My child is sick! Should I stop her medications?
In most cases, no. Most of the medications that rheumatologists use are immunomodulatory, rather than immunosuppressive. Immunomodulatory drugs help to “correct” immune system function without suppressing it. Therefore, it is not necessary to stop your child’s medications unless the child has a “true” fever, defined as having a fever of 101.4 degrees or higher. In fact, minor infections (by cold viruses for instance) cause an activation of the immune system that can also activate the sleeping and confused white blood cells, which can result in a flare of arthritis. So in some ways, children need their medication even more when they have a minor viral infection. The reason we recommend holding off on giving medications if the child’s temperature is 101.4 or higher is because these higher fevers are more likely to be the result of a bacterial infection, and bacterial infections often require antibiotics. In such cases, we would recommend a temporary halt in medication to avoid potentially limiting the effectiveness of the antibiotics. We often recommend skipping the immunomodulatory medications until the child has had at least 5 days of antibiotics. Using this strategy, kids remain healthy and they are more likely to remain in remission without flares of their disease. It is completely normal for a child to get a number of mild viral infections during any given year. If medication were stopped each time, we likely would not be able to keep the child’s autoimmune condition firmly in remission. Having said all of this, before starting or stopping your child’s medications, be sure to consult with your child’s rheumatologist because each case will be different and the ultimate decision will depend on your child’s unique needs.