1/10/13 Two recent studies show that flu vaccines are effective and protective in most people with RA and lupus, while causing little to no disease flare. The autoimmune diseases and some medications taken to suppress inflammation and the immune system may decrease the amount of protection provided by from the vaccine, the protection that is gained creates an important margin of safety for avoiding the flu and the potentially serious complications that can come from it.

Rheumatoid Arthritis

A Brazilian study presented at the annual meeting of the European League Against Rheumatism in May 2011 examined how 340 patients with rheumatoid arthritis, or RA, reacted to the H1N1 flu vaccine compared to 234 healthy patients. The researchers discovered that 60 percent of the RA patients had enough antibodies to be considered protected, compared to almost 83 percent of the healthy controls – a 20 percent difference. Taking methotrexate – but not other disease modifying anti-rheumatic drugs, or DMARDs, including anti-TNF – was associated with less protection.  When it came to disease activity, just 2.6 percent of patients or nine people said their symptoms worsened after taking the vaccine.

Patricia Winokur, MD, a professor of internal medicine at the University of Iowa’s Carver College of Medicine, in Iowa City, who was not involved with the study, says 2.6 percent is a relatively small number of people who had worsening disease activity. She says it’s so small, it’s hard to know whether it happened because of the RA or the vaccine. But she says the bottom line is, the vaccine still had an effect, even if it is reduced. “I think the big picture for patients is, though they may not respond as well as a healthy population, they are still responding and should still get the vaccine,” Dr. Winokur explains.

Lupus

A second study, published online in Arthritis & Rheumatism in May 2011, explored which lupus patients were more likely to respond well to the traditional flu vaccine and what factors were involved..

Researchers led by Judith A. James, MD, PhD, chair of the Arthritis & Clinical Immunology program at Oklahoma Medical Research Foundation, collected blood samples and details about disease activity from 72 lupus patients and 72 healthy people prior to getting vaccinated and again at two, six and 12 weeks afterward. The researchers compared antibodies and other blood markers between the two groups. They found that, overall, lupus patients did not have as strong of a response to the vaccine as healthy controls, however, some lupus patients made close-to-normal responses – and were dubbed “high responders.”

The researchers say one of their more surprising discoveries was that African-Americans with lupus were three times more likely than those of European decent to be high responders, although they aren’t sure why this is.

“Because a lot of lupus patients with severe disease are likely to be African American, I was afraid they were on more aggressive drugs and might not have as good a response. But we found they did well and should be encouraged to take the vaccine,” says Dr. James, who is also a professor of medicine at the Oklahoma University Health Science Center in Oklahoma City and a practicing rheumatologist.

Patients with lupus who didn’t respond as well to the vaccine – so-called “low responders” – had a greater number of active lupus symptoms, were more likely to have blood disorders from lupus and were more likely to be taking prednisone when they were vaccinated. They were also more likely to experience a flare after the vaccination. Dr. James says despite these findings, the overall message for the majority of lupus patients is: It is safe and advisable to take the flu vaccine, as long as it’s not the live form.