The connection between rheumatoid arthritis (RA) and functional ability has been well documented in media and scientific literature. RA is an autoimmune disorder characterized by an overactive immune system that attacks the body’s tissues and joints. The associated inflammation and pain can often lead to debilitating outcomes, including reduced functional ability and decline in quality of life. Less often discussed in media outlets, however, is the thread linking rheumatoid arthritis, vaccine preventable diseases and functional decline.
The population of people with RA represents a sizable percentage of the population at serious risk for infections due primarily to the nature of their condition and the immunosuppressive therapies used in treatment. While most individuals with RA are at risk for communicable diseases, older adults with RA in particular are more vulnerable to infectious diseases such as pneumonia and influenza. The natural advancement of immunosenescence, in conjunction with a weakened immune system and the use of RA immunosuppressive therapies, makes it even more difficult for the ageing body to resist viral antigens. Immunization, then, is not only an important mediatory intervention for this population but plays a critical and potentially lifesaving role.
The importance of high-dose vaccinations for older adults with RA was highlighted in a recent article published by the Rheumatology Network. The argument for high-dose influenza vaccines was made based on a recent Canadian study that showed high dose-trivalent inactivate influenza vaccine (HD-TIV) was 2-3 times more likely to generate antibodies against the influenza strains than the standard-dose vaccine.
This is an important finding given that the annual incidence of influenza globally, as reported by WHO, is around 5-10%, and that this rate is even higher for adults with RA. In fact, two US studies found that people with rheumatoid arthritis were 1.4 times more likely to be diagnosed with influenza than controls.
Despite the myriad of evidence supporting vaccines as crucial health intervention for this population, the vaccine-uptake rates for adults with RA remains low. IFA expert Dr Marla Shapiro has identified some key factors leading to this generally low trend in vaccination rates and found vaccine hesitancy to be a common perpetrator. To combat this, Dr Shapiro recommends improving communication of vaccine designs and concepts of protection.
Global events such as the IFA Vaccines4Life Summit are an important platform for critical conversations around vaccine hesitancy and barriers to access. The upcoming Vaccines4Life Summit held Oct 31, 2020 will facilitate cross sectoral and cross disciplinary collaborations around best practices, and promote the exchange of knowledge building resources. To learn more about this event visit www.ifa2020.org.
 Somes MP, Turner RM, Dwyer LJ, et al. Estimating the annual attack rate of seasonal influenza among unvaccinated individuals: a systematic review and meta-analysis. Vaccine 2018;36:3199–207.
 Gosselin Boucher, V., Colmegna, I., Gemme, C., Labbe, S., Pelaez, S., & Lavoie, K. L. (2019). Interventions to improve vaccine acceptance among rheumatoid arthritis patients: a systematic review. Clinical rheumatology, 38(6), 1537–1544. https://doi.org/10.1007/s10067-019-04430-7
 Volker Vetter, Gülhan Denizer, Leonard R. Friedland, Jyothsna Krishnan & Marla Shapiro (2018) Understanding modern-day vaccines: what you need to know, Annals of Medicine, 50:2, 110-120, DOI: 10.1080/07853890.2017.1407035
Dr. Marla Shapiro Professor, Department of Family and Community Medicine | Preventive Medicine
Dr. Shapiro was named a member of the Order of Canada, for contributions as a family physician and trusted source of health information.