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As a general rule, it’s ok to continue traditional DMARDs (examples: methotrexate, plaquenil, sulfasalazine, leflunomide) when sick, particularly anything mild without a fever or needing antibiotics. For those on biologics, we generally recommend that they are held, particularly if you have a fever or require antibiotics, until you are feeling better. However, during the COVID19 pandemic, we are often a little more cautious and it would be reasonable to hold any DMARD – traditional or biologic – until you are feeling better. In most cases for methotrexate, this would mean missing one dose, which wouldn’t impact arthritis control for most individuals.

Robert from the United States asks: Is leflunomide a steroid? Can leflunomide and prednisone be used together?

Prednisone is a steroid, while leflunomide (Arava) is a disease modifying anti-rheumatic drug (DMARD) used to treat rheumatoid arthritis. Another term for DMARDs is a steroid sparing agent, meaning they aim to achieve the same goals as steroids, but ideally with less side effects. Prednisone works much faster than leflunomide, days versus weeks. Because of that, it is not unusual for a patient to be started on both: Prednisone to help control symptoms short term and then stopped once leflunomide has begun to take effect. This same idea would apply for most DMARDs.