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Rheumatoid arthritis and vaccination — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRheumatological PharmacologyRheumatoid arthritis and vaccinationSCE Rheumatology

A 60-year-old woman with rheumatoid arthritis is due to start rituximab in 4 weeks. She has not received pneumococcal or shingles vaccination and has no acute infection. Current treatment is prednisolone 5 mg and methotrexate. She asks when vaccines should be addressed. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Give indicated vaccines before rituximab where feasible

Explanation lettering: C = shown as A · A = shown as B · E = shown as C · B = shown as D · D = shown as E

Give indicated vaccines before rituximab where feasible is best because vaccine responses are better before rituximab and indicated vaccines should be updated before B-cell depletion when possible. B is less suitable because RA and immunosuppression increase rather than remove vaccination need; C is less suitable because vaccinating immediately after rituximab may produce poor responses; D is less suitable because antibiotics do not replace vaccination; E is less suitable because live vaccines are generally avoided during significant immunosuppression. Clinical pearl: pre-biologic checks include immunisation status, not just blood tests.

Reference: BSR bDMARD safety guideline 2019; BSR csDMARD guideline 2025