A 45-year-old woman has been suffering from rheumatoid arthritis for 10 years and takes methotrexate twice a week. What statement regarding vaccination against pneumococci (23-valent vaccine) would conform to the recommendations for the management of rheumatoid arthritis issued by the European League Against Rheumatism in 2010?

Answer options

1. Vaccination is contraindicated in cases when inflammatory process is active
2. Vaccination is not recommended
3. Vaccination necessitates increase in the dosage of the long-term medicines
4. Vaccination is contraindicated to the patients who take methotrexate
5. Vaccination is recommended

Explanation

Patients with AIIRD are at increased risk of dying from pulmonary infections compared with the general population, with pneumococci being considered as one of the main causative pathogens. 23-valent polysaccharide pneumococcal vaccination (23-PPV) should be strongly considered for patients with AIIRD (grade of evidence Ib–III; strength of recommendation B–C; Delphi vote 8.19). According to recommendations for the management of rheumatoid arthritis issued by the European League Against Rheumatism in 2010 vaccination in patients with autoimmune inflammatory rheumatic diseases (AIIRD) should ideally be administered during stable disease (no grade of evidence possible; strength of recommendation D; Delphi vote 8.88), but no studies have been performed comparing efficacy and harms between patients with AIIRD with the stable and unstable disease. Moreover, all vaccination studies in patients with AIIRD addressed patients with quiescent disease. 1. S van Assen, N Agmon Levin, O Elkayam, R Cervera, M F Doran, M Dourados, P Emery, P Geborek, J P An Ioannidis, D R W Jayne, C G M Kallenberg, U Müller Ladner, Y Shoenfeld, L Stojanovich, G Valesini, N M Wulffraat, M Bijl EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases // Ann Rheum Dis 2011; 70: 414–422 doi:10.1136/ard.2010.13 7216. Published Online First: 3 December 2010 https://ard.bmj.com/content/70/3/414 2. Harrison’s Principles of Internal Medicine / D. L. Kasper et al. – 19th Ed. – McGraw-Hill, 2015. – P. 785– 793