Adults with rheumatoid arthritis (RA) can safely receive the flu vaccine each year as recommended, although their response to the vaccine may be somewhat lower than in healthy individuals, research hints.

There is some reluctance to vaccinate RA patients because there have been reports of post-vaccination flares in disease activity, note Israeli researchers in the Annals of the Rheumatic Disease. Also, the immune response to the vaccine in RA patients is uncertain.

To look into these issues, Dr. Ori Elkayem and others at Tel Aviv Medical Center gave the flu vaccine to 82 RA patients and 30 healthy controls.

In all study subjects, there were significant increases in antibody titers for each antigen contained in the vaccine, although the titers were lower in the arthritis patients than in the healthy control subjects.

The immune response to the vaccine, although lower than normal in the RA patients, was sufficient to offer protection against the three antigens contained in the vaccine used in this study, the authors say.

In the RA patients, neither prednisone nor disease-modifying antirheumatic drugs (DMARDs) - including methotrexate, infliximab and etanercept - adversely affected the immune response to the vaccine.

Importantly, they report, influenza vaccination was not associated with arthritis flares.

“Based on our present data,” Elkayem and colleagues conclude, “we feel that vaccination against influenza, which is strongly indicated in rheumatoid arthritis, can be recommended in patients with this disease.”

SOURCE: Annals of Rheumatic Disease, February 2006.