Should you get the flu shot if you are living with arthritis?

Fall brings pumpkin spice lattes, frosty mornings and plenty of reminders to get your flu shot to help lower your risk of getting seasonal influenza. If you are living with arthritis, particularly inflammatory forms like rheumatoid arthritis (RA), you may wonder if getting a flu shot is right for you. Talk to your health care provider, of course, but in general, a flu shot is a smart move. “The flu shot will not give you the flu, and it will not trigger a flare,” says Dr Jeff Kwong, a Toronto family physician, scientist with Public Health Ontario and associate director of the Centre for Vaccine Preventable Diseases at the University of Toronto. Here’s what you need to know.

1. The risks of rheumatoid arthritis

Because people living with RA can have a compromised immune system, they can have a higher chance of getting the flu and an increased risk of complications. A study that looked at more than 46,000 patients with RA and a matching number of people without RA found that RA patients were more likely to come down with the flu and had a 2.75 times higher chance of complications like pneumonia and stroke. On the other hand, a separate study found that RA patients who received the flu vaccine had a lower risk of hospitalization due to complications from flu and a lower risk of death.

2. The role of medications

It’s true that some arthritis medications (such as methotrexate and biologics) make the flu vaccine somewhat less effective, compared to the general population. Still, it’s important not to write off the shot—it does still provide some protection, says Dr. Kwong. Researchers are also looking at ways to make the flu shot more effective for RA patients. For example, some studies have found that a short, medically supervised “drug holiday,” where patients stopped taking methotrexate for two weeks after their flu vaccine, made the vaccine more effective and did not result in an increase in RA symptoms. (This research is ongoing and this is not yet a recommended guideline.)

3. The right dose at the right time

“We used to say get the influenza vaccine as early as possible. Now there are more and more studies suggesting that the immunity from the vaccine may not last an entire flu season if you get it too early,” says Dr Kwong. “Probably the best timing is early November: early enough that it’s before influenza starts percolating, but late enough it will last you until the end of the flu season.” He adds that if it’s December and you still haven’t got the shot, there is still benefit to getting it. Talk to your health care provider about the timing that’s right for you.

People with compromised immune systems should not get the nasal spray form of the vaccine, because there is a theoretical risk of the live vaccine causing complications (in Canada, the nasal spray vaccine is only publicly funded for children, and is not available in some years, including 2019/20). The injection form of the vaccine has an inactivated, or dead, form of the virus, not a live virus. There are two versions of the injection: a standard dose and a high dose, and the standard dose is usually what is publicly funded across Canada (depending on which province or territory you live in, the high dose may be free for people over 65, or people living in long-term care).

The high dose vaccine is an area of interest for a group of Montreal researchers led by Dr. Inès Colmegna, assistant professor in the Department of Medicine at McGill University’s Faculty of Medicine and a scientist in the Infectious Diseases and Immunity in Global Health Program at the Research Institute of the McGill University Health Centre. During the 2016/17 and 2017/18 flu season, they found that patients with RA who had received the high dose version of the flu vaccine had a significantly improved immune response compared to the RA patients who had the standard dose. In other words, their bodies generated more protective antibodies and they were better protected from the flu.

4. Wash your hands!

In addition to the flu shot, you can help guard against the flu by washing your hands often, coughing and sneezing into your shoulder or crook of your arm rather than your hands, not touching your face, and disinfecting commonly-touched items like phones, door knobs and TV remotes.

Dr. Inès Colmegna’s research into high dose flu vaccines was supported by an Arthritis Society Strategic Operating Grant (2016-19). 

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