Pneumococcal vaccinations help protect patients with rheumatoid arthritis against serious pneumococcal infections of the lungs, brain, blood, and ears

Oct 18 2004

Pneumococcal vaccinations help to protect patients with rheumatoid arthritis against serious pneumococcal infections of the lungs, brain, blood, and ears , according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Antonio, Texas.

Rheumatoid arthritis patients have an approximately two-fold increased morbidity and mortality in infections compared to a population without the disease. Consequently, potential infections resulting from pneumococcal disease can loom as life threatening. Previous studies of the influenza vaccination program in the U.S. and vaccination against pneumococcus have indicated immunization does not worsen the disease in patients with rheumatoid arthritis, but the safety of the immunization had not been tested in these patients. Additionally, there was concern that patients with rheumatoid arthritis would not respond to pneumococcal vaccinations because of the effects of the disease or the treatments used for the disease on the ability of the body's immune system to respond to the vaccination.

Researchers monitored 149 patients with established rheumatoid arthritis and 47 patients without arthritis for effects generated by pneumococcal vaccinations, inoculating each patient with a standard dosage of commercially available vaccine. Of the 149 rheumatoid arthritis patients, 50 were taking methotrexate and either etanercept (Enbrel ®) or infliximab (Remicade ®) TNF-blockers . TNF-blockers reduce the action of proteins in the body that can contribute to inflammation and joint damage. Of the remaining rheumatoid arthritis patients, 62 were on TNF-blocker therapy alone or with some other disease-modifying anti-rheumatic drugs (DMARDs), and 37 were taking methotrexate only. The four groups were measured for antibodies associated with invasive infections prior to and four to six weeks after vaccination.

Study results showed that immune response to the vaccine was highest in patients on TNF-blockers without methotrexate, intermediate in patients on TNF-blockers combined with methotrexate and lowest in patients on methotrexate alone.

"The essence of the current study is that rheumatoid arthritis patients treated with TNF-blocker can be safely vaccinated against pneumococcal infections under the same premises as patients with other diseases, while methotrexate-treated rheumatoid arthritis patients should be vaccinated preferably before initiation of this treatment," said Pierre Geborek, MD, PhD, Department of Rheumatology, Lund University Hospital, Lund, Sweden, and an investigator in the study.

The American College of Rheumatology is the professional organization for rheumatologists and health professionals who share a dedication to healing, preventing disability and curing arthritis and related rheumatic and musculoskeletal diseases. For more information on the ACR's annual meeting, see http://www.rheumatology.org/annual.