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Patients with rheumatoid arthritis (RA) have more than a two-fold higher risk of developing severe complications of influenza than patients without RA. Vaccination remains an essential part of the strategy to decrease the risk of complications associated with this infection. In addition, the use of antivirals -- especially within the first 48 hours after symptom onset -- can further decrease the risk of serious complications in patients at higher risk of progressive disease and complications, as recommended by the Infectious Diseases Society of America.

In their study in , Neuberger and colleagues sought to understand the burden of flu, as well as the real-world impact of antivirals, on health care utilization in patients with RA. They focused on whether patients with RA who contract the flu and who take antiviral medication within 48 hours of illness onset have fewer influenza-related complications and incur lower overall health care resource use and cost.

The study included 2,638 people who received antiviral influenza treatment within two days of flu diagnosis and 1,319 patients who did not. For treated versus untreated patients, the respective mean numbers of all-cause outpatient visits were 0.96 versus 1.21 during 14 days of follow-up (P<0.001) and 1.94 versus 2.24 over 28 days of follow-up (P=0.001). Further, over 28 days the mean number of all-cause emergency department visits was lower among treated (0.23) versus untreated (0.30) patients (P=0.042). The mean number of respiratory-related outpatient visits was significantly lower for treated versus untreated patients, and mean costs for these visits were $17.89 versus $35.27 over 14 days.

Takeaway points from this study show that patients with RA who received antiviral treatment within 48 hours of contracting influenza required fewer health care resources, including emergency department visits or hospitalization. Of note: over a third of RA patients who developed the flu did not receive antivirals quickly or at all.

In rheumatology practice, in addition to continuing to educate RA patients on the importance of vaccination, it is also imperative to continue to educate patients on the seriousness of the flu and the importance of seeking testing and early treatment with antivirals once a diagnosis of the flu is suspected. These efforts can help decrease the risk of complications and the need for subsequent healthcare resource use.

Joad Eseddi, MD, is a fellow physician in the Division of Rheumatic Diseases at UT Southwestern Medical Center in Dallas, Texas.

Read the study here and a Q&A with a study co-author here.