Flare Up's and Viruses

[Farmwife]

I was just musing my time away and this had me thinking. :study:



Does being late on giving the shots (Humira and MTX in this case) cause the possible flare?

:yfaint:OR:yfaint:

Is it the virus that triggers the autoimmune to overreact and makes it harder for the drugs to work, thereby causing a possible flare?


Oh and yes, Grace had blood in her stool and her JRA is worse today.:confused2: But the virus is gone.

 

[Tesscorm]

Okay, these are my thoughts... I don't know if I'm right!!

A crohns flare, I think is one of two reactions... 1 - your immune system reacting to something that should not trigger a reaction (similar to an allergic reaction to cat hair, for example) and/or 2 - there is a trigger (ie some bad bacteria) which rightly triggers an immune reaction (inflammation) but, with crohns, your immune system/inflammation does not shut down once the trigger has been eliminated.

The meds, if working as they are supposed to work, will stop your immune system from reacting to a 'non' trigger and will force a 'normal' reaction when there is a trigger.

However, having said this, I believe the immune system and response mechanism is complex and multi-faceted so, throwing a virus into the mix, may throw off the balance that the meds are trying to maintain. I think of the meds kind of like the flu vaccine - it will prevent/take care of most flu viruses but, once in a while, a different virus comes along that gets around the vaccines capabilities.

Hope that made sense, although I'm not even sure I'm right (but it's how it makes sense in my head)!

 

[Jmrogers4]

Well said Tesscorm, don't know if it's right either but I share a similar thought.

 

[Maya142]

In our experience a virus = flare. Our rheumatologist said it was the virus that caused the flare and then having to move the shots doesn't help. Tesscorm said it really well, that made a lot of sense to me!

Hope the shot will help and Grace feels better soon!

 

[Patricia56]

Some people experience flares with viral illness or other acute infections while others do not. My understanding of why this might be so has to do with variations in the individual's acute phase immune response (the immune response to infection is divided into acute and chronic phases) to these events and the degree to which they are actually immune suppressed.

1. This assumes that a flare is primarily caused by an increase in TNF-alpha cells or B cells (the cells suppressed by biologic or immune suppressing medications).
2. These types of cells are primarily released as part of the chronic immune response - the longer term reaction to a persistent infection. Because these cells are suppressed it is counter-intuitive that they would be the cause of flares in response to acute or new viral or bacterial illnesses. This is why we are warned to watch for bacterial infections, fevers, etc.
3. However, these cells are released in smaller amounts as part of the acute phase immune response along with a host of other physical changes that occur in response to acute insults like viruses.
4. While there is virtually no actual research into this aspect of the extremely complex immune system and the way it functions, it makes sense that there would be wide variation in the rate or rapidity with which different individuals would shift from an acute to a chronic immune response. A quicker shift to chronic phase response would likely increase the number of T-cells and B-cells probably causing a flare.
5. It is also probable that different individuals produce a larger number of T-cells and B-cells during the acute phase immune response also triggering a flare.
6. In those individuals who experience a flare despite immune-suppressing meds, it may be that their immune system is not actually as suppressed as it is in others on the same medications. Thus they flare because their system responds with increased T and B cells despite the immunosuppression.
7. It is also possible that certain viral illnesses could mimic a flare.
8. It is also possible that some latent viral illnesses could be reactivated by immune suppression and mimic a flare or new viral illness.

The bottom line is that we don't really know or understand why some people flare and others don't during various viral and bacterial illnesses.

 

[Patricia56]

And to answer your original question about late meds, it would seem to intuitively make sense that late administration of meds might contribute to a flare.

But it depends on the meds and the individual reaction to those meds.

Some meds are much longer acting than others. And nearly all have a half-life of several weeks. So I wouldn't think that missing a shot or dose by a short period, in most people, would cause a flare since the medication is still in their system.

If you are on biologics and have symptoms just prior to getting your meds then obviously you are probably someone who would have more problems if your meds are delayed than someone who does not. Why? I assume (just a layperson here) that your body has processed and eliminated the med more quickly than it does in most people.

 

[Farmwife]

Wow, some great replies and things to think about.
See what happens when I muse....y'all get smart.:ylol:



Ok, another muse I had, does adding in antibiotics during a flare help stop a possible flare?

 

[Tesscorm]

Hmmm...

It seems most worry that taking antibiotics may actually trigger a flare. Again, just my guesses, but I believe antibiotics kill bacteria, both bad and good. This is why many take probiotics with antibiotics (to replenish the good bacteria that the antibiotic has killed). If you are taking antibiotics for some non-intestinal issue, I think it is this change in bacteria levels that may trigger a crohns reaction/flare.

But, antibiotics are sometimes given during a flare because inflammation can also lead to infection (ie abscess, etc.) and the antibiotic is meant to treat the infection. However, some antibiotics, such as flagyl, also have anti-inflammatory properties so, in this case, perhaps it is also used specifically to help treat a crohns flare???

But, again, everyone is different... my aunt (with crohns) cannot tolerate antibiotics at all... seems to trigger a flare every time. Stephen just took a course of antibiotics (because of wisdom teeth removal) and had no side effects at all (whew... first time since he's been diagnosed... wasn't sure what to expect! )