Is the Flu Vaccine Safe for Rheumatoid Arthritis Patients? | Everything You Should Know

Added: 2026-05-19

[00:00:00]Flu vaccine, [music] safe for patients on biologic drugs like TNF inhibitors.

[00:00:05]Yeah, [music] so TNF inhibitors are tumor necrosis factor inhibitors. They are what potent drugs which are meant to suppress immune system in effective way so that it stops attacking us and causes autoimmune diseases like rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis. How does the flu vaccine help prevent hospitalizations in [music] rheumatic patients? So it is very well known that about 50 to 60% of hospitalization comes down with the flu vaccine which [music] is a simple shot of annual flu vaccine, especially tetravalent flu vaccine.

[00:00:42]>> [music] [music] >> Hi everyone, welcome back to another episode and today we are here talking about an extremely important question which is often misunderstood. The flu vaccine, especially with the people living in rheumatic conditions like rheumatic arthritis or lupus.

[00:01:08]Many people wonder if the flu vaccine is safe for them, when they should take it, and do they have to take it every year?

[00:01:16]This is why we are here with an important question I must say, flu vaccine le akya.

[00:01:22]And to clear all these doubts, we have with us Dr. Vijay Rao, a leading rheumatologist, and he will be answering to all the common questions around the flu vaccination. Hello sir and welcome to this episode and then thank you so much for joining us. I will come again with the first question.

[00:01:41]So is the rheumatology patients get the flu vaccine every year? Is it mandatory for them?

[00:01:46]Yeah, so this question has many parts.

[00:01:48]One is rheumatology, second flu vaccine, third every year. Okay. So rheumatology is about autoimmune diseases where our own immune system attacks us. Mhm. So, we use medicines to suppress the immune system.

[00:02:02]>> Okay. So, to help patients to protect from infections, which are common cold, which is influenza, >> Mhm. rheumatology patients need a vaccine.

[00:02:11]Why do they need every year? Because the influenza viruses change their shape or structure, Okay.

[00:02:17]>> which is called antigenic shift or drift every year. So, the vaccine gets updated every year. So, they have to take it in >> Yes. Okay.

[00:02:25]So, coming to the second one, is the flu vaccine recommended for all patients with rheumatic diseases like rheumatoid arthritis, as I mentioned, or lupus?

[00:02:34]Yeah, more so flu vaccine we recommend for anybody above 6 months of age group, including kids, pregnant woman, >> Okay. all age group, but more so important for above 50 years of age with heart and lung diseases and immunosuppressant medicines for autoimmune diseases, Okay. uh which we use called disease-modifying anti-rheumatic drug therapy or DMARDs.

[00:02:56]Okay. Those are the ones which suppress immune system and make one more prone for viral infections like flu.

[00:03:03]Uh so, anybody above 6 months of age group, any age, any gender, can take.

[00:03:08]Okay. And what is the best time for the rheumatology patients to get this flu shot?

[00:03:13]So, usually it's the rainy season. So, September onwards up until December, January.

[00:03:18]>> They can take >> They can take it because the vaccine strains get updated by the National Institute of Virology in Pune.

[00:03:24]Okay.

[00:03:24]>> And uh based on the virus strains, the vaccine strains get updated.

[00:03:28]>> Oh.

[00:03:28]But having said that, if you miss that window, you can still take it anytime of the year, so that you are >> is the best time.

[00:03:35]>> That that is the best time, yes. So, coming to the again next question, can flu vaccines be given alongside with a routine rheumatology checkup? They have the routine rheumatology checkup, so can they be taken at >> Yes, so your question particularly pertains to whether it is safe to take with medicines which we use for autoimmune diseases. There are two parts to this question. Once One is it safe?

[00:03:59]Second is it effective?

[00:04:00]>> Effective. So, there is something called vaccine avidity or vaccine effectiveness.

[00:04:05]So, for that we generally say that if anybody is using high-dose steroids more than 20 mg per day, Okay. then better to not vaccinate at that time. Better to reduce the steroid to less than 10 mg per day, then give the vaccine.

[00:04:19]Regarding other type of tablets, there is one tablet called methotrexate.

[00:04:23]The Center for Disease Control in America says that you need to stop methotrexate 1 week before the vaccine.

[00:04:28]>> Vaccine. But in practicality, we can't do that because if we stop our tablets, the arthritis flares up.

[00:04:34]So, we give it along with the vaccine injection.

[00:04:37]And there is one tablet injection called rituximab which works on a cell called B cell. Okay. That we recommend that the vaccine should be taken either prior to the injection or 6 months after the injection. Okay. This is with respect to the vaccine effectiveness. Vaccine safety is very good. No problem with rheumatology patients.

[00:04:57]We will again come to the safety part.

[00:04:58]So, a few questions on the safety for rheumatology patients. Is the flu vaccine safe for patients on biologic drugs like TNF inhibitors? Yeah, so TNF inhibitors are tumor necrosis factor inhibitors. They are what potent drugs which are meant to suppress immune system in effective way so that it stops attacking us and causes uh autoimmune diseases like rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis. Vaccine is very safe even with these uh injections. We don't stop the injection.

[00:05:31]We give the vaccine.

[00:05:33]Uh it is very effective in these patients and it doesn't cause The vaccine is a killed virus. It's not active virus.

[00:05:40]>> Okay. So, what it does is it does not cause active infection. Mhm. So, it is a killed one which goes to a immunological memory of our immune system and that takes a photograph of that virus so that when the new virus comes it goes and kills it. So that is the reason of using a killed virus. So we can say it is safe. Yeah.

[00:06:03]So coming to the next can the flu vaccine worsen the autoimmune rheumatic condition? Very unlikely so flu vaccine doesn't cause any flare up of the autoimmune condition. In fact flu infection can cause flare up of autoimmune condition. So my patients who are rheumatic disease patients if they develop any flu infection they usually come back and say that my pain is horrible. So to prevent that you need to take a flu vaccine because flu vaccine per se doesn't cause flare up of autoimmune disease but flu infection can cause that. So what about the side effects? Do they differ from for the rheumatology patients? Do they have separate side effects? No there's no increased side effect risk with flu vaccine.

[00:06:47]In fact that is reduced.

[00:06:49]Because side effects are based on body's reaction to the vaccine. Absolutely. So anyway we are using tablets to reduce the immune system so the attack based on that will be very less. However one can have a local reaction like pain or some kind of mild fever which we say take a paracetamol or something and it will become all right. I often tell this to the patient that if you develop a reaction that means you have got a original vaccine. That's what I was about to say. So can flu vaccines interact with any medications commonly used in the rheumatology? So flu vaccines don't have any interaction as such to any of the medicines used in rheumatology. So it is very safe it can be given with any medicine. Only thing is high dose steroids we don't recommend to vaccinate because the vaccine effectiveness comes down.

[00:07:41]Apart from that everything is fine. So, coming to the practical benefits and myths, how does the flu vaccine help prevent hospitalizations in rheumatic patients? So, it is very well known that about 50 to 60% of hospitalization comes down Oh. uh with the flu vaccine, which is simple shot of annual flu vaccine.

[00:08:02]Especially tetravalent flu vaccine.

[00:08:04]Okay.

[00:08:05]>> Uh so, that will actually prevent the severity of the flu. Mhm. Uh prevent what we call as pneumonitis or viral pneumonitis. Okay.

[00:08:16]Where patient needs to be admitted to ICU and ventilator and all that has to be put, especially for above 50-year-old. Okay. So, a simple shot of flu vaccine can prevent all that. Oh, that's great. Is there a a special flu uh vaccine just for the rheumatology patient? Any special case? So, normally we recommend the tetravalent vaccine.

[00:08:38]Uh I mean, Zydus has that tetravalent vaccine. Um that actually has uh strains for influenza A, influenza B, H influenza, and what we call as H1N1 or swine flu. Swine flu. So, all of these are incorporated in a single vaccine.

[00:08:55]Mhm. So, uh what we call as VaxiFlu or VaxiGrip, any of those. VaxiFlu is what we we use recommend that.

[00:09:05]>> And uh these can be used safely in any of the autoimmune rheumatic disease patients.

[00:09:10]>> And what if someone had a bad reaction to a flu shot before and then should they still get it? Generally, we say that if you develop a severe allergic reaction, we don't recommend To >> again, at least till the immunological memory fades out.

[00:09:26]And then we may re-challenge >> a cooling period for that? Maybe 1 or 2 years we leave and then we revaccinate such patients.

[00:09:33]>> And does the flu vaccine protect against all the strains including the new variants. Yeah, so if you have taken the updated vaccine in that seasonal flu, that is September onwards till December, then all the current variants are covered.

[00:09:48]>> Covered. Because the variation of the vaccine uh is changes every year during that season.

[00:09:56]Viruses are very notorious to change their structure. Okay. So virus has a structure called antigen. Okay. Uh our body recognizes that like an antenna.

[00:10:06]Mhm. And the immune system produces antibodies to destroy that virus. Okay.

[00:10:11]So it's that antenna which is changes every year. So viruses knows that our body can recognize. It takes a photograph and kills. So it slightly changes or modifies us. Mhm. So unless you you have you have taken an updated version of that year, you're safe. So coming to the getting vaccinated and beyond thing, should family members of patient also get vaccinated? Very much because I often have old ladies telling that I don't go anywhere outside, why I need a vaccine? I say you don't go outside.

[00:10:41]>> used to say this. But >> [laughter] >> all other people go out and come to you.

[00:10:44]Yes. So elderly are the ones where everybody else come to them. So if everyone in the house is immunized, we call it as herd immunity. Okay. So that's as a cocoon effect. Mhm. And herd immunity means the virus cannot penetrate anyone. Absolutely. So nobody becomes a carrier.

[00:11:02]And if nobody is a carrier, nobody can cross anything.

[00:11:06]This is the same concept which we used in COVID that we used engaged in a mass immunization program so that you know, people get exposed and uh community >> Everybody is protected.

[00:11:17]>> protected.

[00:11:18]So what if a child has a juvenile idiopathic arthritis and then they can Can they get the flu vaccine? Yes, anybody above 6 months of age as I told >> There is no Above 6 months, everybody Everybody can get it. So normally we recommend the pediatricians to uh vaccinate the child because most of the vaccination in kids is done by the pediatricians. Okay. So, we do put in our recommendations and uh uh uh what is the available best vaccine they can get.

[00:11:46]>> go for that. And how soon after vaccination does the protection start?

[00:11:51]So, the protection starts as early as 2 weeks. Okay. So, you can start seeing that uh the virus strains are or antibodies against them are much detected in the blood. So, as early as 2 weeks you can start You can start >> the protection, yes. So, now we have addressed very common concerns. So, I have heard the flu vaccine can give you flu. Is that true for rheumatic patients? No, that's not true for anybody else.

[00:12:17]That's called not the vaccine virus effect because virus is dead. It can't cause my influenza.

[00:12:25]They would have added a carrier called adjuvant Okay. to carry that virus. You can't directly inject a dead virus.

[00:12:32]So, usually they add a chemical called adjuvant. Okay. And to hold that.

[00:12:37]The adjuvant causes immune reaction and people might develop fever or body pains or local pain and other things. So, it's not the flu.

[00:12:47]People think that they got flu by taking flu vaccine. No, it's actually the the chemical they use in the vaccine which causes that reaction. And why to prioritize the flu shots in rheumatology over other vaccines? So, flu is the first flu is a very common infection.

[00:13:05]So, flu is an infection which is spread very commonly in public transports, in houses, in offices, everyone.

[00:13:13]And as I told, flu is one which changes every year. Mhm.

[00:13:17]So, if you control the flu in autoimmune rheumatic diseases patients whose immunity is suppressed by the tablets we use then the risk of infection comes down.

[00:13:28]The hospitalization comes down and whenever they have a flare the arthritis goes high and the risk of flare comes down. So not only we are protecting them from infections, we are protecting them from the autoimmune disease which can go high in during every infection.

[00:13:44]So it's a double edge protection. So any words you want to say to just make sure everybody should get this flu vaccination.

[00:13:53]>> So what I would say is you must discuss with your primary care provider or a GP or general physician or rheumatologist and you must ask them about vaccinating yourself if you are an autoimmune disease patient taking tablets to suppress immunity and if you are actually above 50 years of age and you have diabetes or heart disease or kidney disease or any lung disease all the more important that you take MaxiFlu or any of the updated tetravalent vaccines yearly so that you're protected from flu infections.

[00:14:36]Thank you doctor for your valuable insights and today's conversation highlights how rheumatoid conditions are often more complex than they appear. So it's not only affecting the joints but also the quality of life if not addressed on time. It also showcases the importance of early diagnosis, the ongoing care and the right treatment approach if it to be managed effectively in this.

[00:15:00]So guys, take your time, take a moment, speak to your doctor and to know more log on to indiafluprotection.com.

[00:15:10]So before ending up this session, signing off this session, I have a very simple question to everyone listening out here. Ask your family, your friends and your loved ones flu vaccine le liya kya?

[00:15:22]>> loved ones. Flu vaccine India here.