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Updated December 29, 2014.

Question: Should People With Arthritis Get a Flu Shot?

People with arthritis or other rheumatic conditions are sometimes confused about whether they should get their annual flu vaccine. What guidelines should be followed regarding flu shots for that population of patients? Is there ever a contraindication for getting a flu shot?

Answer:

What Is the Flu?

Flu, also referred to as Influenza, is a viral illness that affects the respiratory tract (illustration).

Symptoms include:

• fever (often high)
• headache
• fatigue
• dry cough
• sore throat
• runny nose (nasal discharge) or stuffy nose (nasal congestion)
• muscle aches and stomach symptoms (e.g. nausea and vomiting and/or diarrhea)

Typically, up to 20% of the U.S. population may be affected by the flu with more than 200,000 hospitalized due to complications such as pneumonia. It is estimated that 15% of hospitalized patients may die from the illness.

Flu Vaccine: Two Types

The best way to prevent the flu is to get vaccinated each year. There are two types of flu vaccines. The flu shot contains a killed virus which means it can be given to people with chronic medical conditions such as lupus and rheumatoid arthritis. The flu shot is the recommended vaccine.

Another vaccine that is not recommended is the nasal spray flu vaccine. Because it is a live virus, it may be dangerous in people with chronic medical conditions and is not approved even for healthy people who are less than 5 or older than 49. Also, the live nasal vaccine should not be given to pregnant women.

• Flu Vaccine Offers Protection

When Should You Get the Flu Shot?

October and November are the optimal time for vaccination but it still may be beneficial in later months. The CDC (Centers for Disease Control and Prevention) recommends patients at high risk for flu complications get the flu shot. Some of these groups include but are not limited to:

• people over 65
• residents of nursing home or long term care facilities
• adults and children 6 months and older who need regular medical care due to a weakened immune system -- including patients taking medications such as:

• corticosteroids (prednisone, medrol, hydrocortisone)
• azathioprine (Imuran)
• methotrexate (Rheumatrex, Trexall)
• Arava (leflunomide)
• Cytoxan (cyclophosphamide)
• Enbrel (etanercept)
• Humira (adalimumab)
• Remicade (infliximab)

All of these medications may increase the risk of infection.

• How to Avoid Colds, Flu, Infection When You Take Immunosuppressive Drugs

What Else Can You Do to Prevent the Flu?

In addition to vaccination, other suggestions to help prevent infection from spreading include:

• stay home when sick
• cover your mouth and nose (ideally with a tissue) when coughing or sneezing
• wash hands
• avoid touching your eyes, nose or mouth

Finally, antiviral drugs such as Tamiflu (oseltamivir) may be used for preventing or lessening the effects of the flu. For more information please visit the CDC website (Centers for Disease Control and Prevention).

_{Answer provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle of Anti-TNF Blockers and co-author of Natural Arthritis Treatment.}