Vaccinations for rheumatoid arthritis

Abstract

Patients with rheumatoid arthritis (RA) suffer an increased burden of infectious disease-related morbidity and mortality and have twice the risk of acquiring a severe infection compared to the general population. This increased risk is not only a result of the autoimmune disease but is also attributed to the immunosuppressive therapies that are commonly used in this patient population. Given the increase in infection-related risks in RA, there is great interest in mitigating such risk. A number of vaccines are available to the rheumatologist, with a handful that are of importance for RA patients in the United States. The goal of this paper is to highlight the most recent literature on the key vaccines and the specific considerations for the rheumatologist and their RA patients, with a particular focus on influenza, pneumococcal, and herpes zoster vaccines. It is important for rheumatologist to understand and be aware of which vaccines are live and what potential contraindications exist for giving vaccines to RA patients.

Risk of Serious Infection Among Initiators of Tumor Necrosis Factor Inhibitors Plus Methotrexate Versus Triple Therapy for Rheumatoid Arthritis: A Cohort Study

“…RA patients are generally well‐known to have an increased risk of infection and mortality due to infection (13). The mechanism of this risk has been attributed to disease‐related immune abnormality and immunosuppressive medications (14). However, the effect of MTX on infection risk has been controversial, with some studies showing benefits (15) or no risk (16–18) and others showing harmful effects (19–21).…”

Clinical effectiveness of influenza vaccination in patients with rheumatoid arthritis

“…Furthermore, medications, such as prednisolone, methotrexate, rituximab, etanercept and adalimumab use were adjusted for the outcomes of interest. These medications were associated with increasing the risk of hospital‐acquired infections in RA patients or having some impact on the influenza vaccine immunogenicity …”

“…The American College of Rheumatology (ACR) recommends yearly vaccination of all RA patients . The yearly influenza vaccine should be given to all RA patients regardless of disease‐modifying anti‐rheumatic drug use . However, studies assessing the clinical effectiveness of influenza vaccination on patients with RA are limited.…”

Vaccination in Rheumatic Diseases: An Ally or an Enemy?

“…Это могло послужить причиной нарастания аутоиммунной патологии. Однако целый ряд публикаций (включая систематические обзоры), имеющихся в настоящее время в литературе, свидетельствует об отсутствии какого-либо существенного отрицательного влияния вакцинации на активность воспалительного процесса и характер течения РЗ [8][9][10][11]. В частности, в ходе проведенного в Швеции эпидемиологического исследования EIRA не выявлено увеличения числа случаев развития или обострения РА (с включением как позитивных, так и негативных по антителам к циклическому цитруллинированному пептиду форм) на протяжении пятилетнего периода от момента иммунизации наиболее распространенными вакцинами.…”