Vaccines and Disease-Modifying Antirheumatic Drugs Practical Implications for the Rheumatologist

Patients with rheumatoid arthritis are highly vulnerable to infections because of abnormalities in their immune system, and because of immunosuppressive effects of their medications. Vaccinations in this population are complicated by disease-modifying antirheumatic drugs, which also modulate or suppress the immune system and potentially decrease the immunogenicity and efficacy of the vaccines. We review the available data regarding the impact of rheumatoid arthritis therapy on the immunogenicity of various common vaccines. We also review rheumatoid arthritis specific vaccination recommendations, live vaccine safety concerns, and current gaps in our understanding of these issues."