In a nutshell
This study reviewed the most recent evidence on the use of vaccinations in patients with rheumatoid arthritis.
They found that vaccinations are generally well tolerated by patients undergoing treatment for rheumatoid arthritis.
Some background
Rheumatoid arthritis (RA) is a chronic (long-term) condition that is caused by the body’s immune system. In RA, tissue at the joints becoming inflamed. This can cause pain and in some cases immobility. To treat RA, patients are prescribed disease-modifying anti-rheumatic drugs, or DMARDs. These drugs work by reducing the immune response and inflammation.
Patients with RA have a greater risk of infection due to their condition and the immune-suppressive action of DMARDs. As a result it is recommended that RA patients receive vaccinations against infectious diseases on a regular basis. In recent years many new DMARDs have been developed and it is unknown whether vaccination is safe for RA patients taking these new drugs.
Methods & findings
This study reviewed data to assess the safety of vaccination in patients taking DMARDs to treat RA.
Influenza vaccine is routinely administered and well tolerated by RA patients. Patients being treated with rituximab should be vaccinated prior to starting treatment to prevent complications.
Pneumococcal vaccine is safe for administration to RA patients. There is some data lacking for the PCV-13 and PPSV-23 vaccines so the safety cannot be fully established although it is still recommended.
Herpes Zoster (shingles) vaccine is best tolerated 1 month prior to starting treatment with DMARDs or 1 month after discontinuing DMARD treatment. There is some conflicting data as to whether vaccination is necessary given the low rate of HZ infections.
Human papilloma virus (HPV) vaccine is recommended for selected patients that may require it, namely female patients. Data is lacking on the side effects of HPV vaccination in RA patients.
Hepatitis B virus vaccination is recommended for RA patients. Patients should also be pre-screened for hepatitis B as RA therapy can re-activate the virus.
The bottom line
This study concluded that vaccinations are generally well tolerated by patients undergoing treatment for rheumatoid arthritis.
The fine print
In many cases there was a lack of data for specific vaccines. More long-term, randomized studies are needed to identify any risks or benefits.
What’s next?
If you have any concerns regarding vaccination and RA treatment, please discuss with your doctor.
Published By :
Clinical and experimental rheumatology
Date :
Dec 15, 2017
