Prior to initiating immunosuppressive therapy for inflammatory arthritis, which vaccines should be updated?

• A. Vaccination status should be updated, including influenza and pneumococcal vaccines, and TB screening
• B. Only influenza vaccine
• C. No vaccines needed
• D. Only hepatitis B vaccine

Answer: (A)

Immunosuppressive therapy increases the risk of infections and can blunt the effectiveness of vaccines given after starting treatment, so protection should be optimized beforehand. The best approach is to ensure up-to-date non-live vaccines and screen for infections that could flare if untreated. Influenza vaccination should be updated each year because flu can be particularly severe in people with inflammatory arthritis. Pneumococcal vaccination is also important to reduce the risk of pneumococcal pneumonia and other invasive pneumococcal diseases, which can be more dangerous when immunity is suppressed. Screening for latent tuberculosis is essential because several immunosuppressive drugs, especially TNF inhibitors, can reactivate TB; identifying and treating latent TB before starting therapy lowers this risk. While hepatitis B vaccination may be indicated for those with non-immune status or risk factors, the combination of updating influenza and pneumococcal vaccines plus TB screening covers the core pre-treatment protections.