Should a Patient Stop Taking Rinvoq While Feeling Sick?
Do not automatically stop Rinvoq when feeling sick with mild symptoms—this decision must be made on a case-by-case basis in consultation with your healthcare provider, considering the type and severity of illness. 1
Immediate Action Required for Infection Symptoms
If you develop any signs of infection while on Rinvoq, contact your healthcare provider right away before making any medication changes. 2 The FDA label specifically warns that Rinvoq can make you more likely to get infections or worsen existing ones. 2
Signs of Infection Requiring Immediate Medical Contact:
- Fever, sweating, or chills 2
- Shortness of breath 2
- Warm, red, or painful skin or sores on your body 2
- Muscle aches or feeling tired 2
- Blood in phlegm 2
- Diarrhea or stomach pain 2
- Cough 2
- Weight loss 2
- Burning when urinating or urinating more frequently 2
Decision Framework Based on Illness Severity
For Mild Symptoms (e.g., minor cold, mild viral illness):
Treatment changes should be discussed on a case-by-case basis rather than automatically stopping the medication. 1 The 2020 EULAR guidelines (developed during COVID-19 but applicable to general illness management) emphasize that:
- There is no automatic requirement to stop JAK inhibitors like Rinvoq for mild symptoms 1
- Patient fears and beliefs may be decisive in the decision 1
- If you feel safer pausing the medication temporarily and your rheumatologist believes there is no increased risk of disease flare, pausing may be a defendable decision 1
Important caveat: JAK inhibitors can mask certain symptoms such as fever, which may make it harder to assess illness severity. 1
For Worsening or Severe Symptoms:
If initially mild symptoms worsen, immediately seek healthcare advice from an expert in treating the specific infection (pulmonologist, internist, or infectious disease specialist). 1 Your healthcare provider may stop Rinvoq treatment until the infection is controlled. 2
Critical Safety Considerations
When Rinvoq Should Definitely Be Stopped:
Your healthcare provider will stop Rinvoq if you develop: 2
- A serious infection requiring hospitalization
- Significant laboratory abnormalities (very low neutrophil/lymphocyte counts, very low red blood cell counts, or very high liver enzymes) 1
Monitoring Requirements While on Rinvoq:
The 2024 ACR/CHEST guidelines recommend: 1
- CBC with differential and comprehensive metabolic panel at baseline, 4-8 weeks after starting, and every 3 months thereafter 1
- Hepatitis B, hepatitis C, and latent tuberculosis screening before initiation 1
- Lipid monitoring at baseline, 4-8 weeks after starting, then annually 1
Special Populations at Higher Risk
Patients at increased risk for serious infections who require more cautious management include: 2
- Those 50 years and older with cardiovascular risk factors
- Current or past smokers
- Those with history of serious or opportunistic infections
- Those living in areas where tuberculosis or fungal infections are common
Practical Management Algorithm
- Assess symptom severity: Mild (minor cold symptoms) vs. moderate-severe (high fever, significant respiratory symptoms, severe pain)
- Contact your prescribing physician immediately to report symptoms 2
- Do not stop Rinvoq on your own without medical guidance 1
- Your physician will determine whether to:
- Continue Rinvoq with close monitoring
- Temporarily hold Rinvoq until infection resolves
- Stop Rinvoq if serious infection develops 2
- Seek emergency care if you develop severe symptoms (difficulty breathing, chest pain, confusion, inability to stay awake) 1
Key Clinical Pearls
- Unlike glucocorticoids (which should never be stopped abruptly), Rinvoq can be safely paused temporarily if medically indicated 1
- The decision to continue or stop should balance infection risk against the risk of disease flare 1
- Herpes zoster (shingles) occurs more frequently with Rinvoq, particularly at higher doses 1, 3
- Most infections in clinical trials were comparable to other biologics, but vigilance is essential 3