Flu vaccine in the setting of Rheumatoid Arthritis
Vaccination against influenza in Rheumatoid Arthritis: the effect of disease modifying drugs, including TNF a blockers.I Fomin, D Caspi, V Levy, N Varsano, Y Shalev, D Paran, D Levartovsky, I Litinsky, I Kaufman, I Wigler, E Mendelson, O ElkayamAnn Rheum Dis 2005 7
This important paper from Israel addresses questions that often arise in peer to peer discussions among rheumatologists. Does vaccination against influenza affect rheumatoid arthritis (RA) disease parameters and do RA and/or the medications used to treat RA (steroids, disease modifying antirheumatic drugs (DMARDs), and/or biologic agents) affect the humoral (antibody) response induced by the vaccine? 82 patients with RA and 30 healthy control patients were vaccinated with a split-viron inactivated vaccine to address the above questions. The response to vaccination was defined as a >4-fold rise in hemagglutination inhibiting antibodies 6 weeks post vaccination or seroconversion in patients with non-protective levels at baseline. Significant increases in the geometric mean titers for each of the antigens was observed in both the RA and healthy control patients, however, the titers and the percentage of responders were higher in the healthy controls. The percentage of responders was not affected by the use of prednisone, DMARDs, infliximab, or etanercept. There also was no apparent affect of the vaccination on multiple disease activity measures. The results of this study will be very helpful and reassuring to the busy clinical rheumatologists. Similar studies with other inactivated vaccines are needed to address the safety and efficacy of such vaccinations in patients with RA.
Arthur L. Weaver MD, MS
In other words, it appears that patients with rheumatoid arthritis are protected by the flu vaccine but the immune system response to the vaccination is not as robust as in otherwise healthy individuals. It also appears to be true that this response was not affected by the medications that a given patient may be taking. Finally, giving the flu shot does not appear to result in flares of rheumatoid arthritis. Therefore, there is no good reason to withhold vaccination in these patients. A caveat: the vaccine was an inactive virus (the injection, FluVax) as opposed to a live, attenuated, virus (the nasal spray, FluMist).
Ricardo Pocurull, MD
This important paper from Israel addresses questions that often arise in peer to peer discussions among rheumatologists. Does vaccination against influenza affect rheumatoid arthritis (RA) disease parameters and do RA and/or the medications used to treat RA (steroids, disease modifying antirheumatic drugs (DMARDs), and/or biologic agents) affect the humoral (antibody) response induced by the vaccine? 82 patients with RA and 30 healthy control patients were vaccinated with a split-viron inactivated vaccine to address the above questions. The response to vaccination was defined as a >4-fold rise in hemagglutination inhibiting antibodies 6 weeks post vaccination or seroconversion in patients with non-protective levels at baseline. Significant increases in the geometric mean titers for each of the antigens was observed in both the RA and healthy control patients, however, the titers and the percentage of responders were higher in the healthy controls. The percentage of responders was not affected by the use of prednisone, DMARDs, infliximab, or etanercept. There also was no apparent affect of the vaccination on multiple disease activity measures. The results of this study will be very helpful and reassuring to the busy clinical rheumatologists. Similar studies with other inactivated vaccines are needed to address the safety and efficacy of such vaccinations in patients with RA.
Arthur L. Weaver MD, MS
In other words, it appears that patients with rheumatoid arthritis are protected by the flu vaccine but the immune system response to the vaccination is not as robust as in otherwise healthy individuals. It also appears to be true that this response was not affected by the medications that a given patient may be taking. Finally, giving the flu shot does not appear to result in flares of rheumatoid arthritis. Therefore, there is no good reason to withhold vaccination in these patients. A caveat: the vaccine was an inactive virus (the injection, FluVax) as opposed to a live, attenuated, virus (the nasal spray, FluMist).
Ricardo Pocurull, MD
posted by Ricardo Pocurull at 9:03 AM
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