Must-Have Vaccines for Psoriatic Arthritis

From everydayhealth.com

Psoriatic arthritis (PsA) is an autoimmune disease that causes pain, swelling, and stiffness in the joints and often causes psoriasis on the skin and nails. People with PsA are at higher risk for severe symptoms and infections like pneumonia that can lead to hospitalization. So it’s especially important to be up-to-date on your vaccines. 

“An autoimmune disease like psoriatic arthritis affects the immune system negatively, so people don’t always respond sufficiently to viruses,” says Jonathan Greer, MD, a clinical professor of biomedical sciences at the University of Miami in Coral Gables, Florida. “This means the consequences of infections are potentially more severe for them.” 

But an even bigger issue is that PsA is typically treated with immunosuppressant medications, and these reduce your ability to fight infections.

Because of these factors, the American College of Rheumatology (ACR) has made specific vaccination recommendations for people with PsA and other rheumatic and musculoskeletal diseases. Though the list of vaccines for people with PsA is in line with recommendations for the general population, in some cases, vaccines are recommended at younger ages, or at stronger doses.

Can Vaccines Trigger a Flare?

It’s also important to address the concern that vaccines can trigger a flare. The vast majority of studies have not shown an increased rate of flares after the flu vaccines. For other vaccines, results were similar but there have been fewer studies.

“There’s a lot of reticence to get any vaccines these days, a lot of misinformation and disinformation,” says Dr. Greer. He encourages people to speak with their own doctors and follow the recommendations from the ACR. Each person is different, the severity of their disease is unique, and people take a wide range of medications. 

Here are the recommended vaccines for people with PsA and experts’ advice on how and when to get them.

                                                                                                                  Jaka Pilar/Getty Images

Annual Flu Shot

The flu shot is recommended every fall for everyone 6 months and older, but people with PsA may need to get a higher dose. People at increased risk want the most protection possible, because the flu vaccine is only about 40 percent to 60 percent effective, depending on how well the vaccine matches the season’s strains. But even if you do get the flu, the vaccine can reduce your symptoms.

People with PsA who need more protection include those between 18 and 65 who are taking an immunosuppressant medication and anyone 65 or older. If you fall into these groups, it’s recommended that you receive a high-dose flu vaccine or an adjuvant vaccine. 

The high-dose flu vaccine contains four times as much of the antigen as the standard-dose vaccine. Research has found that in older adults, who are considered high risk, a high-dose vaccine is 24 percent more effective at preventing flu and reducing complications that lead to hospitalization than the standard dose.

An adjuvant vaccine contains an ingredient that increases the immune system’s response to the antigen in the vaccine.

COVID-19 Vaccines and Boosters

The COVID-19 vaccine is highly effective at preventing serious symptoms and hospitalization. It’s less effective at protecting you from catching the virus in the first place, but it does offer some protection. Studies show that in people who are immunocompromised, protection against infection and severe symptoms is lower, so it’s especially important to stay up-to-date on your vaccines.

If you’re unvaccinated, it’s important to get the initial two-shot series of COVID vaccines, followed by the latest available dose after a certain period of time. 

If you’re immunocompromised and you’ve had the initial vaccine series, you should get two doses of the most recent vaccine, spaced six months apart.

RSV and Pneumococcal Vaccines

Respiratory syncytial virus (RSV) infection typically causes a cold and cough but can develop into pneumonia. An estimated 110,000 to 180,000 adults ages 50 and older in the United States are hospitalized for RSV each year. The risk increases with age and with certain risk factors, including a weakened immune system. The CDC recommends adults ages 50 to 74 who are at increased risk of severe RSV disease get an RSV vaccine. If you have PsA, and are younger than 50, talk to your doctor about whether you should get the vaccine. 

To prevent pneumonia, anyone with PsA who is taking immunosuppressive medications should get the pneumococcal vaccine. If you have PsA but aren’t taking immunosuppressive drugs, the vaccine may still be recommended. The recommendation for the general public is for all adults 50 and older to get the vaccine as well as adults over 50 who have underlying medical conditions. One vaccine is all many people need.

Shingles Vaccine

Shingles, also known as herpes zoster, can be a devastating illness, causing burning, stabbing pain, and other potential complications. The virus occurs in people who have had chicken pox earlier in life. The virus lies dormant, but can be reactivated along nerve pathways at any time, often when the immune system is weakened. The pain, called postherpetic neuralgia, can persist or recur.

According to research, people with PsA are 23 percent more likely to get shingles than people without psoriatic disease. Factors that increase the risk of shingles in people with PsA include age and certain immunosuppressant medications such as Janus kinase (JAK) inhibitors. 

“Over the age of 60, the chance of having post-shingles pain is about 60 percent,” says Greer. “In people who are immunosuppressed, the pain can spread throughout the body.”

The guidelines strongly recommend that people 18 years and older who’ve had chicken pox and who are taking immunosuppressive medications get the shingles vaccine, called Shingrix. “If you ever had chicken pox, get the Shingrix vaccine. It’s not something to trifle with,” says Greer.

Other Vaccines

You may need to get other vaccines when you travel, and you should talk to your doctor about your medical and vaccine history to make sure you’re up-to-date on everything, such as your tetanus shot.

Should You Stop an Immunosuppressant Drug When Getting a Vaccine?

Some immunosuppressant medications may reduce the effectiveness of vaccines, so it’s sometimes recommended that you temporarily stop taking your immunosuppressant medication before you get a vaccine. One example is the drug methotrexate. It’s recommended that you stop taking it for two weeks when getting the flu vaccine. 

With attenuated live vaccines — where a weakened version of the virus is injected — people taking immunosuppressants may need to defer taking or interrupt their medication for a period before and after their vaccination.

Always check with your entire healthcare team, including your rheumatologist when receiving vaccines, especially live vaccines, to make sure they are safe to administer while taking certain medications.

A task force from the American College of Rheumatology recommends withholding abatacept, belimumab, and most conventional (such as methotrexate and azathioprine) and targeted (JAK inhibitors) immunomodulatory therapies for one to two weeks after each COVID-19 vaccine dose, if disease activity allows.

The Takeaway

• People with an autoimmune condition such as psoriatic arthritis are at higher risk of catching infections and having more severe symptoms. 
• Staying up-to-date with vaccinations can help prevent certain infections or minimize the symptoms and need for hospitalization. 
• This includes getting a yearly flu shot, COVID-19 vaccination, and potentially RSV, pneumococcal, and other vaccines. 
• Talk with your doctor about which vaccines you need and when you should get them and if your medications need to be adjusted.

https://www.everydayhealth.com/rheumatic-conditions/must-have-vaccines-for-psoriatic-arthritis/