Citing recommendations and guidelines from worldwide government agencies and organizations, researchers believe that the consensus supports the safety of vaccinations for patients with rheumatoid arthritis who are undergoing treatment with disease-modifying antirheumatic drugs.
The compromised immunologic status of patients with autoimmune inflammatory diseases, such as rheumatoid arthritis (RA) often exposes them to increased risk for infection and associated complications during the course of their disease, a risk that is associated with 1.5- to 2-fold higher risk for hospitalization and death from the complications of infection.1 The evidence linking immunosuppressive agents with increased infection risk is compelling. A systematic review that evaluated infection risk for the various biologic therapies that are now a standard of care for the treatment of RA, including abatacept, rituximab, tumor necrosis factor inhibitors, tocilizumab, and tofacitinib, show increased risk for infection associated with the majority of these agents.2 Furthermore, meta-analysis of 29 randomized controlled trials involving 11,879 patients, and specifically focused on tumor necrosis factor inhibitors, concluded that the risk for tuberculosis may be increased significantly in patients treated with this class of agents.3 Indeed the US Food and Drug Administration approval label for these agents includes a black box warning about the risk for infections, including tuberculosis and bacterial, invasive fungal, viral, and other opportunistic infections.
Vaccination can potentially prevent infections or can reduce the risk for infection significantly. Consequently, vaccinations in patients with RA are of crucial importance because of the increased risk for infections associated with the disease itself and with the immunomodulatory drugs used to treat it. Various institutions have published guidelines on vaccination recommendations for patients with rheumatologic disease. Specifically, the American College of Rheumatology provides vaccination recommendations for patients with RA who are starting or currently receiving disease-modifying antirheumatic drugs (DMARDs) or biologics4:
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