Arthritis Rheumatoid Arthritis Vaccinations and Rheumatoid Arthritis By Carol Eustice 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 Updated on August 28, 2022 Medically reviewed by Geetika Gupta, MD Medically reviewed by Geetika Gupta, MD Geetika Gupta, MD, is a board-certified internist working in primary care with a focus on the outpatient care of COVID-19. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Benefits Types Concerns Recommendations Frequently Asked Questions When you have rheumatoid arthritis (RA), you may worry about getting vaccines. After all, RA involves a malfunctioning immune system, and vaccines work by activating the immune system. It is fair to wonder whether the combination of the two effects may be harmful or contradictory. In many cases, it is absolutely safe to be vaccinated if you have RA, but there are exceptions and a few precautions you may need to take. DragonImages / Getty Images Benefits of Vaccination Both RA and the immunosuppressant drugs used to treat RA may increase your susceptibility to vaccine-preventable diseases like influenza, shingles, pneumococcal pneumonia, and others. Some studies suggest that the risk may be as high as two-fold compared to people without RA. Moreover, if your RA is severe, you are more likely to experience frequent flares and severe infections compared to those who have their condition under control. Vaccines are beneficial to people with RA as they reduce the risk of getting infections and complications that can arise from these infections. Contrary to what some people might tell you, vaccines do not cause rheumatoid arthritis or any other rheumatic disease. What to Know About Vaccine Myths and Misinformation Types of Vaccines Vaccines work by exposing your body to either an infectious organism (pathogen) or a component of a pathogen. The exposure induces a pathogen-specific immune response in the form of protective antibodies. Armed with these antibodies, the body can fight off the pathogen and prevent it from establishing an infection. When you have RA, the type of vaccine you get matters. Some are perfectly safe to use, whereas others may need to be avoided as a precaution. Live Attenuated Vaccines Live attenuated vaccines contain live weakened pathogens that are unable to cause disease. However, these vaccines generally aren't recommended for people with immunosuppression, including those on immunosuppressive RA therapy. This is because a live vaccine can in theory revert to its natural virulent state. If this occurs in a person who is immunosuppressed, it may cause the very disease that it was meant to prevent. The risk of this occurring is extremely low. Despite these theoretical concerns, there are live attenuated vaccines generally recommended for people with immunosuppression. There are six live attenuated vaccines approved for use in the United States: Nasal flu vaccine Measles, mumps, and rubella (MMR) vaccine Chickenpox vaccine Oral typhoid vaccine Yellow fever vaccine Rotavirus vaccine If you have RA and have been advised to get a live vaccine, it is important to speak with your healthcare provider to weigh the benefits and potential risks. In some cases, there may be a safer alternative you can use. Rheumatoid Arthritis and Infection Risk Safe Vaccines Other types of vaccines don't contain a live virus and therefore can't cause an infection. These are considered safe for people with RA and other autoimmune diseases, including those on immunosuppressant drugs. The types of non-live vaccines are broadly classified as follows: Inactivated vaccines: These contain killed pathogens and include vaccines for hepatitis A, influenza (injection only), and rabies. Subunit, recombinant, polysaccharide, and conjugate vaccines: These use specific pieces of a pathogen for a more targeted immune response and include vaccines for hepatitis B, human papillomavirus (HPV), meningococcal disease, pertussis (whooping cough), and shingles (herpes zoster). Toxoid vaccines: These use a chemically modified toxin from a pathogen, such as toxoids used to prevent diphtheria and tetanus. The Safety and Science of Vaccine Ingredients COVID-19 and New Vaccine Types Several COVID-19 vaccines—some on the market and some still in development—use novel vaccine platforms. Among them: Moderna and Pfizer-BioNTech COVID-19 vaccines are both messenger RNA (mRNA) vaccines. These work by delivering genetic coding to cells to "teach" them how to build COVID-19 proteins that provoke the immune response. Johnson & Johnson COVID-19 vaccine is a vectored vaccine that uses a modified, harmless cold virus (adenovirus 26) to deliver genetic coding to cells to build COVID-19 proteins. Novavax COVID-19 vaccine is a protein-based subunit vaccine that uses a custom-made spike protein that mimics the natural spike protein in the SARS-CoV-2 virus. The protein is combined with an adjuvant to boost the immune response to the vaccine. Other vaccine candidates in development are based on these and other vaccine platforms. Thus far, there is no reason to believe that any of the approved vaccines pose a threat to people with compromised immune systems, including those with RA. The benefits of the COVID-19 vaccination are largely believed to outweigh the risks. Up-to-Date Guidance on COVID-19 The American College of Rheumatology (ACR) offers guidance regarding RA medications and COVID-19 vaccines. You and your healthcare provider can find the updated recommendations online. The Centers for Disease Control and Prevention also offers resources for you to learn about and stay up to date on COVID-19 vaccines: How COVID-19 Vaccines Work COVID-19 mRNA Vaccines COVID-19 Viral Vector Vaccines COVID-19 Vaccines in Development Everything to Know About RA and COVID-19 Vaccine Concerns To ensure that vaccines are safe and effective for people with RA, considerations need to be made on a case-by-case basis. Timing The best time for people with RA to receive vaccines depends on the level of disease activity and which treatments they're currently receiving. Vaccination is generally most effective when a person is in remission. This means not experiencing an active flare nor undergoing extensive treatment (such as systemic corticosteroids) to manage flares. For example, if you are being treated with high-dose prednisone, vaccination may not produce a strong immune response, leaving you unprotected. However, if you are on low-dose prednisone, you can still generate good protection from vaccination. Vaccines and DMARDs When it comes to live attenuated vaccines, caution should be used for people taking disease-modifying anti-rheumatic drugs (DMARDs). DMARDs are a category of otherwise unrelated drugs that can slow disease progression in people with RA. These include immunosuppressants and biologic drugs such as: Actemra (tocilizumab) Arava (leflunomide) Azulfidine (sulfasalazine) Cimzia (certolizumab pegol) Enbrel (etanercept) Humira (adalimumab) Methotrexate Plaquenil (hydroxychloroquine) Remicade (infliximab) Simponi (golimumab) Some RA medications can blunt the immune response and potentially reduce a vaccine's effectiveness. For example, it is recommended that people taking methotrexate skip at least one (and sometimes two) doses after flu vaccination to ensure an ample immune response. On the other hand, some medications may have no impact on vaccination. One study found that Actemra didn't interfere with the response to the flu vaccine in people with RA. The decision as to whether you should receive a live vaccine or take a break from DMARDs is an important one. You and your healthcare provider should work together to decide what is right for you. How Rheumatoid Arthritis Is Treated Vaccine Recommendations The benefits of vaccinations almost always outweigh the risks in people with RA. Even so, experts recommend the following precautions: Get vaccines updated before starting DMARDs whenever possible.Avoid vaccinations during flares.Live attenuated vaccines can be considered after careful consultation with your healthcare provider.If you took biologics during the second half of pregnancy, your baby shouldn't receive a live attenuated vaccine until they're 6 months old. The vaccine recommendations for people with RA are summarized in the following table. As there are currently no official U.S. guidelines, those recommended by the European Alliance of Associations for Rheumatology (EULAR) are listed below. They include alternative approaches like passive immunization, in which you receive antibodies from a donor to protect against a disease (rather than getting a vaccine). The ACR's COVID-19 vaccine recommendation is also included. Vaccine Recommendation Special Considerations Influenza Strongly consider Pneumococcal Strongly consider Tetanus toxoid Receive as recommended for general population Passive immunization for those on B-cell depleting therapy Hepatitis A, B Yes, if at risk Booster or passive immunization may be indicated Herpes zoster May be considered if at high risk Yellow fever Should be avoided HPV Receive as recommended for general population COVID-19 Yes, as a high-priority population Discuss with your healthcare provider as some ongoing treatments may need to be held or timed accordingly Frequently Asked Questions Which specific vaccines should I avoid if I have RA? People with RA should avoid the live FluMist vaccine for influenza. Other live attenuated vaccines include those for measles, mumps, and yellow fever. Some of these may be appropriate for those with RA, but you should discuss the risks and benefits with your healthcare provider. Can vaccines trigger RA flares? There have been unproven reports of vaccines triggering RA flares, but without demonstrated causality, it's difficult to be certain. Large, controlled studies would be necessary to prove this and the data is not currently available. A Word From Verywell When thinking about vaccines, it's normal to worry about how they might affect your RA or interact with your RA drugs. It's important to remember, though, that vaccines have undergone rigorous studies in many different population groups, including people who are immunocompromised. Guidelines published by the Advisory Committee on Immunization Practices (ACIP) can help you and your healthcare provider decide which vaccines are best for you to receive and when. Facts About Vaccine-Preventable Diseases 14 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, et al. 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;5(2):e001041. doi:10.1136/rmdopen-2019-001041 Perry LM, Winthrop KL, Curtis JR. Vaccinations for rheumatoid arthritis. Curr Rheumatol Rep. 2014;16(8):431. doi:10.1007/s11926-014-0431-x Institute for Vaccine Safety. Do vaccines cause arthralgia or arthritis? Hanley KA. The double-edged sword: How evolution can make or break a live-attenuated virus vaccine. Evolution (N Y). 2011 Dec;4(4):635-43. doi:10.1007/s12052-011-0365-y World Health Organization. Live attenuated vaccines. U.S. Department of Health and Human Services. Vaccine Types. Centers for Disease Control and Prevention. Different COVID-19 vaccines. Centers for Disease Control and Prevention. Benefits of Getting a COVID-19 Vaccine. American College of Rheumatology. COVID-19 Guidance. Youssef J, Novosad SA, Winthrop KL. Infection risk and safety of corticosteroid use. Rheum Dis Clin North Am. 2016 Feb;42(1):157-76. doi:10.1016/j.rdc.2015.08.004 Park JK, Lee MA, Lee EY, et al. Effect of methotrexate discontinuation on efficacy of seasonal influenza vaccination in patients with rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis. 2017;76(9):1559-65. doi:10.1136/annrheumdis-2017-211128 Mori S, Ueki Y, Hirakata N, Oribe M, Hidaka T, Oishi K. Impact of tocilizumab therapy on antibody response to influenza vaccine in patients with rheumatoid arthritis. Ann Rheum Dis. 2012;71(12):2006-10. doi:10.1136/annrheumdis-2012-201950 Arthritis Foundation. RA & vaccinations in the COVID-19 pandemic. Terracina KA, Tan FK. Flare of rheumatoid arthritis after COVID-19 vaccination. The Lancet Rheumatology. 2021;3(7):E469-E470. doi:10.1016/S2665-9913(21)00108-9 By Carol Eustice Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Cookies Settings Accept All Cookies