Importance of Vaccinations in Rheumatic Diseases

Dr.Pravin Patil, Rheumatologist

Pune Rheumatology Center

Why should I consider vaccination in rheumatic diseases?

Patients with autoimmune inflammatory rheumatic disease, such as Rheumatoid Arthritis and Lupus (SLE), are at higher risk for serious infections. People living with rheumatic disease should protect themselves against infections.

The risk of infections, like common colds and serious infections such as flu or pneumonia, can be increased in rheumatic disease. The disease and treatments both alter the body’s immune system, reducing the ability to effectively clear infections before they become severe. Vaccination, also known as immunisation, is a process that helps your immune system fight infections.

Studies have shown that patients with most rheumatic diseases are at a higher risk of infection. In fact, patients with rheumatoid arthritis have double risk of catching severe infections than the general population. The increased risk is due to the weakened immune system caused by the autoimmune disease. Having diabetes and age >60 increases further risk.  Immunisations are a way in which we can help to train our immune systems to recognise infections more quickly and effectively.

How do vaccines work?

Vaccines expose your body to a sample of an infection, allowing the immune system to be better prepared when it encounters the infection for real. 
It is important to highlight that vaccines do not prevent you getting exposed to an infection, but rather help your body respond to an infection and prevent you becoming severely ill.

Which vaccines should I be getting?

Recent recommendations highlight the use of influenza, pneumococcal, shingles and covid-19 vaccines in rheumatic disease patients.

● Seasonal influenza vaccine

● Pneumococcal vaccines

● Covid-19 vaccines including booster dose

Flu Vaccination

It is recommended that people who have rheumatoid arthritis receive vaccination for respiratory influenza, also known as the flu vaccine. It also protects you from swine flu.

• The flu vaccine should be received yearly. The injection is in your upper arm. 
It is a common misconception that you can get the flu from the vaccine. It typically takes about two weeks for the vaccine to start work against the flu.

Pneumonia Vaccination

The Pneumonia vaccine (PCV-13) is a newer pneumonia vaccine. The vaccine is designed to protect you against conditions such as pneumonia, septicaemia and meningitis. A single injection provides protection for 5 years.

It should be repeated every 5 years. The injection is in your upper arm.

Irrespective of age, anyone with rheumatic disease is recommended to have an annual influenza vaccine, as well as pneumonia vaccine and covid-19 vaccine with booster dose. 

Timing of vaccination

● Seasonal influenza vaccine – every year

● Pneumococcal vaccines – once in every 5 years

● Covid-19 vaccines including booster dose – as per government guidelines

If you are taking a particular therapy like Rituximab or Methotrexate then timings of the vaccinations should be discussed with your rheumatologist.

For maximum protection, vaccinations should be given several weeks prior to the start of the Rituximab therapy. This increases the likelihood of developing a protective immune response. For patients receiving Rituximab a delay in any vaccinations until at least three months (and ideally six months) after their last administration of rituximab is recommended, as patients may not be able to develop protective antibodies until three to six months after receiving Rituximab. If a patient needs to receive a vaccine, it is recommended to vaccinate then wait two to four weeks before administering the next Rituximab dose.

Should I interrupt my rheumatic disease medications when having a vaccine?

For some vaccines, it is advisable to temporarily interrupting your rheumatic disease medicine to improve effectiveness of the vaccine. Withholding methotrexate from the day of the vaccine for two weeks will improve the chance of your body responding well to the vaccine.

However, interrupting your rheumatic disease medicine can increase your risk of flare. If your disease has been well controlled, then a short pause in your rheumatic disease medication may be reasonable. But, if your rheumatic disease is active, then there is risk of flare of your rheumatic diseases. You should always discuss the risks and benefits of interrupting treatment with your rheumatologist. 

Talk to your doctor about which vaccinations might be appropriate for you, and when during the course of your treatment is the best time to receive them.

Key Points:

● To give your immune system the best chance to fight with viruses it is important for patients with rheumatic diseases to get vaccines.

● The flu vaccine takes approximately two weeks to begin working.

● There is a new pneumonia vaccine called the PCV-13 and is highly recommended.

● Take Covid-19 vaccines including booster dose as per national guideline.