Adult and paediatric patients with rheumatic diseases may be immunodeficient due to treatment with high-dose corticosteroids, immunosuppressive drugs such as cyclophosphamide or biologics. The diseases themselves may also lead to immune compromise. In view of the paucity of evidence, it is generally recommended that live attenuated vaccines – including BCG, MMR, VZV, yellow fever, cholera and oral poliomyelitis - be avoided in patients with rheumatic diseases on immunosuppressive regimens. Where possible, such vaccines should be given before commencing immune suppression. I will review the available evidence along with evidence of exacerbation of infections in patients treated with immunosuppressive regimens including biologics. I will also consider potential alternative strategies for treatment of rheumatic disease which avoid systemic immune suppression.
Disclosure of Interest R. Thomas Grant/Research support from: R&D collaboration with Janssen for RA immunotherapy