Swine flu advice for patients with Hughes Syndrome or related disorders

St Thomas’ Lupus Unit has received the following advice from the Infection Department regarding swine flu.

Patients on aspirin, Plavix, heparin, warfarin or hydroxychloroquine (Plaquenil) alone

Patients with Hughes Syndrome who only take the above medication are not considered to be immune suppressed. The advice for these patients is the same as for the general population. Please see the Department of Health website:

http://www.direct.gov.uk/en/Swineflu/DG_177831

Patients and INR

There are some reports that Tamiflu does increase the INR in patients on warfarin. When in doubt patients should be advised to always check their INR a day or two after taking any new drug.

Patients on steroids (including prednisolone) or immune suppressing agents such as azathrioprine, methotrexate, mycophenolate, cyclophosphamide or similar drugs

If patients develop ‘flu like’ symptoms included a documented fever, they should immediately contact their GP or NHS Direct to commence treatment with Tamiflu (or Relenza). Immune suppressed patients are more likely to get swine flu and to suffer symptoms for longer than health individuals.

If possible, the GP or health professional should attempt to confirm the diagnosis of swine flu by collecting nose and throat swabs. Treatment should be commenced as soon as possible. The standard course of treatment is for 5 days but a longer course may be appropriate and if symptoms persist or worsen the patient should be reviewed clinically. Treatment for Hughes Syndrome or lupus should not be discontinued unless a bacterial infection such as a chest infection develops.

Patients with severe lung disease

Patients who have had previous lung damage from a connective tissue disorder will be at greater risk of pneumonia if they develop swine flu. Therefore, in addition to treatment for swine flu, their GP or health professional will need to consider early treatment with antibiotics if patients develop symptoms of chest infection eg. shortness of breath or discoloured spit. Patients who have had previous heart or kidney complications will need to ensure that their GP or health professional is aware of this.

Vaccination against swine flu

The Department of Health is planning a national vaccination programme. It is known that a very small proportion of Hughes Syndrome or lupus patients may have a mild flare of their disease following any vaccinations. However, the advice is that the benefits of protection from vaccination usually outweigh any small risks of a disease flare.

When the vaccination programme starts, patients considered to be on the priority “at risk” register are advised to have the vaccination.