Arthritis Rheumatoid Arthritis Vaccinations and Rheumatoid Arthritis By Carol Eustice facebook Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. Learn about our editorial process Carol Eustice Medically reviewed by Medically reviewed by David Ozeri, MD on October 12, 2020 linkedin David Ozeri, MD, is a board-certified rheumatologist. He is based in Tel Aviv, Israel, where he does research at Sheba Medical Center. Previously, he practiced at New York-Presbyterian Hospital. Learn about our Medical Review Board David Ozeri, MD Updated on December 14, 2020 Print Vaccinations can help protect you from certain infections if you have rheumatoid arthritis (RA). Vaccinations do not worsen the condition, but some vaccines might not be effective or could cause an infection if you have RA. DragonImages / Getty Images With RA, you may be at increased risk of preventable infections. The condition can predispose you to infections, and the immunosuppressive medications used to manage RA can increase your risk as well. Several vaccinations are recommended for adults, and you would need to have these vaccines if you have RA. A number of vaccine recommendations for patients with RA have been put in place to help guide the process. Types of Vaccinations There are different types of vaccines: killed (inactivated), live attenuated (a weakened version of live virus or bacteria), or subunit. The subunit, usually a protein or a sugar molecule, may be extracted from a virus or bacteria or made in the laboratory. Vaccines expose your body to an infectious organism, or to a component of the infectious organism. This exposure causes your body to have an immune response, which protects you from getting sick if you are exposed to the infectious organism later. Common vaccines include: Attenuated vaccines: Measles, mumps, and rubella (MMR)Killed vaccines: Anthrax, cholera, hepatitis A, influenza injection, plague, poliomyelitis, and rabiesLive attenuated vaccines: Tuberculosis, influenza nasal spray, smallpox, oral typhoid, herpes zoster (chickenpox), and yellow feverProtein subunit vaccines: Diphtheria, hepatitis B, and pertussisSugar subunit vaccines: Meningococcus, pneumococcus, Haemophilus influenza B (a sugar vaccine with protein conjugate), and typhoid injection General vaccine recommendations vary by age and region of the world and are based on the risk of exposure to an infectious organism. The anthrax vaccine is not currently available for the general population, and the smallpox vaccine has not been given since the early 1970s. People With Rheumatic Disease Have Concerns Because vaccines elicit an immune response, and RA is a disease that affects the immune system, some people with rheumatic diseases who take disease-modifying anti-rheumatic drugs (DMARDs) like immunosuppressant or biologic drugs may be concerned about the interaction. In addition, some people with rheumatic diseases, such as lupus, may have concerns about the safety and effectiveness of vaccines. Should you be concerned? What are the facts? Safety Killed vaccines, protein, and sugar vaccines are considered safe, even for people with rheumatic disease who are treated with immunosuppressant medications. A live vaccine can cause an infection and can also stay in the body and re-emerge in people who are being treated with immunosuppressants. However, these vaccines are recommended for people with RA, under most conditions. You and your doctor would have to decide if and when you should receive certain live vaccines. Effectiveness Vaccination is most effective when people with RA are doing well (not in a flare) and not on extensive treatment. For example, if you are being treated with high-dose prednisone or immunosuppressants, you might not produce strong antibodies and can be left unprotected even after being vaccinated. If you are being treated with low-dose prednisone, you can still generate good protection with vaccination, though. Do Vaccines Cause or Worsen Rheumatic Disease? Vaccines are not considered a cause of rheumatic disease or a risk factor for worsening rheumatic disease. Infections can be serious if you have RA or another autoimmune disease or if you are taking immunosuppressive therapy. If your immune system is impaired due to disease or treatment, it is generally considered safer to get a vaccine than to get an infection. A vaccine triggers a limited immune response, whereas an infection damages the body and triggers an immune response. An infection can temporarily worsen RA and other rheumatic diseases, triggering a flare. Bottom Line Current guidelines regarding vaccines and adults who have autoimmune inflammatory rheumatic diseases (AIIRD): The vaccination status and indications for further vaccination in patients with AIIRD should be assessed yearlyAn individualized vaccination program should be madeVaccination in AIIRD should not take place during a flare-upVaccines should be preferably administered prior to planned immunosuppression, in particular, B cell depleting therapyNon-live vaccines can be administered in AIIRD during the use of glucocorticoids and DMARDsLive-attenuated vaccines may be considered with caution with AIIRD Specific vaccination recommendations: Influenza vaccination should be strongly considered for the majority of patients with AIIRDPneumococcal vaccination should be strongly considered for the majority of patients with AIIRDPatients with AIIRD should receive tetanus toxoid vaccination in accordance with recommendations for the general population. Passive immunization should be considered for patients treated with B cell depleting therapyHepatitis A and hepatitis B vaccines should be administered to AIIRD patients at risk — in specific situations, booster or passive immunization is indicatedHerpes zoster vaccination may be considered in high-risk patients with AIIRDVaccination against yellow fever should be generally avoided in patients with AIIRDPatients with AIIRD, in particular patients with SLE, should receive vaccinations against HPV in accordance with recommendations for the general populationImmunocompetent household members of patients with AIIRD should be encouraged to receive vaccines according to national guidelines with the exception of the oral polio vaccineLive-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy Was this page helpful? Thanks for your feedback! Dealing with chronic inflammation? An anti-inflammatory diet can help. Our free recipe guide shows you the best foods to fight inflammation. Get yours today! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Furer V, Rondaan C, Heijstek M, van Assen S, Bijl M, Agmon-Levin N, Breedveld FC, D'Amelio R, Dougados M, Kapetanovic MC, van Laar JM, Ladefoged de Thurah A, Landewé R, Molto A, Müller-Ladner U, Schreiber K, Smolar L, Walker J, Warnatz K, Wulffraat NM, Elkayam O. Incidence and prevalence of vaccine preventable infections in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD): a systemic literature review informing the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD. RMD Open. 2019 Sep 19;5(2):e001041. doi: 10.1136/rmdopen-2019-001041. PMID: 31673420; PMCID: PMC6803008. Hospital for Special Surgery. Vaccinations and Rheumatic Disease. Updated January 10, 2011. Furer V, Rondaan C, Heijstek M, van Assen S, Bijl M, Agmon-Levin N, Breedveld FC, D'Amelio R, Dougados M, Kapetanovic MC, van Laar JM, Ladefoged de Thurah A, Landewé R, Molto A, Müller-Ladner U, Schreiber K, Smolar L, Walker J, Warnatz K, Wulffraat NM, Elkayam O. Incidence and prevalence of vaccine preventable infections in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD): a systemic literature review informing the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD. RMD Open. 2019 Sep 19;5(2):e001041. doi: 10.1136/rmdopen-2019-001041. PMID: 31673420; PMCID: PMC6803008.