Rheumatology: Flu shots vs possible ra flare-ups

March 18, 2006

TOM SIMPSON, MD, of Saint s, ON, writes: " A 47-year-old woman

with seropositive rheumatoid arthritis is taking prednisone 10 mg per

day, methotrexate 22.5 mg per week, hydroxychloroquine and

salazopyrine. I'd like to know if giving her a flu shot would be

recommended, or if it could stimulate her immune system and worsen

her arthritis? "

The concern raised is reasonable; that is, could the administration

of flu vaccine trigger a flare-up of this patient's arthritis?

Conversely, you also have to consider whether a patient under such

treatment is likely to respond to the vaccine enough to engender

immunity. This concern has been raised particularly with respect to

patients being treated for systemic lupus erythematosis. While there

are case reports of vaccinations triggering a rheumatoid-like

polyarthritis, there aren't any data that unequivocally show that flu

shots can cause flares of established disease which is being

appropriately treated. The decision to administer the shot must

depend on the patient's agreeing to it, taking into account the past

reports of possible flares and also that there's a question of health

risk if she isn't vaccinated. The importance of the flu shot

increases with the patient's age, but is still important even in this

younger woman's case, considering her treatment and the

susceptibility to infection. LR

1999-03-03.qa

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