Vaccinations and Rheumatoid Arthritis

Most of us started receiving vaccinations as young children. We get vaccinated to prevent disease. However, some people worry about the safety of vaccination and potential negative consequences. A vaccine is administered by injection, inhalation, or sometimes ingestion. Exposure to a vaccine causes an antibody to be produced by your body (the immune response) which then protects you from getting sick if you are exposed to a specific pathogen or toxin.

There are several 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, may be extracted from a virus or bacteria or made in the laboratory. Killed vaccines include anthrax, cholera, hepatitis A, influenza injection, plague, poliomyelitis, and rabies. Live attenuated vaccines include tuberculosis, influenza nasal spray, smallpox, oral typhoid, chicken pox, shingles, and yellow fever. Attenuated vaccines include measles, mumps, and rubella. Protein subunit vaccines include diphtheria, hepatitis B, and pertussis. Sugar subunit vaccines include meningococcus, pneumococcus, haemophilus influenza B (a sugar vaccine with protein conjugate) and typhoid injection. The anthrax vaccine is not currently available for the general population, and the smallpox vaccine has not been given since the early 1970s.

Because a vaccine elicits an immune response, some people with rheumatic diseases who take immunosuppressant or biologic drugs are concerned about the interaction. In addition, some people with rheumatic diseases, such as rheumatoid arthritis and lupus, have wondered if vaccinations are safe and effective in their particular case. Some worry that vaccinations may make their condition worse. Other people have even suggested that a vaccination may have caused their rheumatic disease. Should they be concerned? What are the facts?

According to the Hospital for Special Surgery, rheumatoid arthritis patients who take immunosuppressant drugs should avoid live vaccines. A live vaccine can cause an infection in someone who takes immunosuppressant medications and can also stay in the body and re-emerge in patients treated with immunosuppressants. Killed vaccines, protein, and sugar vaccines are considered safe, even for people with rheumatic disease who are treated with immunosuppressant medications.

Vaccination is most effective when people with rheumatoid arthritis are doing well (i.e., not in a flare) and not on extensive treatment. For example, rheumatoid arthritis patients who are treated with high-dose prednisone or immunosuppressants do not produce strong antibodies: they can be left unprotected even after being vaccinated. The treatment, not the disease itself, can interfere with protection provided by a vaccine. Patients treated with low-dose prednisone can still generate good protection with vaccination, though.

Many people believe they developed rheumatoid arthritis after getting a flu vaccine or another type of vaccination, possibly because people seem to draw parallels between events in their life.

One study by Sibilia et al, published in 2002, carefully considered the induction of rheumatoid arthritis by the hepatitis B vaccine. While there was some consideration given to genetic susceptibility being triggered by the hepatitis B vaccine, researchers concluded individual risk versus benefit should determine whether it's appropriate to receive a hepatitis B vaccine. The consensus of scientific literature, though, is that vaccines do not cause rheumatoid arthritis or other rheumatic diseases.

According to the Hospital for Special Surgery, with regard to worsening of existing rheumatic disease, there haven't been many studies. Most evidence is related to flu vaccination in lupus patients, and it was concluded that there is no worsening of lupus due to vaccination. While there are reportedly fewer studies pertaining to rheumatoid arthritis, the conclusion is the same: rheumatoid arthritis is not made worse by vaccination.

There are 3 takeaways regarding this important information about vaccination in people with rheumatoid arthritis:

• Vaccination is generally considered safe and effective for people with rheumatoid arthritis or other rheumatic diseases.
• Protection from vaccination may be less than optimal in patients treated with immunosuppressant drugs.
• Patients treated with immunosuppressant drugs should not be given a live vaccine.