Vaccine Guidelines for Individuals with Rheumatic and Musculoskeletal Diseases

If you or a loved one are living with rheumatic and musculoskeletal diseases (RMDs), you may be concerned about your ability to tolerate vaccines. The American College of Rheumatology (ACR) recently released new vaccine guidelines that provide important recommendations for individuals living with rheumatoid arthritis, lupus, osteoarthritis, and other RMDs.

Patients with rheumatic and musculoskeletal diseases are encouraged to receive the influenza (Flu) vaccine annually.

Patients with rheumatic and musculoskeletal diseases who are taking immunosuppressive medications are also encouraged to receive the following vaccines:

• Pneumococcal (pneumonia) vaccine
• Shingles vaccine

This is because these individuals are at an increased risk of complications from these diseases.

You may be concerned that your disease will flare up after a vaccination, but studies have shown this is not the case. With a couple of rare exceptions in adults, most vaccinations are safe and effective in individuals living with RMDs. Live vaccines, such as those given for the measles, MMR, varicella, and yellow fever, can make individuals sick if they’re already taking medications that suppress the immune system. It is important to note that individuals with RMDs may also have weakened immune systems, making it more difficult for their bodies to respond to vaccines.

A vaccination strategy should always be shared with your rheumatology healthcare provider. Some medications can make vaccines less effective, but with the assistance of your care team - vaccinations can be timed for the best result. Special care should also be given for children taking immune-suppressing medications or babies whose mothers were on those medications during pregnancy. If a patient’s disease is under control abstaining from methotrexate for two weeks after a flu shot will increase a person’s immune response to the vaccine. Alternatively, some medications such as rituximab and high dose glucocorticoids can block responses to vaccines making them less effective, but with the assistance of your care team - vaccinations can be timed for the best result.

By following these guidelines, patients can help protect themselves against serious infections and illnesses and ensure that their immune systems are as strong as possible. See a full summary of ACR’s latest guidelines.

Consult your healthcare provider for up-to-date information about vaccinations, including COVID-19, and for additional guidance look to the Advisory Committee on Immunization Practices, the Centers for Disease Control and Prevention, and the American Academy of Pediatrics.