Keeping up with your vaccinations is always a smart move, but getting immunized is especially important when you have an autoimmune disease like rheumatoid arthritis (RA). Both RA and the medicines you take to treat it can increase your risk for infections.
When Joan Wilkinson’s RA flared, her rheumatologist insisted that she and her husband get pneumonia and shingles vaccines to protect her from these common infections. “He said, ‘When you leave here today, go straight to the pharmacist,’” she recalls.
“Since immune system function can be suppressed by RA and the medications used to control RA, any disease that is usually kept in check by the healthy immune system can become a greater concern in patients with RA,” says Joel Thome, PharmD, pharmacist and assistant professor of pharmacology at Pacific Northwest University of Health Sciences in Yakima, Washington.
Despite the higher risk of acquiring an infection, vaccination rates among people with RA are low, according to a study by Eric Ruderman, MD, and his colleagues at the Northwestern University Feinberg School of Medicine in Chicago. Only about half of patients had received the pneumonia vaccine, and just 8% were vaccinated against the virus that causes shingles.
Why are so few RA patients getting their vaccines? “We found that a lot of it is awareness. It’s not so much hesitancy on the part of patients to get vaccinated, but frankly, their physicians hadn’t recommended it,” says Dr. Ruderman.
One reason doctors don’t initiate the vaccine discussion may be that they assume the primary care doctor or pharmacist will handle it. Kevin Winthrop, MD, MPH, professor of public health at Oregon Health & Science University in Portland, says “Better patient education and awareness can help patients be proactive about discussing vaccines with their doctor.”
Which Vaccines You Need
Because RA can affect lung function, Thome says, “Vaccines for preventable diseases of the respiratory system can be particularly important, like the flu shot and pneumonia vaccine.”
If you’re over 50, you also need the herpes zoster vaccine. After you’re exposed to chickenpox in childhood, the virus lies dormant in your body. It can reawaken decades later in the form of the painful, blistering disease called shingles. RA weakens the immune system, making it easier for the virus to reactivate. Anti-TNF drugs like infliximab (Remicade) and etanercept (Enbrel) can significantly increase your risk of developing shingles.
When To Get Vaccinated
Your doctor will recommend you get vaccinated before you start RA treatment. Many RA drugs, including DMARDs and biologics, suppress your immune system and increase your risk for infection. At the same time, some of these drugs can reduce your body’s response to certain vaccines — including influenza and pneumococcal polysaccharide (PPSV23).
If you take a biologic, you shouldn’t get live vaccines, like the one against herpes zoster (for shingles). “To my knowledge, there haven’t been reports of significant problems, but the concern is if your immune system is compromised by a biologic and you get a live vaccine, you could get sick from the vaccine,” Dr. Ruderman says.
Ideally, you want to get vaccinated when your RA is under good control. Severe or uncontrolled RA might lower your immune response, resulting in less protection. “But, of course, it depends on the vaccine, the disease and the patient,” cautions Thome. “Since patients with RA should receive their flu shot every year before flu season, sometimes it is necessary to give this vaccine even when disease symptoms are active.”
Regardless of your RA control, your disease should never stop you from getting the vaccines you need to stay healthy. “There may be some lessening of response, but not enough to be meaningful and not enough to affect the decision to do it,” Dr. Ruderman says.
Vaccine Side Effects
‘‘There’s always the fear with someone who has an autoimmune disease that vaccination is going to trigger flares, but we really haven’t seen that,” Dr. Winthrop says. Most vaccine side effects — whether you have RA or not — are mild. They can include soreness at the injection site, fever and achiness.
Talking to Your Doctor About Vaccines
Considering the average doctor visit lasts just 15 minutes and you have many RA concerns to address, vaccines can easily slip your mind. Write a note reminding yourself to bring them up. If your doctor doesn’t initiate the discussion, you should.
Also make sure your electronic medical record is updated to help your doctors keep track of the vaccines you’ve had. Ask your rheumatologist or primary care doctor to send you a reminder when you’re due for your shots so you don’t neglect this.
Vaccine Schedule for RA
|Vaccine||What it Prevents||Doses||Who Shouldn’t Get It|
|Inactivated influenza vaccine||Flu||Once a year, in the early fall||People with RA should avoid the live FluMist vaccine
|Pneumococcal 13-valent conjugate (PCV13)||Pneumonia, meningitis, bloodstream infection (sepsis)||One dose||N/A
|Pneumococcal polysaccharide (PPSV23)||Pneumonia, meningitis, bloodstream infection (sepsis)||One or two doses||N/A
|Herpes zoster (Zostavax)||Shingles||One dose at age 50 or older
|Get this vaccine before you start taking a biologic
|Hepatitis B||Hepatitis B||Three doses||N/A|
AUTHOR: Stephanie Watson
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