Factors That Influence Flu Vulnerability
“Psoriatic arthritis does increase the risk of getting the flu and COVID 19 — presumably because the immune system of someone with PsA is impaired because it is preoccupied with attacking itself,” says Stuart Kaplan, MD, chief of rheumatology at Mount Sinai South Nassau Hospital in Oceanside, New York. Plus, because some people with moderate to severe PsA take medication that suppresses their overactive immune systems — such as disease-modifying anti-rheumatic drugs (DMARDs) and biologics — they’re at higher risk for flu infection, Dr. Ruderman says. Meanwhile, the infection itself can trigger flares of psoriasis, according to the National Psoriasis Foundation.
Don’t Skip Your Flu Shot or COVID-19 Booster
And yet despite these potentially serious risks and the fact that rheumatologists consistently urge those with any rheumatic disease to get an annual influenza vaccination, not everyone who has PsA does. In a study presented at the 2018 annual meeting of the American College of Rheumatology, researchers found that only 53 percent of 526 patients with psoriatic arthritis had “ever” received the influenza vaccine and only 30 percent had been vaccinated in the previous two flu seasons. Research published in the Journal of Psoriasis and Psoriatic Arthritis found similar levels of vaccine hesitancy for the COVID-19 vaccine among those with PsA — but those who got the flu shot were more likely to get the COVID-19 vaccine. It’s especially important for people with PsA to stay up-to-date with COVID-19 vaccines because, as a study in Current Rheumatology Reviews found, people with rheumatic diseases, including PsA, have a higher mortality rate from COVID-19 infection than the general population does.
Schedule a Flu Shot ASAP
Getting a flu vaccine should be an annual tradition if you have PsA, Ruderman says, so if your doctor doesn’t broach the subject, you should. Indeed, the 2019 guidelines from the European League Against Rheumatism (EULAR) suggest that the influenza and pneumococcal vaccines “should be strongly considered for the majority of patients with AIIRD,” short for autoimmune inflammatory rheumatic diseases such as PsA. As the 2019 EULAR guidelines notes, “vaccination is particularly important in AIIRD patients, potentially translating into a lower rate of hospital admissions due to infections, emergency room visits, and the rate of invasive infectious diseases.” Make sure you get the injectable flu vaccine, not the nasal spray, especially if you are taking biologic therapy or strong immunosuppressive therapy, Ruderman says. The reason: The inhaled flu vaccine contains live viruses, which could make you sick if you are immune-compromised because you have PsA; by contrast, the injected flu vaccine contains the inactivated (or killed) strains of the virus, so it won’t make you ill. In fact, a study published in the journal Vaccines found that patients with PsA who were taking a monoclonal antibody (secukinumab) to treat their disease had a similarly strong response rate to the influenza vaccine as a group of healthy controls did — and the people with PsA had no exacerbations of their symptoms after the vaccination. So that concern can be crossed off the worry list!
Should You Ask for a High-Dose Flu Shot?
Talk to your doctor about whether you should get a high-dose influenza vaccine. The 2022 guidelines from the American College of Rheumatology (ACR) suggest that people with rheumatic diseases, such as PsA, who are 65 or older or those between ages 18 and 65 who are on immunosuppresive medication get a high-dose influenza vaccine. If you have PsA, “it makes sense to aim for the highest antibody levels possible with the high-dose vaccine if it’s available,” Dr. Kaplan says. “If it’s not, the standard vaccine is certainly better than nothing.” Dosage issues aside, the sooner you get the influenza vaccine, the better, because it takes about two weeks for the shot to give you optimal protection against the flu. (The flu shot is usually available from September or October through the winter months.)
Keep Up Other Flu-Fighting Measures
Don’t let your flu-protection efforts end with the shot. You can take additional steps to protect yourself from the flu as well as from COVID-19: Wash your hands or use alcohol-based hand sanitizers regularly, making sure always to do so before you eat. Avoid touching your mouth or eyes throughout the day, because this is often how germs enter your body. And steer clear of people who are noticeably sick. Assume the flu is out there and act accordingly. Measures such as social distancing and mask wearing, widespread during the pandemic, “absolutely help prevent spread of any virus, not just COVID-19,” Ruderman says. He points to the fact that there was almost no influenza reported in the United States during the winter of 2020, when many people were taking these precautions.
What Should People With PsA Do About Other Vaccinations, Such as COVID-19 or COVID-19 Booster Shots?
The short answer is: You should get them — and you don’t need to space them out. According to the Centers for Disease Control and Prevention (CDC), you can get the flu shot at the same time as your COVID-19 vaccine booster or other vaccines. The injections should be given in different sites, separated by at least an inch if you’re having them on the same arm. In addition, the latest guidelines from the ACR advise people with PsA who are under age 65 and on immunosuppressive medication to get the pneumococcal vaccination and those with PsA who are over 18 and taking immunosuppressive medication to get the recombinant zoster vaccine for shingles.
