title: Vaccines and Disease-Modifying Antirheumatic Drugs: Practical Implications for the Rheumatologist.
abstract: 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."
authors.affiliation: Department of Rheumatology, Oregon Health and Science University, Mail Code OP09, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA. Electronic address: friedmam@ohsu.edu.
authors.forename: Marcia A
authors.initials: MA
authors.lastname: Friedman
authors.affiliation: Department of Infectious Diseases, Oregon Health and Science University, 840 SW Gaines Rd, Portland, OR 97239, USA.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Winthrop
mesh_terms: D000069594:Abatacept / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000009:adverse effects*; D000075202:Contraindications; D004347:Drug Interactions; D053061:Herpes Zoster Vaccine; D006801:Humans; D016867:Immunocompromised Host; D000071497:Immunogenicity, Vaccine; D007252:Influenza Vaccines / Q000009:adverse effects; D008727:Methotrexate / Q000009:adverse effects; D010880:Piperidines / Q000009:adverse effects; D022242:Pneumococcal Vaccines / Q000009:adverse effects; D011743:Pyrimidines / Q000009:adverse effects; D011758:Pyrroles / Q000009:adverse effects; D012216:Rheumatic Diseases / Q000188:drug therapy*; D000072140:Rheumatologists; D000069283:Rituximab / Q000009:adverse effects; D014612:Vaccines / Q000009:adverse effects*; D014613:Vaccines, Attenuated; D022341:Yellow Fever Vaccine
chemical_list: D018501:Antirheumatic Agents; D053061:Herpes Zoster Vaccine; D007252:Influenza Vaccines; D010880:Piperidines; D022242:Pneumococcal Vaccines; D011743:Pyrimidines; D011758:Pyrroles; D014612:Vaccines; D014613:Vaccines, Attenuated; D022341:Yellow Fever Vaccine; D000069283:Rituximab; D000069594:Abatacept; C479163:tofacitinib; D008727:Methotrexate
keywords: Anti-TNF; Biologic; DMARD; Efficacy; Immunogenicity; Rheumatoid arthritis; Rituximab; Vaccine