Number one: You need the flu shot — full stop

Less than half of patients with rheumatoid arthritis (RA) and psoriatic arthritis get vaccinated for influenza, according to a recent study. But when you have inflammatory arthritis, your risk of getting the flu is higher; if you get sick, the infection and potential for complications is more severe. Here’s why, and what else you need to know to help you stay healthy this flu season:

2. If you have arthritis, you’re more vulnerable to the flu

Or any viral infection, for that matter. That’s because rheumatoid, psoriatic, and other forms of inflammatory arthritis cause dysfunction in your immune system. “Simply having RA decreases your body’s natural immune defenses, and therefore increases your risk of serious infection by two or three times,” explains Justin Owensby, PharmD, PhD, a research pharmacist with the department of clinical immunology and rheumatology at the University of Alabama at Birmingham. Plus, certain medications you take to manage your condition can also weaken or suppress the immune response, which leaves you that much more susceptible to infection.

3. And it’s more of a threat to your health

The flu is miserable for anyone. But people with RA have a 2.75-fold increased risk of complications from the flu, such as pneumonia, heart attack, and stroke, according to a study published in the journal BMC Musculoskeletal Disorders. Recent research also suggests if you have RA and the flu, you’re more likely to be hospitalized and require a longer hospital stay.

4. Get the flu shot, not the nasal spray

The injected form of the vaccine, or flu shot, is inactivated, which means that it’s made from dead influenza virus. On the other hand, the nasal spray version contains live virus, which is not recommended for people with weakened immune systems.

Here’s why: “Vaccines ‘program’ the immune system to remember a particular infectious disease agent by allowing it to ‘practice’ on a weakened or killed version of the pathogen,” explains Dr. Owensby. Live attenuated (weakened) vaccines are designed to produce an infection without symptoms, but may still cause mild side effects. People with compromised immune systems, however, may not be able to control an infection, and complications might be more severe, he says.

If you have RA or another kind of inflammatory arthritis, inactivated (or killed) vaccines are recommended because they stimulate a less strong immune response and therefore are less likely to cause unwanted side effects.

5. It’s false that the flu shot gives you the flu

Sure, you may have heard otherwise from your mom or aunt or well-meaning, misinformed friend. But this is a common myth that is absolutely not true, says rheumatologist Vinicius Domingues, MD, CreakyJoints’ medical advisor and an assistant professor of medicine at Florida State University. Flu viruses that have been “inactivated” or killed are not infectious and cannot cause flu illness. What you may feel: sore and tender, along with redness and swelling, in the spot where you got the shot.

6. It’s true some RA meds may impact how well the shot works

But that doesn’t mean you should skip the flu shot, or that you should stop taking your meds to get it. It’s clear that patients on traditional DMARDs and biologics have a less of a response to the flu vaccine than the general population, says Dr. Domingues. But multiple studies have shown getting the shot decreases the incidence of pneumonia, hospital stay, and death, he adds.

A review of research published in the journal Current Rheumatology Reports found people with RA who are treated with methotrexate or TNF inhibitors — such as Enbrel (etanercept), Humira (adalimumab), and Remicade (infliximab) — have an acceptable response to the flu vaccine, although it is a lower a response than what healthy people may get.

Treatment with the infused drug rituximab has been shown to decrease the response to the flu shot, says Dr. Owensby; doctors may recommend delaying the time between vaccine and your next infusion.

Higher doses of steroids may also lower vaccine response, say experts.

Scientists are continuing to research how people with RA can improve their response to flu vaccine. One recent study showed briefly discontinuing methotrexate for two weeks after getting the flu shot may boost immune response. Other research just presented at this year’s American College of Rheumatology’s Annual Meeting reported that the high-dose flu shot (which the CDC recommends for older people) substantially improved the immune response in seropositive RA patients, compared to the standard-dose flu shot. More research is needed, but here’s what we know so far.

If you are unsure about getting the flu shot with your current RA meds or when to get it, talk to your pharmacist or rheumatologist.

7. It’s not too late to get vaccinated

The CDC recommends people get their shots before flu starts spreading in your community; ideally by the end of October. But you can still the vaccine through the fall, even into January or later. It takes about two weeks after vaccination for antibodies that protect against flu to develop in the body.

8. Wash your hands often

Even after you get the flu vaccine, taking steps to protect yourself from the flu is important — and washing your hands is one of the most effective ways to help stop the spread of germs. You can also use alcohol-based hand sanitizers if soap and water aren’t readily available; and always cover your mouth and nose when you sneeze or cough.

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