Patients With RA Less Likely to Receive Influenza Vaccination


Influenza vaccination rates remain low within patients with rheumatoid arthritis. Investigators urge rheumatologists to encourage vaccination acceptance as a part of routine care.

Rates of influenza vaccination coverage in patients with early rheumatoid arthritis (RA) are below national targets of adults living with other chronic conditions, even though they are at a higher risk of influenza and related complications, according to a study published in Open Rheumatology.1

“Despite the large variability in coverage between and within countries, influenza vaccination coverage is still generally low, making it essential to improve vaccination acceptance as part of RA care,” investigators stated. “Identifying characteristics related to vaccination hesitancy can help target interventions to vulnerable patients.”

Patients enrolled in the Canadian Early Arthritis Cohort (CATCH) registry between September 2017 and February 2021 were included in the study. Eligible patients volunteered vaccination status from the previous year and completed a Beliefs About Medicines Questionnaire (BMQ), including the Necessity-Concerns Differential (NCD). Clinical characteristics were analyzed via medical records and predictors of vaccination were identified through logistic regression. Sociodemographic information, vaccination status, and medication usage was accounted for.

A sample of 431 patients (80% White, 67% women) with a mean age of 56 years was evaluated. Of the sample, 71% completed the BMQ and had information regarding the previous year’s influenza vaccination status. Before being diagnosed with RA, influenza vaccine rates were 38%. Post diagnosis, this increased to 46% (n = 105). Of the 105, 66% reported vaccination prior to diagnosis of RA.

Patients who had a history of previous influenza vaccination (odds ratio [OR] 15.33; 95% confidence interval [CI] 6.37-36.90), those who were on biologics or Janus kinase (JAK) inhibiting drugs (OR 5.42; 95% CI 1.72-17.03), and those who had a higher BMQ NCD score at baseline (OR 1.08; 95% CI 1.02-1.15) were more likely to receive the vaccine. Additional factors that increased these odds were older age and patients who had comorbidities, such as hypertension, diabetes, cancer, and cardiovascular disease.

The most common concerns in the BMQ Necessity scale were worries about RA medication, long-term safety, and dependency on RA medications.

Conversely, women (OR 0.32; 95% CI 0.14-0.71), participants with a non-White racial background (OR 0.13; 95% CI 0.04-0.51), and participants who identified as current smokers (OR 0.09; 95% CI 0.02-0.37) were less likely to have vaccination coverage.

The main strength of the study included the well-characterized cohort of individuals with early RA. A limitation was that vaccination status was self-reported. While many organizations rely on self-reported data, this may create an overestimation of actual amounts by up to 10%. However, while post diagnosis information was incomplete, characteristics between both included and excluded groups were comparable.

“Similar to patients with established RA, our results indicate that influenza vaccination coverage in patients with early RA remains suboptimal,” investigators concluded. “Having conversations about the vaccination history and attitudes toward RA medications and influenza vaccination offers a potential opportunity to increase both RA medication adherence and vaccine uptake in adults with newly diagnosed RA.”


Ta V, Schieir O, Valois MF, et al. Predictors of Influenza Vaccination in Early Rheumatoid Arthritis 2017-2021: Results From the Canadian Early Arthritis Cohort [published online ahead of print, 2022 Mar 29]. ACR Open Rheumatol. 2022;10.1002/acr2.11427. doi:10.1002/acr2.11427

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