What You Need to Know About RA and Vaccinations

Patient Expert

People who live with rheumatoid arthritis (RA) have approximately double the risk of infection compared to the general population. This is partly due to the fact that many of us take immunosuppressant medications, such as methotrexate and the Biologics. However, it's also theorized that the immunologic response that happens in autoimmune diseases, such as RA, may contribute to this vulnerability.

There are a number of things you can do to manage the risk of infection. One of the tools we can use is vaccinations. As with so many other aspects of life with RA, there are important facts to know about vaccinations, interactions, and exceptions to the general rule.

An important trio of vaccines

Most rheumatologists will recommend that you get an annual flu shot, as well as the pneumonia vaccine and a tetanus shot. These three vaccines are important tools in helping you stay healthy, especially when you take immunosuppressants.

The annual flu season can lay waste to workplaces and schools, but most recover and are back to normal within a few weeks. This may not be the case for people who are immunosuppressed, who are more vulnerable to developing complications from the flu. As well, the Biologics can make you more vulnerable to pneumonia and its complications, so it's important to protect yourself. Lastly, the tetanus shot, given every 10 years, protects you against a bacterial infection that can be fatal.

Egg allergy and flu vaccine

As with most medications, vaccines come with a caution that they should not be administered if you are allergic to one of the ingredients. Knowing what those ingredients are is difficult with most vaccines. However, it is more common knowledge that flu vaccine is cultivated in eggs. If you have an egg allergy, it's quite possible that you may tolerate this vaccine; however, if you've had a reaction in the past, you should have a conversation with your doctor about how to manage the risk. There are some flu vaccines available that are not grown in eggs. If you're concerned, talk to your doctor about utilizing one of those vaccines.

Live vaccines and immunosuppressants

Live vaccines contain a weakened, but live, version of the microbe causing the disease. That means it cannot make you sick, but it may be more effective in teaching your immune system to protect against that disease. Forms of live vaccines include nasal flu vaccine, shingles and chickenpox, yellow fever, oral polio and childhood illnesses like the measles, mumps and rubella (MMR) vaccine.

When you take an immunosuppressant medication, such as methotrexate or the Biologics, live vaccines are not recommended. When you are immunosuppressed, live vaccine can cause an infection or may stay in the body and re-emerge as illness. When you're getting vaccinated, talk to your doctor about the type of vaccinations you should receive. Killed or inactivated, sugar, and protein vaccines are considered safe.

RA and the shingles vaccinePeople who have RA have up to double the risk of contracting shingles compared to the general population. The American College of Rheumatology (ACR) recommends that older people who take non-biologic DMARDs get the shingles vaccine. It is also recommended that you get this vaccine** before** starting one of the Biologics, due to it being a live vaccine.

If you are already on a biologic and wish to get the shingles vaccine, the ACR recommends that you stop taking the medication for a time, get the vaccine and wait 30 days before starting the biologic again. This may expose you to the risk of a flare, so discuss your options with your rheumatologist. A recent study seemed to indicate that people taking Biologics may afterall not be as likely to develop shingles or other illnesses after taking a live vaccine, but more research is needed before the current recommendation can change.

Travel vaccines and RA

If you are planning to travel to an area of the world that requires you to be vaccinated, it's important to talk to your doctor about the effect these may have on your RA. Most travel vaccines are killed or inactivated and should therefore be safe regardless of the medication you take. However, a few vaccines are live, including yellow fever and polio vaccines. If you are travelling to a place that requires yellow fever vaccine, make sure you speak to your doctor about the risks and, should you choose to go, how to manage them. As well, you will need a waiver letter. You should also be aware that the yellow fever vaccine is grown in eggs, so if you have an egg allergy, speak to your doctor.

What kind of vaccinations have you received? Has your doctor made any particular recommendations?

Lene writes the award-winning blog The Seated View. She's the author ofYour Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.