New Vaccination Guidance Released for People With Rheumatic Diseases

Expanded indications, medication timing around vaccination, and live attenuated vaccines are included in the American College of Rheumatology's update.

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new ACR vax guidelines
Afraid getting vaccinated may trigger a flare? Talk to your doctor, especially if you’re on immunosuppressive meds.Luis Alvarez/Getty Images

Get ready to roll up your sleeve and get jabbed. People with rheumatoid arthritis (RA), lupus, and other rheumatic diseases may find that they are eligible for more vaccinations now that the guidance has been updated.

Earlier this month, the American College of Rheumatology (ACR) released a summary of new vaccination recommendations for people with rheumatic and musculoskeletal diseases (RMD). The new guidelines do not address COVID-19 vaccination, which was the focus of the last ACR update, in 2021. Instead, the new guidelines are focused on risk reduction for flu, pneumonia, and other potentially serious diseases.

What’s New About ACR’s 2022 Vaccine Guidance 

There are expanded indications for some vaccines, tweaks about vaccination timing around other treatments and other vaccines, and more recommendations for live or adjuvanted vaccines.

Adjuvanted means that an extra ingredient is added to the vaccine to help boost the body’s immune response. Live vaccines use an attenuated (weakened) form of the germ that causes the disease.

“Giving high-dose or adjuvanted influenza vaccination is conditionally recommended over giving regular-dose influenza vaccination,” says ACR spokesperson Anne R. Bass, MD, professor of clinical medicine at the Hospital for Special Surgery and Weill Cornell Medicine in New York.

Vaccine Indications Were Broadened (to Include More People With RDM)

  • People, including those under age 65, who are on immunosuppressive medications to treat RMD should receive the adjuvanted flu shot. (Previous advice called for this only for RMD patients over 65.)
  • Despite active disease, treatment with steroids, or use of rituximab, people with RMD should get the seasonal flu shot
  • Adults on immunosuppressive medications for RMD should get the pneumococcal (pneumonia) vaccine.

Vaccine Questions, Concerns Sparked More Direction From ACR

While doctors have questions regarding how the rheumatic disease itself, or the drugs used to treat it, interferes with vaccine efficacy, people living with RMD may worry that the vaccinations will trigger a flare-up. These guidelines were issued to address the concerns of patients as well as doctors, Bass said in a press statement.

Daniel Hernandez, MD, director of medical affairs and Hispanic outreach for the arthritis advocacy and research organization CreakyJoints, says that rheumatoid arthritis and other rheumatic disease patients have been voicing a lot of questions about vaccines.

“ACR is making a strong statement that a seasonal flu vaccine and a pneumococcal vaccine should be two to prioritize in your next discussion with your rheumatologist,” says Dr. Hernandez.

Generally speaking, the changes will mean briefer wait times between shots. The new guidance specifies vaccination timing for people on immunosuppressive meds for RMD.

Highlights on Timing Recommendations in Updated Vaccination Recommendations 

  • Less spacing between meds and vax. The new guidance shortens the interval between the last dose of a biologic DMARD (disease-modifying antirheumatic drug) and the administration of a live attenuated vaccine.
  • Take more than one vaccine at once. Multiple vaccinations on the same day rather than getting each individual vaccination on a different day is conditionally recommended.

New Suggestions Will Start Conversations About Safety, Insurance Coverage 

While the broadened recommendation for an adjuvanted influenza vaccination is a departure from previous guidance, Bass notes that there haven’t been safety issues in those who have been taking the high-dose flu shot, and while insurance coverage outside of the typical age range remains to be seen, “the guidelines itself will be a useful resource when discussing reimbursement with insurance companies.”

Other viruses covered in the new vax guidelines include shingles and human papillomavirus. The full guidelines will be submitted for publication in forthcoming issues of Arthritis and Rheumatology and Arthritis Care and Research, according to the ACR.

Consult With Your Doctor, and Aim to Make Vaccination Decisions Together

Treating autoimmune diseases is complex. Getting vaccinated is important for long-term health and preventing disease. In addition to being at higher risk for severe diseases, being immunocompromised means vaccines can be trickier.

Michael Schweitz, MD, a retired rheumatologist in Florida and medical adviser to CreakyJoints, says that this new guidance plays into the complex treatment of autoimmune diseases.

“The effects of immunosuppressive medications on vaccine efficiency and risk, as well as the effect of vaccines on disease impact, has continually been a concern,” says Dr. Schweitz. “The American College of Rheumatology guidelines provide important information and guidance for both physicians and patients, to help those with the diseases make rational vaccination decisions.”