“We were somewhat surprised to find out that most of the medicines [lupus patients] were on, and the doses they were on, didn’t impair their ability to make an effective response,” Dr. James explains. “We have always worried that people with these diseases won’t have effective responses to vaccines or that the vaccine will cause the disease to flare. But what we found was, it is safe in the majority of patients. Almost none of the patients we saw had severe disease flares. They were usually mild to moderate disease flares and they may have had those anyway. That’s the problem with lupus. It waxes and wanes and you don’t know if it’s due to the flu shot or if it [would] flare anyway.”

Bottom Line

Flu and other infectious diseases are a leading cause of illness and death among people with lupus and RA. And while not all patients respond well to vaccines, Dr. James says overall vaccines do help reduce risks, which is important when you’re trying to help patients protect themselves in any safe way they can.

“Most of our patients who are on certain kinds of medications aren’t candidates for live vaccines, but for all other vaccines, they might be good candidates to try and create protective responses so we can decrease infection rates and the severity of infections in our patients,” Dr. James explains. “A lot of our patients worry the flu shot will give them the flu. It won’t. It may make your arm sore or make you feel not great for 24 hours. But if it keeps you from getting hospitalized or makes the flu symptoms milder, that’s important. Flu still kills people.”

Dr. James also stresses that patients should be having a discussion about flu shots and other vaccines not just with their rheumatologist but also with their primary-care provider, because they are the ones who most often administer vaccines.

“A lot of times primary-care doctors have very short periods of time with patients and our patients are complicated,” Dr. James says. “So make sure your doctor knows what medications you are taking.”

Dr. Winokur says patients should also know that there are ongoing studies trying to get even more clarification on this issue for patients. She and a team from the University of Iowa are starting a study this fall to see if 80 RA patients – who will be compared to 80 healthy patients of similar ages – respond differently or better to the new high-dose influenza vaccine approved to treat the elderly.

“It’s a strategy that’s very effective for the elderly, who respond much less well to [traditional] flu vaccines and it’s improved their response. The question is, would it also be true in this type of population,” Dr. Winokur asks.