Immunosuppression medications can cause patient fear, especially given the side effect profiles. The risks of these medications should be discussed in the context of the serious risks associated with untreated rheumatic disease.
General Precautions
- Educate patients that immune-suppressing medications may be held during infection, but to discuss with the prescribing provider before stopping abruptly. Doing so may cause the patient’s autoimmune disease to flare, which further complicates the management of both the infection and autoimmune disease.
- Regular lab monitoring and follow-up with rheumatology providers is important for various medications to continue evaluating for any potential side effects to internal organs such as the kidney or liver.
- Steroid pills that a patient has been on for more than a couple weeks should not be stopped abruptly. Discuss with the prescribing provider if there are concerns with the management of steroids.
- Highly recommend providers review with the patient and recommend that the patient read the contraindications for any new medication start.
- Overall, empower the patient to bring up their concerns to the prescribing provider. Immune-suppressing medications have shown to be effective in controlling rheumatic diseases, but the risks and benefits should be discussed thoroughly so that the patient is knowledgeable and comfortable regarding their medications. Additionally ensure the patient that there are multiple therapeutic modalities that can be considered for certain rheumatic diseases.
- Patients generally can receive killed vaccines while on rheumatology medications; recommend consulting their rheumatology providers or reviewing the American College of Rheumatology Vaccine Guidelines for specific medications.
Specific Patient Fears
High Costs
- Many medications, especially the injectable medications, have patient assistance programs through the drug companies to offset costs.
- Almost all medications in the ACR Medication Guides have resources for patients from the manufacturer that can address issues with insurance coverage and cost.
Injection Use
- Nurse teaching with a clinic nurse can be very valuable in building patient confidence in self-administering injections.
- Injections can come as an injection pen instead of a prefilled syringe from a vial. This injection pen often only involves pushing a button and a sensation of a small pinch.
Higher Infection Risk
- While many of the immune-suppressing medications can increase risk of infection, the prescribing provider can guide the patient through additional precautions (e.g., wearing masks, etc.) that can help decrease the infection risk a bit.
- During infection, many immune-suppressing medications will likely be briefly held (exceptions will be medications that are not immune suppressing and steroid pills).