Rheumatoid Arthritis — SCE Rheumatology MCQ

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EasyRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

A 63-year-old woman with rheumatoid arthritis takes methotrexate. She has received this season’s inactivated influenza vaccine. Her vaccination record confirms that she has never received pneumococcal vaccination. She has no travel plans or other specific exposure risks. Which additional vaccine should be offered as part of her routine vaccination assessment?

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Correct answer: E — 20-valent pneumococcal conjugate vaccine (PCV20)

The correct answer is E. In the UK, immunosuppression due to disease or treatment is an indication for pneumococcal vaccination, and the current at-risk programme uses PCV20. This is a non-live vaccine and can be administered during methotrexate treatment. Pneumococcal vaccination is also strongly supported in adults with autoimmune inflammatory rheumatic disease alongside annual influenza vaccination. Oral typhoid, BCG, live attenuated influenza and yellow fever vaccines are live vaccines and are not routine vaccines for this patient; moreover, typhoid and yellow fever vaccination would only arise in a relevant travel setting. Live vaccines are not simply universally prohibited with every DMARD regimen, but require individual assessment and are not the indicated routine intervention here.

Reference: UK Health Security Agency. Pneumococcal vaccination programmes for infants, adults and individuals at increased clinical risk, updated 13 April 2026. https://www.gov.uk/government/collections/pneumococcal-vaccination-programme