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When you have an autoimmune inflammatory rheumatic disease like lupus, psoriatic arthritis, or rheumatoid arthritis, it’s important to receive certain vaccinations as a safeguard against infection. Many of our patients have questions about which vaccines they need, when to get them, and their safety. Below, we’ll go over some common concerns and help dispel a few myths about the relationship between vaccines and rheumatism.
How Vaccines Work
To understand some of the complexities involved in vaccinating rheumatic patients, it’s important to first understand how vaccines work.
When we administer a vaccine, we’re deliberately exposing your body to something in order to provoke an immune response that creates an antibody. This antibody protects the body from future infection. There are three types of vaccines:
- Killed vaccines, also known as inactivated vaccines, in which the bacteria and viruses being injected, ingested, or inhaled are not live and pose little infection risk. Common killed vaccines include anthrax, flu injections, rabies, and hepatitis A.
- Attenuated vaccines that use weakened viruses or bacteria; these are also referred to as live vaccines. They produce a mild infection in patients, ultimately resulting in antibody creation and immunity from future infection. These vaccines include chicken pox, measles, mumps, and rubella.
- Subunit vaccines are made with a protein or sugar derived from viruses and bacteria and prompt the body to create an antibody without exposing patients to harmful organisms at all, living or dead. These types of vaccines have no infection risk. Vaccinations for hepatitis B, pertussis, typhoid, and meningitis are subunit vaccines.
For people who are in good health, without any underlying conditions, all three types of vaccines are safe and effective. For rheumatic patients, we take some important precautions to ensure the safety and efficacy of vaccinations; namely, we only give killed and subunit vaccines to such patients while they are on immunosuppressive medications, never attenuated viruses.
Why Vaccinations Are Recommended for Patients With Rheumatic Diseases
Modern medicine has made great strides in treating rheumatic diseases. Because these disorders involve the body’s own immune system attacking itself, treatment centers around suppressing the immune system.
This is good news when it comes to slowing the progression of autoimmune diseases, but it comes with a very significant downside: a suppressed immune system means the body is more susceptible to infection. It’s a double-edged sword to be sure, but we can minimize infection risk by using vaccinations against common infectious diseases.
Suggested Vaccines for Rheumatic Patients
While we know that vaccines are important for patients with autoimmune disorders, vaccination rates are low, as many people are never told they should get them. It’s a smart idea to get all of the vaccinations listed below, but if you’re looking for a good starting point, begin with vaccinations for diseases of the respiratory system, like the flu shot and pneumonia vaccine, as rheumatic diseases can affect lung function, leaving you particularly susceptible to these infections.
These are the vaccines we recommend that patients with rheumatic diseases receive in order to protect their health:
This vaccine protects against pneumonia. Because rheumatic diseases can weaken the lungs and treatment suppresses immune response, the mortality rate is higher for these patients and vaccination is critical.
This vaccine is recommended for the same reason as the pneumococcal vaccine––mortality rate for the flu is higher for patients with autoimmune disorders. You should get the flu shot at the onset of every flu season, but not the nasal spray, as it contains the live virus.
Hepatitis A Vaccination
This is a two-dose series of vaccinations that uses killed viruses to provoke an immune response. It is recommended for anyone who has risk factors for contracting hepatitis A and who has not previously been vaccinated.
Hepatitis B Vaccination
Like hepatitis A vaccinations, this one is recommended for patients who have other risk factors present and have not received the vaccine in the past.
Also called a zoster vaccine, shingles vaccines can come in live attenuated or recombinant (killed) forms. The recombinant vaccine is recommended for all patients who are over the age of 50.
All other inactivated and subunit vaccines should be given per the same schedule and indications as the rest of the adult population.
If you have not started treatment with immunosuppressive medications yet, you can also receive live vaccines up to two weeks before beginning treatment, or as recommended by your doctor. In these cases, the MMR (measles, mumps, and rubella) vaccine is suggested for patients who have not received two doses of the vaccine (typically anyone born between 1957 and 1980).
When to Get Vaccinated
Ideally, patients should get vaccinated before they start treatment with any biologic or immunosuppressive medication. This allows the vaccines to take effect and your body to create antibodies before treatment begins to impact the immune system.
If you didn’t get vaccines prior to starting treatment, you can still get them now with the following caveats:
- You should not get a live vaccine, only attenuated and subunit vaccines.
- You should wait until your condition is under control before getting any vaccinations, although some exceptions may be made, such as when you’re about to travel or for the seasonal flu vaccine.
Of course, every patient is different; when you’re a patient at CORE Medical & Wellness, our rheumatologist, Dr. Jenny Gartshteyn, will evaluate your situation and work with you closely to determine the best timing for you to receive vaccinations if you haven’t gotten them already.
Myths About Vaccines and Rheumatic Disease
As you can see, the relationship between vaccines and biologic and immunosuppressive medication is a complicated one. Because of the intricacies involved, there are many misunderstandings that have developed surrounding this topic. Unfortunately, these misunderstandings often lead to people with lupus, psoriatic arthritis, rheumatoid arthritis, and other autoimmune disorders shunning much-needed vaccinations because they fear the impact they could have on their health.
As discussed above, if you’re a rheumatic patient and you’re currently taking a drug that suppresses your immune system, it’s more important for you to receive vaccines than it is for the average person. Being on this type of medication increases the likelihood that you will contract an infection, and having a rheumatic disorder means that any infection will hit you harder, particularly infections that impact the lungs.
Here are some common myths you’ll find on the internet about vaccines and rheumatic diseases:
Vaccinations Interact With Biologic and Immunosuppressant Drugs
It’s absolutely understandable that patients have concerns about how their medications interact with vaccinations. Patients who are on drugs that suppress their immune systems should not receive live vaccines, as they can cause infection after exposure or even linger in the body and cause infection much later. That said, killed and subunit vaccinations are considered safe for all patients with rheumatic disease, even those on immunosuppressant medications.
The other concern patients have surrounding drug interaction is whether vaccines will work at all if they’re taking medications that suppress the immune system. Evidence shows that vaccinations are most effective when not administered during a flare or extensive treatment (high-dose medications). Vaccines are generally reliable when a patient is healthy and on low dosages of medication.
Vaccinations Cause Rheumatic Diseases
This is false––by and large, vaccines cannot and do not cause autoimmune disorders. While some people believe they developed lupus or rheumatoid arthritis after getting a vaccine, this is merely a coincidence in timing rather than evidence of direct cause. Very rarely, flu vaccines can induce a neurological disease called Guillain-Barré syndrome, but the risks posed by influenza infection outweigh the risk of developing this disorder, which is why flu vaccinations are still recommended despite this small risk.
Another possible source of confusion here is that some live virus vaccines, like rubella, have the ability to cause a mild form of arthritis that can last up to several weeks. The symptoms are similar to what people experience when they contract Fifth disease, and they are temporary.
Vaccinations Make Autoimmune Disease Worse
There is also no evidence that vaccines can worsen rheumatic diseases or cause flares. You can, however, expect to have the normal side effects of vaccinations, which include mild fever, body aches, and soreness at the site of the injection.
A Family Member Getting a Vaccine Can Sicken Patients With Rheumatic Disease
This is only a possibility when the vaccine in question is a live vaccine. If you are taking an immunosuppressive medication and someone in your household––a spouse or a child, for instance––is receiving a live vaccine, it’s a good idea to avoid close contact in the days after the vaccination. That said, it’s important to keep your family’s vaccines up-to-date to protect your health, and the risk posed by being around someone who received a live vaccine is much smaller than the risk posed by being around a family member with a full-blown infection.
Rheumatology at CORE Medical & Wellness
CORE Medical & Wellness provides evidence-based treatment for rheumatoid arthritis, lupus, and other autoimmune disorders. If you’re a current patient or a prospective patient and you have concerns about vaccinations, call us today at 888-521-0688 to schedule an appointment with Dr. Jenny Gartshteyn.