When thinking about travelling in recent years, certain factors may give you pause. For instance, the general pain, stiffness and fatigue that comes from travelling with autoimmune arthritis, plus the risk of infections (especially if you’re immunocompromised).

Autoimmune diseases (including autoimmune arthritis) occur when the body’s immune system, which usually protects us from infection, mistakenly attacks healthy cells as well. When the immune system is affected by such conditions or medicines to treat them, the risk from infection may be increased.

Rest assured: There are many ways to travel safely and comfortably with autoimmune arthritis (such as rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis). “If patients with these conditions enjoy travelling, they should be open to it,” says Brett Smith, DO, a rheumatologist at Tennessee Direct Rheumatology and East Tennessee Children’s Hospital. “While patients have a disease that alters their daily life, we also want them to enjoy life and not hold back.”

However, there are a few reasons your doctor may recommend rescheduling the trip: “If you’ve had a recent respiratory illness or a recent flare of your disease, or you’ve had your medicines adjusted, you might consider changing your travel schedule,” says Dr Brent.

Likewise, if you’ve just been diagnosed with a new underlying condition, you may want to pause to ensure you can adequately manage it before heading off.

Yes, You Can Travel with Autoimmune Arthritis

The key to managing your symptoms on your trip is planning, bringing enough of the medications and supplies you’ll need and keeping in contact with your doctor. The type of travel you’re embarking on will make a difference in how you manage pain and other symptoms along the way, too.

“If you’re driving for an hour, that’s different than if you’re taking a plane across the country,” says Lawrence Brent, MD, Professor of Medicine at the Lewis Katz School of Medicine and Associate Director of the Rheumatology Fellowship Program at Temple University Hospital. “Navigating airports can be very challenging for someone not only in terms of pain but also mobility.”

“You can do it, but it’s going to take you much longer,” says Dr Brent. “It all depends on how much you want to do the trip and what you think you can do — plus your pain tolerance, which is very individual. If you’re going with someone who can help, that makes a big difference.”

Contact your airline, bus, train or cruise company for information on how they can help you travel as comfortably as possible at all stages of your journey.

Getting Ready to Go

Travelling with medications

If you are planning to travel you can (and usually should) take your medications with you as appropriate. Even if you are only going for a few days, you need to consider the risk of what might happen if you can’t get back before you are next due to have your medication and plan accordingly. Apart from that, taking your medications while you are away helps you to take them on schedule and keeps you feeling as well as possible.

Talk to your doctor about how you can contact them, if needed, during your trip. Include details of alternative contact options in your communication plan as well. You can also ask them about getting enough medication ahead of time, so you’re prepared if you experience a flare or are delayed during your travels.

“I usually offer patients with rheumatoid arthritis (or another type of autoimmune arthritis) a short course of steroids to take with them, just in case they have a flare,” says Dr Smith.

Of course, you’ll also want to triple-check your luggage before you leave and make sure you have any aids or devices you need to take your medication.

Travelling within Australia

If you are travelling by car, train or road, there are no restrictions regarding what medications you can bring with you. Ensure you have enough supply for the duration of your trip. Some oral medications can be packed in your normal luggage. However, if your medication does require refrigeration, you’ll need to be more organised.

Most biologic subcutaneous self-injected medications can be kept at room temperature (up to 25°C) for one to two weeks but they cannot be put back in the fridge after a certain amount of time. Check the Consumer Medication Information leaflet for each medication for details on how to keep it cool when travelling.

You can also download Consumer Medication Information leaflets for most medications available in Australia via the Medicine Finder function on the NPS MedicineWise website.

Car fridges can be a practical storage solution while you travel, or you could also use the free travel storage wallet that came with your medication. Travel wallets are specifically designed to keep your self-injectable medicine cool for around eight to ten hours. If you didn’t receive one from your rheumatologist or medication supplier, contact your supplier’s Patient Support Program (sometimes called a Customer Care Program) and ask if they can send one to you.

If you’re going on a longer trip (by any means of transport), you can call a pharmacy at your destination and advise them that you’ll be arriving with a prescription for your medication and that you’d like them to dispense it for you. Give them at least a day’s notice in case they need to order it in for you.

Check that you have enough repeat prescriptions to cover you for the duration of your trip. In most cases, you’ll get 24 weeks’ worth of repeat prescriptions each time you reapply for your advanced DMARD medication through your rheumatologist, so aim to plan your trip accordingly. Also, allow ample time for your advanced DMARD prescription application to be processed by Medicare.

If you are flying domestically, you generally won’t be able to store your medication in the onboard refrigerator, so be prepared to carry it in a travel wallet on board with you. (The temperature in the cabin is stable, whereas it can get very cold in the cargo hold and potentially freeze your medication.)

Travelling overseas

Prescriptions issued in Australia cannot be dispensed through overseas pharmacies, so you’ll need to bring all the medication you’ll need with you or find out if you can see a doctor in your destination country who could issue you the prescriptions you need. Some countries have reciprocal arrangements with the Australian Medicare system, but that does not guarantee you’ll have access to a doctor there. Your doctor, Medicare and your travel insurance provider may be able to give you more information about this.

Again, some airlines may not let you use their onboard fridge to keep your medication cold and it’s not a good idea to keep this sort of medication in your checked-in luggage as it could freeze and become unusable. It’s important to check this with your airline and also ask them how you should carry your medication through security.

To travel overseas with any prescription medicine, there are some things you must do by law.

  • Carry a letter from your doctor stating what the medicine is used for, how much you take, why you need it and that it is for your personal use (or for someone in your care).
  • Keep the medicine in its original packaging at all times, with your prescription label complete and legible, so it can be easily identified. Biologic medications would be the main exception, as they need to be placed in a travel wallet (or onboard refrigerator) to keep them at the required temperature.
  • Check that you can legally bring your medicine into your destination country. (This also applies to any supplements and complementary medicines, such as homoeopathic medicines.)

Managing Your Health Risks

Consider what viruses might be circulating while you are in transit or in the community you’ll be visiting.

“If there is an endemic infection with an outbreak at the travel location, consider rescheduling the trip,” says Dr Smith. “If you have an active infection close to travel time, you might like to postpone your trip just to be cautious, since healthcare access will depend on the destination.”

Get up to date on all vaccines

In addition to your regular COVID-19 vaccines and boosters, plus those that protect against pneumonia and shingles, consider what other vaccines may protect you from disease during your trip.

“If you are travelling to an international location, update your vaccines according to public health guidelines and consult your rheumatologist about the potential need to hold any medications before or after vaccination,” says Dr Smith.

Follow standard mitigation efforts

If you’re immunocompromised and decide to travel, follow all necessary precautions such as spending time outside rather than in indoor public spaces, wearing a protective mask or respirator and keeping your distance from others.

“Carrying a bottle of hand sanitiser can also be an easy solution to lower the risk of infection while travelling,” says Dr Smith. “Additionally, only eat and drink from reliable food and water sources while travelling.”

These preventive measures are helpful not only for avoiding COVID-19 but other germs that can cause common colds, influenza and gastroenteritis.

Managing Pain During Your Trip

While you are in transit, do your best to continue moving. You already know that with arthritis, particularly rheumatoid arthritis, stiffness is a common occurrence — and the longer you sit still, the more stiffness you’ll experience.

For road trips, aim to stop regularly so you can get out and stretch or stay overnight. In larger forms of passenger transport, opt for an aisle seat so you have easier access to get up and walk around during your trip. You may also find it helpful to bring a pillow to make hard seats a little more comfortable.

It’s also worth considering the climate of the destination you’re headed to: “Warmer environments can be more beneficial for pain, stiffness and function, so take that into consideration when choosing a destination,” says Dr Smith.

Accessing Healthcare Overseas

Australia has reciprocal health care agreements with 11 countries. These countries provide some emergency care to Australians. Most agreements specify the care must be urgent and medically necessary. They usually need a co-payment from the patient.

If you travel to a country without an agreement, you’re not covered. If you need medical assistance, you or your insurer must pay the full cost of treatment. A reciprocal health care agreement is not a substitute for insurance. Choose a travel insurance plan that best suits all your health needs.

One last piece of advice from Dr Smith: “Most importantly, try to enjoy life.” If that can include travel for you, bon voyage. If not, still aim to enjoy little moments of adventure in your local community, whether it’s trying a new outdoor fitness class, visiting a park you’ve never been to before or simply video chatting with a far-away friend.

Further Resources

The Australian Government’s Smartraveller website has detailed information on:

Some countries, including Australia and the US, offer travellers aid services at airports, train stations and other transport hubs. Contact the transport hubs you’ll be using for information on their services.

 

This article has been based on a corresponding article by Kelsey Kloss on the CreakyJoints US website and content from our CreakyJoints Australia resource A Patient’s Guide to Living with Rheumatoid Arthritis in Australia

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