Treatment guidelines published by the Infectious Diseases Society of America remind doctors and patients that people with a chronic inflammatory disease, even those who take immune-suppressing medications, should not shy away from getting flu and pneumonia vaccines.
People with rheumatoid arthritis (RA), lupus, psoriatic arthritis and other autoimmune forms of arthritis face an elevated risk of infections, including influenza (the flu) and pneumonia. The increased risk may be due to the disease, which changes how the immune system functions, as well the medications used to control the disease, many of which suppress the immune system.
And while the flu is miserable – and potentially dangerous – for anyone, it’s especially so for people with inflammatory arthritis, whose infections may be more severe than those who don’t have an autoimmune condition. If you have inflammatory arthritis and you get the flu, you’re more likely to have complications, including pneumonia.
The guidelines suggest that people with a chronic inflammatory condition who take immunosuppressive medications – including methotrexate and various biologic drugs – get the flu shot and pneumonia vaccine according to the Center for Disease Control and Prevention (CDC) schedule. The CDC recommends that people get vaccinated against flu by October (the 2015-2016 flu shots are available now). However, as long as flu viruses are circulating in the community (seasonal flu activity typically occurs between October and May), it’s not too late to get vaccinated. Others in the household should also be vaccinated.
A flu shot will not give you the flu or increase your risk of a flare, says Elaine Husni, MD, PhD, director of the Arthritis & Musculoskeletal Treatment Center at Cleveland Clinic. There’s no reason to skip it.
“The non-live vaccines like the flu and pneumonia shot are very needed and necessary for patients who are immunocompromised because they are more susceptible to flu and pneumonia,” says Dr. Husni.
Although the guidelines recommend the flu shot, they advise against getting the flu vaccine in nasal spray form (FluMist). It contains a live, though weakened, virus and can therefore be dangerous to people whose immune systems are weak. The virus in the injected form of the vaccine is inactivated (killed).
Even after you get your flu shot, it’s still important to take all the steps you can, such as washing your hands frequently, to avoid getting the flu. One reason is that, depending on which medications you’re taking for your condition, your response to the flu vaccine may not be as strong as that of healthier people, and therefore your protection from the flu may not be as great. A literature review that examined 12 studies on the subject found that methotrexate decreases the response to the pneumonia vaccine and possibly the flu vaccine, and rituximab decreases the response to both.