Quick answer: If arthritis medicines such as methotrexate, biologics, JAK inhibitors or steroid tablets weaken your immune system, winter viruses like flu and COVID-19 can hit harder. Check which NHS vaccines you are offered, keep a plan for what to do if you get ill, and contact your GP, NHS 111 or rheumatology advice line early. Never stop or pause arthritis medicines without their advice.
Every winter, flu, COVID-19 and other viruses spread more easily. For most people they mean a miserable week. If your immune system is dampened by arthritis medicines, or you are older or living with frailty, they can be more serious and can knock your joints and strength back for weeks. This guide is about making a simple plan before you get ill, so you are not deciding everything while you feel rotten.
Who needs to take extra care?
- People taking medicines that weaken the immune system, such as methotrexate, leflunomide, azathioprine, mycophenolate, biologics, JAK inhibitors or steroid tablets
- People with inflammatory conditions such as rheumatoid arthritis or lupus, which can raise infection risk on their own
- Older people, and anyone living with frailty or several long-term conditions
- Carers and household members of the people above, who can pass infections on
Osteoarthritis on its own does not usually weaken the immune system, but age, frailty and other conditions still matter.
Step 1: check your winter vaccines
The NHS offers some vaccines free to people at higher risk. Who is eligible depends on your age, your medicines and where in the UK you live, and the rules are reviewed each year, so check the NHS website or ask your GP surgery.
- Flu: offered every autumn to people aged 65 or over, people with a weakened immune system, main carers and some others. Our flu jab guide explains eligibility and booking
- COVID-19: seasonal vaccines are offered to groups at higher risk, which has included people with a weakened immune system. Check the NHS COVID-19 vaccine page each season
- Pneumococcal, shingles and RSV: offered by age or health condition. Our shingles vaccine guide covers that one
The injected flu and COVID-19 vaccines used for adults in the UK are not live. Some other vaccines are live and may not suit you on certain medicines, so ask your rheumatology team first. Our vaccines on DMARDs and biologics guide explains the difference.
Step 2: make a sick-day plan now
Ask your rheumatology team or GP these questions at your next contact, and write the answers down:
- Which of my medicines should I keep taking if I get an infection, and which should I ask about pausing? Do not stop or pause arthritis medicines yourself, and never stop steroid tablets suddenly
- What is the number for my rheumatology advice line, and when is it open?
- Am I in the group that can get COVID-19 antiviral treatment? If so, the NHS advises keeping rapid lateral flow tests at home and testing as soon as you have symptoms
- Who will help with shopping, medicines and pets if I am unwell for a week?
Keep a printed list of your medicines and doses by the phone, so you or a carer can read it out to NHS 111 or a GP.
Step 3: everyday ways to lower risk
- Wash your hands often, especially before eating and after being out
- Ask visitors with a cold or fever to wait until they are better
- Keep your home warm; our guide to staying warm at home covers heating help
- Keep gently active indoors so a week of illness does not cost you a month of strength; see staying active in winter
If you get ill
- Contact your GP, NHS 111 or your rheumatology advice line early if you take medicines that weaken the immune system, rather than waiting to see if it passes
- Rest, drink fluids and eat little and often
- Get up for short walks around the house each day if you can. Long spells in bed or a chair weaken muscles quickly, especially if you live with frailty
- Joints often ache more during and after an infection. The flare-up guide helps you tell a flare from something more serious
When to get urgent help
- Call 999 or go to A&E if you have difficulty breathing, chest pain, sudden confusion, or you are getting worse quickly
- Get urgent advice if a joint becomes hot, red and very swollen, especially with fever. A joint infection is an emergency
- Contact NHS 111 if you are not improving after a few days, or you cannot keep fluids down
Getting back to normal
After a winter virus, restart your usual activity at a smaller dose and build up over a week or two. Our pacing guide and fatigue guide help if tiredness lingers. If you fell or found getting up harder while ill, read our falls prevention guide and ask your GP about a physiotherapy review.
Frequently asked questions
Should I stop methotrexate if I get COVID-19 or flu?
Some rheumatology teams advise pausing certain medicines during an infection, but only do this on their advice. Contact your advice line, GP or NHS 111.
Can I have my COVID-19 and flu vaccines on biologics?
Yes, the injected flu and COVID-19 vaccines are not live and are usually recommended. Ask your team about timing if you are unsure.
I care for someone on these medicines. What can I do?
Check whether you can get a free flu jab as a carer, stay away when you are ill if someone else can help, and ask about a carer's assessment for backup support.
Sources and further reading
- NHS: Flu vaccine
- NHS: COVID-19 vaccine
- NHS: Treatments for COVID-19
- NHS: Flu
- NHS: RSV vaccine
- UKHSA: Immunisation against infectious disease (the Green Book)
Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- Flu jab and arthritis — free NHS eligibility and booking
- Vaccines on DMARDs and biologics — live and non-live vaccines
- Shingles vaccine — who is offered it
- Rheumatoid arthritis — condition hub
- Staying active in winter — building back up gently
- Staying warm at home — heating help and moving more
- Flare-up guide — flare or something more serious
- Newly diagnosed — first steps