Vaccines

Vaccinations aren’t just for kids, especially if you have inflammatory arthritis, such as rheumatoid arthritis or ankylosing spondylitis. Unfortunately, while people with inflammatory arthritis need the disease-fighting protection that vaccines offer more than other people, they are actually less likely to be up to date on their vaccinations.

Here are key facts that experts want you to know about vaccines when you live with arthritis.

1. Vaccines are critically important for people with inflammatory arthritis

“Compared to the general population, people living with inflammatory arthritis are at substantially higher risk of getting a vaccine-preventable infection, such as the flu or pneumonia, and consequently more complications and hospitalizations from those infections,” says Justin Owensby, PharmD, PhD, a research pharmacist with the University of Alabama at Birmingham.

What’s more, if you require immune-suppressing drugs to treat your arthritis, your body is less able to fight off infections, such as the flu and pneumonia, which makes you more likely to get sicker or even die when one occurs.

“Both the arthritis itself and current drug therapy to treat arthritis increase the risk of infection for those living with inflammatory arthritis,” says Dr. Owensby.

That’s why it’s important to get the flu vaccine every year and follow your doctor’s recommendations for when to get the pneumococcal and shingles vaccines.

2. A vaccine won’t give you the disease it’s supposed to prevent

Vaccines spur your immune system to create antibodies against a specific germ so your body is ready to recognize and fight off an infection if you were to become exposed.

Vaccines generally come in two different buckets: those made from inactivated components and those made from small amounts of live but weakened virus. Vaccines for chickenpox, measles-mumps-rubella (MMR), and the nasal version of the flu vaccine are made from these weakened live vaccines.

If you take arthritis medications that suppress your immune system, your rheumatologist will usually not recommend that you receive a live vaccine, says Dallas, Texas rheumatologist Scott Zashin, MD. For example, the older shingles vaccine Zostavax is created using live virus and is not currently recommended for anyone with a compromised immune system.

Your rheumatologist will recommend vaccines made from killed viruses or those that contain only the portions of virus (called subunits) that immune system cells recognize and attach to. “You cannot get pneumonia or shingles from a vaccine that contains killed viruses or bacteria,” says Priyanka Iyer, MD, a rheumatology fellow at the University of Iowa.

3. You may need adult vaccines at an earlier age

The Centers for Disease Control and Prevention recommends that all adults age 65 and older be vaccinated against pneumonia, for example, but that’s too long to wait if you have inflammatory arthritis.

“I give pneumonia vaccine to all patients with inflammatory arthritis who are 18 or older and going to be taking methotrexate or a biologic medication,” says Dr. Zashin.

Two vaccines against pneumonia are available. If you haven’t been previously vaccinated against pneumonia, you’ll likely get Prevnar first, followed by Pneumovax several months later. If you aren’t sure whether you’ve received a pneumococcal vaccine, ask your doctor about whether you have or should be.

4. Your medications may determine the timing of when you get vaccines

When you take immune-suppressing drugs, this also dampens your body’s ability to respond well to a vaccine. For that reason, rheumatologists want to make sure you’re up to date on vaccinations before starting on a biologic medication. You and your doctor should discuss your vaccine history before you begin taking a biologic medication; here are other tests you may need before starting a biologic as well.

If you’re already taking methotrexate, your doctor may tweak your medication schedule to get the most from your flu vaccination. At the 2017 annual meeting of the American College of Rheumatology, Korean researchers reported that patients with rheumatoid arthritis produced more antibodies if they took a two-week drug holiday from methotrexate after receiving their flu shot.

“I hold methotrexate for two weeks after a vaccination,” says Dr. Zashin.

5. Vaccine options are changing

It may seem like you hear about a new vaccine every time you go to the doctor’s office. For example, Shingrix is the new shingles vaccine that is made from killed (inactivated) virus. The Advisory Committee on Immunization Practices (which advises the CDC on vaccination options and schedules) calls it the preferred vaccine for most people age 50 and older to avoid shingles and complications such as nerve pain.

According to CDC recommendations, Shingrix is recommended for adults with chronic medical conditions including rheumatoid arthritis “unless a contraindication or precaution exists.” Your doctor may be cautious about recommending Shingrix if you’re taking biologic medication that suppresses your immune system until there’s more research on how the vaccine impacts this group.

“We can give Shingrix, but because it has not been well-studied in patients with inflammatory arthritis we don’t know the true benefit and risk and effectiveness of vaccine. Some lupus specialists are not yet recommending that their patients take that vaccine,” says Dr. Zashin.

6. Your various health care providers should be kept in the loop on your vaccinations

Chances are you see multiple doctors to manage your arthritis and related diseases, including a primary care doctor and rheumatologist. While your primary care doctor may be the one who administers your vaccines, your rheumatologist should be involved in deciding whether and when you should get vaccinated.

“Ideally, both your rheumatologist and primary care practitioner should be aware of your vaccination status. However, you should feel free to take your questions/concerns/interests about getting vaccinated to your physicians and also your pharmacist. It is important to remember that your pharmacist can be used as a resource for questions about whether or not you should get specific immunizations while taking certain medications,” says Dr. Owensby.

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