Should You Pause Arthritis Medications for Vaccines? 

Por Linda Rath | 8 de enero de 2026 

Inflammatory autoimmune diseases, like rheumatoid arthritis (RA) and psoriatic arthritis (PsA), and medicines used to treat them weaken the immune system’s ability to fight off infectious diseases like the flu and COVID. That makes it more important for people with these conditions to be vaccinated against infectious diseases. But at the same time, immune-suppressing drugs like methotrexate also make many vaccines less effective, so timing can be key.  

COVID Vaccine 

According to a report by the Infectious Diseases Society of America, the COVID shot is usually about 33% to 56% effective for people with a compromised immune system. Taking a "drug holiday" may increase its effectiveness. 

American College of Rheumatology (ACR) guidelines recommend stopping methotrexate for two weeks after a COVID shot. People who take a break from methotrexate develop significantly more antibodies than those who don't.  

However, a 2024 analysis of four studies involving more than 700 people showed that pausing methotrexate led to many more flares than not pausing it. Any pause in medications should be carefully monitored, and whether to take a methotrexate holiday depends on a patient's age, type of autoimmune disease, drug dose and other factors. This echoes Cleveland Clinic Rheumatologist Cassandra Calabrese, who has cited the challenges of making blanket vaccine recommendations for everyone with a rheumatic disease. Instead, she has said, vaccine decisions should be individualized for each patient. 

Despite limiting COVID vaccines for lower-risk groups, the Centers for Disease Control and Prevention (CDC) in November 2025 encouraged adults 65 and older and immunocompromised people to get two shots of the current vaccine from two to six months apart. Studies show protection fades considerably after four to six months. 

Flu Vaccine  

In early January 2026, the CDC upended long-held flu vaccine guidelines by no longer requiring a flu shot for infants and children. Children may still receive the shot if a doctor recommends it after shared decision-making, according to the CDC. The American Academy of Pediatrics and other major pediatric organizations continue to recommend the flu vaccine for most children.  

The CDC and ACR agree that adults over 65 and people who are immunocompromised should receive an annual high-dose or adjuvanted vaccine. (Adjuvants are substances added to vaccines to make them more effective and generally improve the immune response for most people.)  

Many clinical trials have shown that pausing the disease-modifying antirheumatic drug (DMARD) methotrexate for two weeks after the flu vaccine increases its effectiveness. No other DMARDS need to be paused after the flu vaccine.  

Rituximab (Rituxan, Riabni, Ruxience, Truxima) makes vaccines less effective. Some studies show the flu vaccine is more effective if it’s given around 6 months after rituximab. But timing is tricky because patients receive rituximab once every six months, so there isn’t a specific guideline regarding timing. The best bet is to discuss with your doctor when is the best time to get your flu vaccine if you are receiving rituximab infusions. 

Pneumococcal (Pneumonia) Vaccine 

The CDC recommends a pneumonia shot to protect against serious lung infections, meningitis and sinus, ear and bloodstream infections. ACR recommends the shot for anyone 18 and older who takes immune-suppressing drugs. ACR doesn’t suggest pausing methotrexate after a pneumonia shot, but other experts do, based on recent studies. People taking rituximab should get the vaccination and delay their rituximab infusion for at least two weeks after. Taking a break from biologics like tumor necrosis factor (TNF) blockers and Janus kinase (JAK) inhibitors does not help immune response and can cause disease flares. 

Shingles (Varicella Zoster) Vaccine 

Both the CDC and the ACR recommend the shingles vaccine Shingrix for autoimmune patients starting at age 18. It’s not known whether a second shot is needed when immunity wanes. For those on rituximab, it’s best to get the vaccine and delay their rituximab infusion for at least two weeks after. 

Immunocompromised people can have a sometimes-severe reaction to the adjuvant in Shingrix, including fever and body aches and pains. These may be mistaken for a disease flare, but if they persist more than a week, let your doctor know. The vaccine can also increase the risk of Guillain-Barré syndrome, a serious nerve disorder. Getting the vaccine is important for people with compromised immunity. Those who get shingles have a 36% increased risk of stroke and the strong likelihood of complications.  

Human Papillomavirus Vaccine (HPV) 

The ACR and CDC recommend that young people receive at least one dose of the HPV vaccine between ages 11 and 12, before they're sexually active. Unvaccinated adults are usually offered the vaccine between the ages of 26 and 45. Like other vaccines, it should be received about the time when rituximab is scheduled and delaying rituximab at least two weeks after the shot. There's no need to delay methotrexate or other DMARDs. 

Respiratory Syncytial Virus Vaccine (RSV) 

RSV, a potentially serious lung and respiratory tract infection, was long considered a threat mainly to infants and very young children. Under the new 2026 guidelines, RSV vaccines for infants and young children are no longer recommended unless their mothers weren’t vaccinated during pregnancy. The American Academy of Pediatrics recommends that children 8 to 19 months with “severe immunocompromise” be vaccinated with nirsevimab (Beyfortus) before the start of the second RSV season (October through the end of March in much of the continental U.S.), regardless of whether vaccination occurred during pregnancy or in the child’s first RSV season. 

The Food and Drug Association (FDA) in 2023 and 2024 approved the first adult vaccines for RSV, Abrysvo and Arexvy. The recommendation right now is for one dose only for high-risk groups, but since immunity fades considerably after one year, it’s likely a second dose may be needed. Older adults with heart or lung disease or weakened immune systems are considered at higher risk. As many as 180,000 adults over age 50 are hospitalized with RSV every year. 

The vaccines are too new to know about delaying medication after the shot, but experts suspect recommendations may be similar to those for flu or pneumonia. In 2025, the FDA warned about an increased risk of Guillain-Barré with Abysvo and Arexvy, and the vaccine is no longer recommended for healthy, low-risk adults. 

Measles, Mumps & Rubella (MMR) or Measles, Mumps, Rubella and Varicella (MMRV) Vaccines 

The CDC's Advisory Committee on Vaccine Practices in September 2025 changed the schedule for the measles vaccine, recommending that children under age 4 no longer receive the combination MMRV shot. Kids over age 4 can still get the MMRV combination vaccine. CDC officials cited the slightly increased risk of febrile seizures in younger kids after the MMRV shot. The advantage of combined vaccines is that kids need fewer injections. 

Both shots available in the U.S. contain live attenuated (weakened) viruses, and the ACR in 2022 recommended against live vaccines for anyone with a weakened immune system, including kids and adults who take DMARDs for autoimmune diseases. Even a small amount of live virus can lead to serious illness.  

If you must receive a live vaccine, here are some general guidelines: 

• Pause corticosteroids, methotrexate, and other DMARDs four weeks before and four weeks after a live vaccine.  

• Pause Janus kinase (JAK) inhibitors (tofacitinib, baricitinib, upadacitinib) one week before and four weeks after a live attenuated vaccine. 

• Discontinue biologics, like tumor necrosis factor (TNF) blockers, for one medication cycle before and four weeks after a live vaccine. (A medication cycle is how often you get the medication, such as every two weeks or once a month.) 

During 2025 and the first part of 2026, the U.S. recorded 2,000 measles cases - the highest in more than a decade. If you're unvaccinated and have been exposed to measles, getting an immunoglobulin shot within six days can help fight the infection.  

Because your arthritis makes you vulnerable, take extra measures to protect yourself from measles and other infectious diseases — especially if can’t get vaccinated — like avoiding crowds where you might be exposed to measles and washing your hands frequently.