Vaccines and arthritis medicines: What you need to know this winter

With winter on its way many people in our community are asking about vaccines including flu, COVID-19, and shingles. 

If you’re taking (or about to start) medicines like DMARDs or biologics, you might be wondering what this means for your immune system and how vaccines fit into your care. 

Our pharmacist Linda has pulled together some practical information to help you understand your options and feel more confident talking with your GP or specialist about what’s right for you. 

DMARDs and biologic medicines are very effective at reducing pain, controlling inflammation, and protecting joints in inflammatory arthritis. However, because they affect how the immune system works, they also increase the risk of infections. Understanding this helps explain why vaccination planning is an important part of your care. 

The seasonal influenza vaccine doesn’t just reduce the risk and severity of ‘the flu’, it also reduces the risk of heart attacks and stroke by about one third (1).  

Some vaccines are funded for people with autoimmune conditions or those taking (or about to start) immunosuppressant medicines such as DMARDs or biologics. Flu vaccines are funded for people with autoimmune diseases. Since July 2024, the shingles vaccine has also been funded for people taking DMARDs for conditions such as polymyalgia rheumatica, systemic lupus erythematosus, or rheumatoid arthritis — even if you are not 65 years old. 

If your rheumatologist is planning to start you on DMARDs or biologics, it can be helpful to talk with your specialist about which vaccines you might need beforehand. If you are already taking these medicines, your GP or rheumatology team can guide you on which vaccines are recommended and the best timing alongside your treatment. 

With inflammatory arthritis, the immune system becomes overactive and mistakenly attacks the joints, leading to ongoing inflammation and potential long‑term damage. DMARDs work by calming this immune response, which helps prevent joint damage but also reduces the body’s ability to fight infections. This effect is called immunosuppression and is a normal part of how these medicines work. 

Biologics are a newer type of DMARD that target specific parts of the immune system rather than suppressing it broadly. Even though they are more targeted, biologics still interfere with normal immune responses and increase infection risk. 

People living with inflammatory arthritis already have a higher chance of infections (2). DMARDs and biologics can increase this further, and infections may feel more severe or take longer to recover from.  For this reason, it is important to report signs of infection early, avoid close contact with people who are unwell, and keep vaccinations up to date. 

Vaccines work best when the immune system is fully active. Wherever possible, having recommended vaccines before starting DMARDs or biologics helps build stronger and longer‑lasting protection.

Many vaccines, including flu, COVID‑19, and pneumococcal vaccines, are safe while on treatment, though responses may be weaker and booster doses may be needed (3).

Some vaccines, known as live vaccines (like MMR), are usually not recommended while using DMARDS or biologics.  If one is needed, your GP or specialist can help guide the safest approach. 

DMARDs and biologics play an important role in protecting joints and controlling inflammatory arthritis. Because they affect the immune system, it can be helpful to think about, infection prevention and vaccination as part of your overall care.  Talking with your GP or rheumatology team can help you decide what’s right for you.