Should we vaccinate during an active rheumatic disease?

Area of Science:

• Rheumatology
• Immunology
• Infectious Disease Prevention

Background:

• Infections are a significant risk in Autoimmune Inflammatory Rheumatic Diseases (AIIRD), increasing complications and mortality.
• Vaccination is vital for AIIRD patients, but its timing relative to disease activity and immunosuppressive therapy is debated.
• Vaccine efficacy can be influenced by AIIRD disease activity and Disease Modifying Anti-Rheumatic Drugs (DMARDs).

Purpose of the Study:

• To clarify the optimal timing for vaccination in patients with AIIRD.
• To evaluate the impact of disease activity and immunosuppressive therapy on vaccine response.
• To provide evidence-based recommendations for vaccination strategies in AIIRD.

Main Methods:

• Review of real-life studies on vaccination in AIIRD patients.
• Analysis of factors influencing vaccine immunogenicity, including disease activity and DMARDs.
• Consideration of EULAR 2019 recommendations for vaccination in rheumatic diseases.

Main Results:

• Vaccination generally does not significantly affect AIIRD disease activity.
• High disease activity, particularly in Systemic Lupus Erythematosus, correlates with reduced vaccine response (seroconversion).
• Immunosuppressive therapies (DMARDs) can decrease vaccine immunogenicity.

Conclusions:

• Vaccination is recommended for most AIIRD patients, ideally during periods of disease quiescence.
• Administering vaccines before initiating immunosuppression is advised.
• When on immunosuppressive therapy, vaccination during quiescent disease offers the best window for seroconversion, allowing for safe drug spacing.