Summary of CRA recommendations for vaccination in patients with rheumatoid arthritis (RA) (Recommendations 7–9).
| Inactivated/Killed Vaccines | Live Attenuated Vaccines | ||||
|---|---|---|---|---|---|
| Influenza (annual) | Pneumococcal (booster after 3–5 yrs) | Hepatitis B | Herpes Zoster | Other | |
| Methotrexate* | ✓ | ✓ | ✓† | ✓†† | Caution |
| Leflunomide | ✓ | ✓ | ✓† | ✓†† | Caution |
| Sulfasalazine | ✓ | ✓ | ✓† | ✓†† | Caution |
| All biologics | ✓ | ✓ | ✓† | Avoid | Avoid |
↵✓ Recommended; ideally administer prior to initiating therapy.
↵† Recommended in high-risk groups including residents, travelers or close contact with individuals from hepatitis B endemic areas, illicit drug users, persons engaging in risky sexual behaviors/history of sexually transmitted infection, men who have sex with men, chronic liver disease, occupational exposures, frequent blood transfusions.
↵†† Recommended in RA patients > 60 years old.
↵* Methotrexate ≤ 25 mg per week.