What should I do if I think I have the flu?

The Centers for Disease Control (CDC) says most healthy adults and kids will get better with “mom’s chicken soup” and plenty of fluids. (Follow CDC's seasonal influenza and H1N1 flu updates.) 

If you have an immune system that’s been suppressed by medication,however, you need to take the flu more seriously. Get to your primary care physician as quickly as possible, particularly if you have a fever. Your doctor can prescribe antiviral medications, like oseltamivir (Tamiflu) and zanamivir (Relenza). These medications disrupt the spread of flu viruses in the body by blocking their ability to reproduce, and they work best if taken within 48 hours. 

Perhaps surprisingly, the antiviral medications seem to offer the greatest benefits to people with underlying medical conditions. In a study published in the September 2009 issue of Lancet Infectious Diseases, these medications shortened the length of the illness in healthy adults by only about 12 hours compared with those who weren't treated with antivirals.  For people with diabetes and asthma, however, the medications shaved about a day off the length of time they were sick compared to those who were untreated.

Beyond antiviral therapy, experts say prompt medical attention is called for if someone who is sick is having trouble breathing, or if someone who is sick seemed to be getting better and then relapses a day or so later.

According to Thomas Frieden, MD, director of the CDC, this pattern of recovery and relapse is an indication of a secondary bacterial infection that may lead to pneumonia.

Also, children need emergency care if they are having trouble breathing, have a bluish tint to their skin or lips, are vomiting non-stop or are hard to wake up.

How can I tell if my body aches from the flu or a flare?

The flu tends to come on very quickly. It may start with a dry cough or a sore throat that progresses from a tickle to sandpaper in one day. The body aches usually come a few hours later.

Sometimes, a bad rheumatoid arthritis flare can start the same way, and it can come on as quickly. That’s because your body is responding much as it would if you had the flu, cranking out inflammatory proteins called cytokines that can make you feel achy and miserable.

According to John Hardin, MD, a rheumatologist and Chief Scientific Officer of the Arthritis Foundation, flares can make you miserable, but the aching and pain are typically, but not always, localized to the joints.

With the flu, however, you are more likely to feel uncomfortable all over. He describes this as the “sick inside” feeling. He says people coping with rheumatoid arthritis flares can feel beat up in their joints, but they don’t usually get the “sick inside” feeling.

Dr. Hardin says it would also be rare to get a sore throat or a cough with a flare, but much more common with the flu.

Those who have lupus, where flares may involve multiple body-wide symptoms, including fevers, are most likely to confuse the two. If you have lupus and are starting to feel bad, it may help to think back to previous flares. If you’re having a flare, your symptoms should be in line with what you’ve experienced before. But you may need a to see your rheumatologist or primary care physician to help sort out what’s going on.

What ages are at greatest risk of H1N1?

It depends on what you mean by risk. According to the CDC, children and young adults ages 5 to 24 are experiencing the greatest number of cases, but most of these are mild and manageable with bed rest, fluids and a lot of television. (OK, we threw the television in there.)

The H1N1 flu gets to be much more serious when it strikes infants and toddlers. Children under age four are at greatest risk for hospitalization. That’s why, if you have toddlers, you may have noticed the new public service announcements starring Elmo and Gordon from Sesame Street talking about the importance of hand washing and sneezing into the crook of an arm to prevent the flu.

So far, unlike the seasonal flu, adults over age 65 are experiencing the lowest rates of H1N1, and researchers think it’s probably because those born before 1957 have had prior run-ins with flu strains that have primed their immune systems to help them fight it off. 

That said, when seniors do get this flu, they appear to be at greatest risk of dying from it. The CDC says that adults over age 65 have the greatest case-to-fatality ratio.

Are there other high-risk groups? Should people with arthritis be worried?

According to the CDC, about 70 percent of people hospitalized with H1N1 have also had underlying medical conditions, a broad category that includes obesity and even pregnancy.

Having stiff and sore joints, by itself, does not seem to increase your risk of getting the flu, so people with osteoarthritis are probably not at any greater risk than the rest of the population.

But people who have inflammatory forms of arthritis, like lupus, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, vasculitis and polymyalgia rheumatica, among others, may be at greater risk for any kind of infection-viral or bacterial.

According to Jennifer Hootman, PhD, an epidemiologist at the Centers for Disease Control and Prevention, "Studies suggest that persons with systemic, inflammatory rheumatic diseases have a higher (about 2-fold) risk of getting any infection, including inflammation and pneumonia as well as higher risk of complications (hospitalizations and mortality)." 

This risk may be present whether you take medications that suppress your immune system or not.

And if you take certain medications, such as corticosteroids, biologic response modifiers or disease-modifying anti-rheumatic drugs, which lower your immune function, or if you have another health condition that tends to occur along with arthritis, such as heart disease and diabetes, your risk for influenza may be even higher.

In an attempt to find out who exactly is at greatest risk from the flu, Edward N. Janoff, MD, a professor of medicine and microbiology at the University of Colorado Denver School of Medicine, and a team of researchers scoured data published between 1966 and 2009 looking at susceptibility to influenza in people with HIV/AIDS, cancer, organ or bone marrow transplants and those on dialysis or steroids.

Their findings, published in the August 2009 issue of The Lancet Infectious Diseases, are that most immunosuppressed populations are at higher risk of influenza-associated complications.

But, “they’re probably at no greater risk from this virus than they are from seasonal influenza,” Dr. Janoff said. “I think they will experience this new flu similar to how they’ve experienced flu in the past.”

Dr. Janoff points out that so far there has not been a huge uptick in patients with immunosuppressive conditions getting severe complications or dying from the swine flu.

He says part of the reason is that they make up a very small minority of the population. He also says that typically people who are on treatment for rheumatologic diseases are on the low spectrum of people with immunosuppression issues – compared to patients dealing with AIDS or transplants.

Is it safe to get a vaccine?

Vaccines work by given the immune system a sneak preview of a virus, so that it can quickly recognize and respond to the real threat when it comes along.

Some research has indicated that people who take medications to suppress their immune systems ­– disease-modifying drugs, such as methotrexate, prednisone, and the biologics, including etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade) – might not get any benefit from a vaccine.

A study published in the August 2009 issue of Arthritis & Rheumatism addresses this question.