Aging Support Group

WELCOME TO JOHNS HOPKINS HEALTH ALERTS!

Johns Hopkins Health Alert

Rheumatoid arthritis (RA), like other chronic autoimmune diseases, is the result of immune system dysfunction. If you have one of these conditions, your immune system mistakenly attacks your body's own tissues instead of going after harmful bacteria, viruses, and other dangerous intruders. As a consequence, people with RA are about twice as likely to get infections as those who don't have an autoimmune disease. 

To further complicate the situation, many of the medications used to treat RA work by suppressing the immune system to stifle its reaction to the body's tissues. Although these medications perform an important function in slowing the progression of the disease and reducing symptoms, they may also prevent the immune system from doing its normal j ob -- fighting infectious invaders. Faced with this double-edged sword, is there anything you can do to enhance the health of your immune system? 

You bet -- immunization against infectious disease. Vaccines play an important role in protecting people of all ages from certain infectious diseases. Because RA diminishes the effectiveness of your immune system, vaccines are even more important for you. But there's a catch: Some vaccines are not appropriate for people with RA, because they contain live organisms. 

Must-Have Vaccines:

• Influenza vaccine. Even if you are taking one or more RA medications, you can expect to get good protection against the flu virus.
• Pneumococcal vaccine. This vaccine protects against common types of pneumonia, bacteremia (blood infection), and meningitis.   All adults should get the pneumococcal vaccine at least once.  
• Tetanus-diphtheria-pertussis. Everyone needs protection from diphtheria and tetanus, and if you're under 65 years old, you should get the vaccination for pertussis as well.    

Vaccines To Avoid: Most vaccines are safe and fairly effective in people with RA, but there are some that you should avoid, because they use live viruses or bacteria. Also avoid attenuated vaccines, which use a weakened—but not dead—organism. 

• FluMist. This inhaled nasal flu spray vaccine is made from attenuated virus and should not be used by people with RA.
• MMR. Typically given to people born in 1957 or later, the MMR, or German measles, vaccine should not be given to people taking certain immunosuppressive medications used to treat RA.
• Herpes zoster. As with the MMR vaccine, the herpes zoster vaccine may be inappropriate in people taking certain immunosuppressive medications, such as steroids or other drugs used to treat RA.
• Bacillus Calmette-Guérin (BCG). This vaccine is sometimes administered to prevent tuberculosis, but it should not be given to a person with RA because it is made from an attenuated strain of bacterium that causes tuberculosis.
• Varicella (chickenpox). Varicella vaccination is not usually required for anyone born in the United States before 1980 and should not be administered to anyone taking immunosuppressive drugs.
• Smallpox. This vaccine, which is made from a live virus that is related to (but milder than) smallpox, is rarely administered in the United States. However, in the event of a public emergency, it would be made available to anyone exposed to the smallpox virus.  
• Yellow fever. This is a live oral vaccine. Consult with your rheumatologist and an infectious disease specialist about what to do if you must go to a country where yellow fever is endemic. But don't be surprised if they won't administer