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Vaccines and Disease-Modifying Antirheumatic Drugs: Practical Implications for the Rheumatologist

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Friedman MA1, Winthrop KL2. Rheum Dis Clin North Am. 2017 Feb;43(1):1-13. doi: 10.1016/j.rdc.2016.09.003. Epub 2016 Oct 22.

Abstract

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1 Department of Rheumatology, Oregon Health and Science University, Mail Code OP09, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA. Electronic address: friedmam@ohsu.edu.

2 Department of Infectious Diseases, Oregon Health and Science University, 840 SW Gaines Rd, Portland, OR 97239, USA.

Abstract

Patients with rheumatoid arthritis are highly vulnerable to infections because of abnormalities in their immune system, and because of immunosuppressive effects of their medications. Vaccinations in this population are complicated by disease-modifying antirheumatic drugs, which also modulate or suppress the immune system and potentially decrease the immunogenicity and efficacy of the vaccines. We review the available data regarding the impact of rheumatoid arthritis therapy on the immunogenicity of various common vaccines. We also review rheumatoid arthritis-specific vaccination recommendations, live vaccine safety concerns, and current gaps in our understanding of these issues."