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Seasonal Flu Information for Rheumatology Health Professionals

Are my patients with inflammatory arthritis and rheumatic diseases at high risk for influenza?

  • People with immunosuppression, either from their medical condition (e.g. inflammatory rheumatic disease) or due to medications, are at high risk for influenza infection and related complications.
  • Medications that can weaken the immune system and increase the risk of influenza-related complications include corticosteroids, disease modifying anti-rheumatic drugs (DMARDs), and biological response modifiers.
  • Although the exact type and severity of immune dysfunction that correlates with risk of influenza-associated complications has not been well defined, patients with more severe immunosuppression are predisposed to serious complications such as prolonged or increased severity of illness.
  • CDC estimates that almost 6 million adults may be at risk for influenza-related complications because they have inflammatory rheumatic disease.
  • People with osteoarthritis are likely not at increased risk for influenza-related complications unless they also have another high risk condition such as asthma, diabetes, heart disease, or cancer.

Rheumatological* diagnoses considered at high risk for influenza-related complications

  • Rheumatoid arthritis (RA)
  • Systemic lupus erythematosus (SLE)
  • Psoriatic arthritis
  • Anti-phospholipid syndrome
  • Polymyalgia rheumatica
  • Systemic sclerosis/scleroderma
  • Spondyloarthropathies
  • Sjögren’s syndrome
  • Polymyositis/dermatomyositis
  • Vasculitis (e.g., giant cell arteritis)
  • Necrotising arteritis
  • Sarcoidosis
  • Polyarteritis nodosa

* Influenza-related complications have not been examined for all listed conditions, but persons with these conditions have immunosuppression either due to their illness or the medications used to treat their condition.

Should I advise my patients to get a flu shot?

Yes. Children and adults with inflammatory rheumatic disease should be advised to receive:

  • A seasonal flu shot every year.
  • Persons with inflammatory rheumatic disease should receive the inactivated influenza vaccine which contains fragments of killed influenza virus and is given by an injection.
  • The live attenuated influenza vaccines (e.g., FluMist®) which are administered by a nasal spray are not recommended in persons with immunosuppression (including persons with inflammatory rheumatic disease).
  • The optimal timing of influenza vaccination for patients taking biologic response modifying medications is unknown. However, generally patients treated with rituximab, influenza vaccine should ideally be administered before initiation of therapy.

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What else should I tell my patients with inflammatory rheumatic disease who develop flu-like symptoms?

  • If you develop flu-like symptoms contact your healthcare provider.
  • Avoid contact with others. Seek medical care early. You should stay home and avoid travel, including not going to work or school, until at least 24 hours after your fever is gone except to get medical care or necessities. Your fever should be gone without using fever-reducing medications.
  • If you leave the house to seek medical care, wear a facemask, if available and tolerable, and cover your coughs and sneezes with a tissue.
  • Do not stop taking any medicine you take for your arthritis unless told to do so by your physician.
  • Seek medical attention early. Treatment is available for persons with severe disease and those at high risk for complications. Persons with inflammatory rheumatic disease are considered high risk for complications from the flu; therefore, your health care provider may choose to prescribe antiviral medications for you if you get the flu.
  • If you are exposed to someone who has flu, consult your health care provider. They may prescribe medication to help prevent you from getting the flu or watch you closely to see if you develop flu symptoms.

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Should I prescribe antiviral medications for my patients with inflammatory rheumatic disease and suspected influenza?

  • Clinical judgment is an important factor in treatment decisions. Most patients who become infected with influenza have a mild, self-limiting, respiratory illness and recover without further treatment.
  • Early empiric treatment with antiviral medications (e.g., oseltamivir or zanamivir) should be considered for persons with suspected or confirmed influenza who are at higher risk for complications including patients with inflammatory rheumatic disease.
  • Detailed antiviral treatment recommendations are available at:

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Do rheumatology health professionals need to get a flu shot?

Yes. CDC recommends all healthcare providers receive a seasonal influenza vaccine every year.

  • Healthy persons (including healthcare providers) who are infected with influenza virus, including those with subclinical infection, can transmit influenza virus to persons at higher risk for complications from influenza, such as patients with inflammatory rheumatic disease.
  • Persons working in healthcare settings who should be vaccinated include physicians, nurses, other workers in both hospital and outpatient settings, medical emergency-response workers, employees of nursing home and long-term care facilities who have contact with patients or residents, and students in these professions who will have contact with patients.

For more information:

Flu and Arthritis (For Patients)

CDC General Influenza Information

Arthritis Foundation Flu: What People with Arthritis Should Know

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