Prevention

Patients with autoimmune rheumatic diseases are at higher risk of vaccine-preventable infections, yet coverage for influenza and pneumococcal vaccines is still poor. This Nature Reviews Rheumatology article argues that commonly used vaccines are safe, that flares and new autoimmune disease after vaccination are uncommon, and that real-world data show protection even when antibody responses are blunted. The main problems are timing around methotrexate, rituximab and obinutuzumab, CAR T cells and bispecific T cell engagers, the avoidance of live vaccines, and the hesitancy that keeps uptake low.

Five-year data from the TREAT EARLIER trial show that a time-limited intervention (one glucocorticoid injection plus 12 months of methotrexate) in clinically suspect arthralgia produced durable benefit in ACPA-negative individuals at increased risk — RA in 9% vs 32%, NNT 4 — but nothing lasting in ACPA-positive individuals, splitting the at-risk phase into two diseases with two different answers.