Hold for Infections: My Recent Experience with Biologics and Immunosuppression

My life with biologics stretches back six years now. I was diagnosed nearly 15 years after initial symptoms appeared, and since I had been self-medicating with NSAIDs for years (without much success), the next step was to try biologics.

Biologics work relatively well for me so far, and I am thankful for that. Ever since I’ve started this journey with biologics I have heard the same advice over and over again from rheumatologists: if you develop an infection, stop using the biologic until the infection clears.

My recent infection episode

Somehow, I’ve managed to avoid infections for the past six years...until recently. Several months back I developed this rough, irritated strip of skin in the crease behind my ear. Last year I developed a bit of psoriasis, so I assumed that irritation was either psoriasis or extremely dry skin and that it would resolve on it’s own with time.

The irritated area of skin hung around for two months without causing any other issues, until one day, out of the blue, my lymph nodes in my neck blew up. Swollen and sensitive to the touch, the side of my neck looked like a AAA battery was trapped just under the skin and trying to escape.

Alarmed by these new symptoms, I called my doctor.

The doctor’s instructions

It took a matter of seconds for my doctor to identify the irritated area behind my ear as impetigo. I had never heard about impetigo before! I learned that impetigo is a highly contagious skin infection common in children, but uncommon in adults. That is, uncommon in adults that don’t have a suppressed immune system.

Since I’m on a biologic and a DMARD, my immune system is suppressed and my body had a hard time battling the bacterial infection on its own. I’m sure this is a common experience for some fellow Spondies who are on immunosuppressants, but the experience was altogether new to me.

The solution: take an antibiotic, use an antibiotic cream, and stay off the biologic for 7 - 10 days.

7 Days Without My Biologic

Two aspects of this experience worried me.

First, the fact that my body could not fight bacterial infections on its own (or at least this one) was a terrifying thought. I knew this was an aspect of the immunosuppressant drugs, but it struck a nerve anyway. I started to envision my future with a weakened immune system, constantly fighting infections and hopping on and off of my biologic. I know this is a grim and unlikely vision of my future, but isn’t it just human nature to imagine the worst while coming to terms with a new reality?

Second, I worried about coming off my biologic, even for a week. Biologics are successful at nearly eliminating my fatigue (most days), mitigating much of my joint pain and stiffness, and reducing the severity of my flare-ups. A week without my biologic might translate to a week of intense pain, limited mobility in my hands (where I experience peripheral arthritis), and debilitating fatigue.

I was right to worry about one thing. Those seven days without my biologic crawled by. My days in the office were full of joint stiffness and pain, my evenings were spent resting and preparing for the day to come. But my infection subsided within a few days and I was able to start back up on my biologic on day 8, as planned!

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