Vaccination and Rheumatic Diseases: Is There Still a Dilemma?

The development of rheumatic diseases after immunization has been reported in the medical literature but a causal relationship has not been established. Infections remain an important cause of morbidity and mortality in patients with rheumatic diseases who may be immunodepressed for immunological dysfunctions or immunosuppressed due to the pharmacologic therapy. Although vaccines against infectious diseases are considered the standard way in preventive medicine, it is still a controversial issue among rheumatologists whether or not patients with rheumatic disorders should undergo vaccination. In recent decades increased numbers of studies on influenza and pneumococcal vaccines administered to patients with systemic lupus erythematosus have proven their safety. These vaccinations, generally immunogenic (i.e. able to induce a protective level of specific antibodies), may not induce an adequate response in patients receiving immunosuppressive therapy. The safety and the immunogenity of Tetanus toxoid, and HBV vaccinations in SLE patients are not completely defined so far. Considering the few available studies, influenza, pneumococcal, and HBV vaccines seem to be safe and immunogenic in patients with rheumatoid arthritis. The effect of TNFα blocking therapies on human immune responses to vaccination is discussed. We also review existing knowledge on vaccination in patients with Sjogren's syndrome and in children with rheumatic disorders, discussing risks and benefits.