nodule in my throat again.

Another thing we learn as time marches on: how to be as germ-free as possible. I choose my social activities wisely and never go into places where there's an outbreak of flu or colds or viruses.

I should have stock in Johnson & Johnson's "Wet Ones." I wipe myhands and other body parts as needed whenever I leave a store or a place where I've handled doorknobs, shaken hands, etc.

While I cannot take flu shots I'm a huge advocate and encourage family and friends and coworkers to get them. At least it gives me a layer of protection.

How did the Urgent Care arrive at that diagnosis?

Marlene - you triggered something in my memory bank. Not that long ago I came down with some sort of respiratory distress....details escape me. In any case, I likely thought it was a bacterial respiratory infection and didn't take my MTX. When I did talk to my rheumatologist, he told me to take it. [He didn't explain - and I probably wasn't in the mood for a detailed explanation.....but I wonder if it's because, as you wrote, the current thinking does NOT support stopping the DMARDS.]

Well I was diagnosed with asthma a couple months after the RA and I am a smoker working on quiting but I was pretty sick. I started with a cough about a wk and a half ago but I thought I would just wait it out and not over react then this last Monday I woke up feeling like I was on fire but not running a temp and I felt exhausted shortly after getting up which happens from time to time. I called the rheumatologist bc my dose had increased last Saturday so I thought maybe that was it, he said no go to your doctor. I am in the process of getting a new one bc she can't seem to handle a patient like me. So I waited until I was for sure something was wrong. No he didn't do an xray, I had audible wheezing and congestion when he told me to take a deep breath. My shortness of breath had gotten worse and I was sweating profusely throughout the day and night. He thought about sending me to the hospital but we came up with a plan. See in my former life I was a nurse but this RA is all new to me. Ty for your information and support, much appreciated.

Happychat: what specialty doctor diagnosed you with Asthma? I understand that this can be easily misdiagnosed by a non-pulmonologist. Since you are a smoker, have you been diagnosed with COPD?

It was a pulmonologist. I have copd/asthma. If I stop smoking soon which I am working on the damage done is reversible per my pulmonologist. Copd emphysema is the diagnosis for permanent lung damage is my understanding from talking with her.

I called my rheumatologist and they told me to wait 1wk after clearance from other doctor to restart my methotrexate.

I, too, have COPD and asthma. COPD doesn't go away and worsens over time. Spiriva has been very effective for me to help control my symptoms. [I smoked 3 packs a day for 20 years. Used Nicorette to quit back in the 80's and have not gone back to smoking......not even one puff.]

My asthma is relatively mild compared to others with this disease. Still, I have Advair and a rescue inhaler on hand.

That's great I hope to be there one day soon. I understand COPD doesn't go away but from my understanding from my pulmonologist is the damage at this point is reversible but if I continue you my smoking it will become irreversible at some point no one knows when but it will hapoen. I have worked as an RN for 17yrs and my last stent was in critical care so I have seen all the scary things first hand so I know what lies ahead if me if I don't quit. And adding to this crazy bussiness is RA, that makes everything more complicated. I am an over thinker and have seen to much in my years. Honestly I am scared to death of this but the show must go on.

So why not try the Nicorette?

I have it gives me painful hiccups. I know it sounds funny but it does.