Can You Get the Shingles Vaccine With Rheumatoid Arthritis?

The Centers for Disease Control and Prevention (CDC) recommends that older and immunocompromised adults get two doses of Shingrix (the recombinant zoster vaccine, or RZV) to prevent shingles and related complications. Some people with rheumatoid arthritis (RA) may worry that vaccines like Shingrix will make their symptoms worse.

Rheumatoid arthritis is a chronic medical condition that causes swelling, inflammation, loss of mobility, stiffness, and pain in the joints. RA is an autoimmune disorder, which means that it causes the body’s immune system to “overreact” and attack its own healthy cells.

RA increases the risk of many other medical conditions, including shingles. Shingles (herpes zoster, or HZ) is a medical condition caused by a reactivation of the varicella-zoster virus (VZV)—the same virus that causes chicken pox. Shingles leads to a painful, blistering rash that spreads and scabs over in about seven to 10 days. 

Man with rheumatoid arthritis getting shingles vaccine

SDI Productions / Getty Images

Learn more about RA and the shingles vaccine, including benefits, risks, official recommendations, and medication complications.

Shingles Complications

People over age 50 and immunocompromised people are especially at risk of developing long-term complications from shingles, such as postherpetic neuralgia (PHN). PHN causes severe, long-term nerve pain in the area of the shingles rash. In rare cases, shingles can lead to pneumonia, hearing loss, vision problems, encephalitis (brain inflammation), and even death.

Risk of Shingles in RA Patients

Rheumatoid arthritis significantly increases the risk of shingles and related complications. Studies suggest that people with RA have a 1.5 to 2 times higher risk of developing shingles than the general population. 

When people with RA do get shingles, they are also more likely to develop serious medical complications. For example, a 2017 study found that people with RA who contracted shingles were twice as likely to have a stroke in the following months. 

It’s not entirely clear why people with RA are more likely to get shingles. Some people with RA have a weakened immune system, which increases the chance of developing a variety of illnesses and infections. RA flare-ups (times when symptoms worsen) also increase the body’s overall level of inflammation, which has been linked to both shingles and PHN. 

Additionally, many people with RA take immunosuppressants—drugs that work to reduce the body’s natural immune response—to treat their symptoms and prevent flare-ups. Several common rheumatoid arthritis medications have been found to increase the risk of shingles, including:

Can You Get the Shingrix Vaccine With RA?

The CDC currently recommends that most people with RA and other autoimmune conditions get Shingrix, especially because of their significantly higher risk of shingles. According to the American College of Rheumatology (ACR), the benefits of vaccination for people with rheumatoid arthritis usually far outweigh the relatively minor risks. 

Recent research suggests that Shingrix is safe and effective in preventing shingles in people with RA. A 2021 study found that Shingrix was over 90% effective among people with RA and other autoimmune and inflammatory conditions.

Meanwhile, a 2020 study indicated that reports of flare-ups from patients with RA were rare after two doses of the shingles vaccine.

Exclusion From Clinical Trials

People with RA and other autoimmune disorders were excluded from the initial clinical trials for Shingrix.

Additionally, a handful of case reports have indicated that the shingles vaccine may increase the risk of overactive inflammatory responses. This has led some people with RA to worry about the risk of side effects from the shingles vaccine.

However, larger studies indicate that Shingrix is safe and effective for most people with autoimmune disorders. One 2021 study found that Shingrix was effective in preventing both shingles and PHN, even among immunocompromised people and people over 80 years old. 

Shingrix Ingredients

Shingrix is a recombinant vaccine. This means that its active ingredient is a small part of the germ that causes the herpes zoster virus. It also contains an adjuvant—an ingredient that boosts the long-term effectiveness of a vaccine.

Shingrix replaced Zostavax (zoster vaccine live), which hasn’t been in use in the United States since 2020. Zostavax is a live vaccine. Live vaccines contain a weakened version of a virus—in this case, herpes zoster. Live vaccines are generally not recommended for people who are taking immunosuppressive drugs. 

Shingrix Side Effects

Most people experience at least some side effects from the shingles vaccine. Some of the most common Shingrix side effects include:

  • Redness, pain, and/or swelling at the injection site
  • Muscle pain
  • Fever
  • Headache
  • Nausea
  • Stomach pain
  • Fatigue
  • Chills

Most of the side effects from Shingrix are relatively mild and go away on their own within about two to three days. 

If you experience symptoms of a severe allergic reaction after getting Shingrix—such as difficulty breathing, hives, a rapid heartbeat, or swelling in the face or tongue—you should seek emergency medical assistance.

Potential RA Medication Complications

Many of the medications that are prescribed to manage RA symptoms work by suppressing inflammation and the immune response. In some cases, immunosuppressants can make vaccines less effective. 

If you take immunosuppressive drugs to treat rheumatoid arthritis, here’s what you should know about getting Shingrix:

  • People who are taking low-dose immunosuppressive drugs to treat RA or any other condition should usually get Shingrix.
  • If you’re about to start taking an immunosuppressant, it’s best to get the shingles vaccine a few weeks before your first dose, if possible.
  • If you’re taking a moderate or high dose of an immunosuppressive medication to manage RA, talk to your healthcare provider about getting Shingrix. They may decide to delay your next dose of the shingles vaccine.

Where the FDA and CDC Stand

According to the CDC, people ages 50 and up and immunocompromised adults ages 19 and older should get two doses of Shingrix to prevent shingles, PHN, and other possible complications. Shingrix is effective and safe for most people, including people with autoimmune disorders.

The CDC currently recommends that people with chronic medical conditions, such as RA, get the shingles vaccine. Additional CDC guidelines for people with autoimmune conditions are as follows:

  • Shingrix is usually delivered in two doses, two to six months apart. If you are immunocompromised, your healthcare provider may suggest that you get your second Shingrix dose after just one to two months instead.
  • It’s usually best to wait until your symptoms are well-controlled to get Shingrix. If you’re currently having a severe RA flare-up, you should typically wait until you feel better to get the shingles vaccine.
  • If you’re taking immunosuppressants to manage RA symptoms, talk to your healthcare provider about the vaccine schedule that works best for you.

The Food and Drug Administration (FDA) approved the use of Shingrix in 2017 for people ages 50 and older. In 2019, the FDA approved Shingrix for immunocompromised adults ages 18 and older. The FDA hasn’t yet issued any specific guidelines about Shingrix and RA.

Shingles Vaccine Alternatives

Shingrix is currently the best way to protect yourself against shingles and serious potential complications. However, if you have RA and don’t plan to get the shingles vaccine, here are a few ways to lower your shingles risk:

  • Manage your stress: Uncontrolled stress can trigger both rheumatoid arthritis flare-ups and shingles. Manage your stress level with relaxation techniques, breathing exercises, and the help of a mental health therapist if needed.
  • Exercise moderately: When your RA symptoms are under control, you’re less likely to develop other medical conditions, including shingles. Excessive physical activity can lead to RA flare-ups. However, regular moderate exercise can promote your health and prevent your symptoms from acting up.
  • Avoid infections: You’re more at risk of developing shingles when your immune system is compromised. Avoid infections and illnesses by washing your hands on a regular basis, getting plenty of sleep, and eating nutritious foods.


Rheumatoid arthritis (RA) is an autoimmune and inflammatory condition that causes chronic pain, swelling, and loss of mobility in the joints. People with RA have a higher risk of developing many different medical conditions, including shingles (herpes zoster)—a painful, blistering rash caused by the same virus that causes chicken pox. 

Shingrix (the recombinant zoster vaccine) is a shot that helps to prevent shingles and shingles-related complications, such as postherpetic neuralgia (PHN), in older and immunocompromised adults. People age 50 and older and immunocompromised people age 19 and older should get two doses of Shingrix. 

While people with RA were not included in the initial clinical trials for Shingrix and there is no evidence specifically related to RA and vaccine safety, the vaccine has been shown to be safe in people with other autoimmune conditions. People with RA should usually get Shingrix, even if they are taking a low-dose immunosuppressive medication to treat their symptoms. Recent research suggests that Shingrix is effective and safe for people with RA.

A Word From Verywell

If you have rheumatoid arthritis, you have a significantly higher risk of getting shingles and Shingrix can help to protect your health. Talk to your healthcare provider if you’re worried about medication complications, potential side effects, or anything else about the shingles vaccine.

Frequently Asked Questions

  • Does Shingrix trigger RA pain?

    A few isolated reports suggest that people experienced rheumatoid arthritis flare-ups after getting Shingrix. However, larger studies suggest that post-Shingrix RA flare-ups are rare and that the shingles vaccine is effective for people with RA.

    Because people with RA and other autoimmune disorders are especially at risk of developing shingles and related complications, the CDC recommends that they get two doses of Shingrix.

  • How does shingles affect the immune system?

    Shingles is often linked to a weakened immune system. People whose immune systems are compromised by a disease or medication are significantly more likely to get shingles and shingles-related complications. Stress, infections, aging, and even minor illnesses can also lower your immune function and increase the risk of getting shingles.

  • Can shingles cause autoimmune disease?

    It’s not entirely clear whether shingles can increase your risk of getting an autoimmune disorder. However, research suggests that the opposite is often true—that having an autoimmune condition increases your risk of getting shingles.

    People with rheumatoid arthritis are about 1.5 to 2 times more likely to get shingles than the general population. They’re also more likely to experience complications after contracting shingles.

29 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Shingrix shingles vaccination: what everyone should know.

  2. Stevens E, Weinblatt ME, Massarotti E, Griffin F, Emani S, Desai S. Safety of the zoster vaccine recombinant adjuvanted in rheumatoid arthritis and other systemic rheumatic disease patients: a single center's experience with 400 patientsACR Open Rheumatol. 2020;2(6):357-361. doi:10.1002/acr2.11150

  3. MedlinePlus. Rheumatoid arthritis.

  4. Centers for Disease Control and Prevention. Rheumatoid arthritis.

  5. Redeker I, Albrecht K, Kekow J, et al. Risk of herpes zoster (shingles) in patients with rheumatoid arthritis under biologic, targeted synthetic and conventional synthetic DMARD treatment: data from the German RABBIT registerAnn Rheum Dis. 2022;81(1):41-47. doi:10.1136/annrheumdis-2021-220651

  6. MedlinePlus. Shingles (herpes zoster).

  7. Centers for Disease Control and Prevention. Signs and symptoms of shingles (herpes zoster).

  8. Centers for Disease Control and Prevention. Complications of shingles.

  9. Calabrese LH, Abud-Mendoza C, Lindsey SM, et al. Live zoster vaccine in patients with rheumatoid arthritis treated with tofacitinib with or without methotrexate, or adalimumab with methotrexate: a post hoc analysis of data from a phase IIIb/IV randomized studyArthritis Care Res (Hoboken). 2020;72(3):353-359. doi:10.1002/acr.24010

  10. Calabrese LH, Xie F, Yun H, et al. Herpes zoster and the risk of stroke in patients with autoimmune diseasesArthritis Rheumatol. 2017;69(2):439-446. doi:10.1002/art.39855

  11. Yun H, Yang S, Chen L, et al. Risk of herpes zoster in autoimmune and inflammatory diseases: implications for vaccinationArthritis Rheumatol. 2016;68(9):2328-2337. doi:10.1002/art.39670

  12. Maltz F, Fidler B. Shingrix: a new herpes zoster vaccineP T. 2019;44(7):406-433.

  13. NHS. Rheumatoid arthritis - treatment.

  14. Segan J, Staples MP, March L, Lassere M, Chakravarty EF, Buchbinder R. Risk factors for herpes zoster in rheumatoid arthritis patients: the role of tumour necrosis factor-α inhibitorsIntern Med J. 2015;45(3):310-318. doi:10.1111/imj.12679

  15. Sunzini F, McInnes I, Siebert S. JAK inhibitors and infections risk: focus on herpes zosterTher Adv Musculoskelet Dis. 2020;12:1759720X20936059. doi:10.1177/1759720X20936059

  16. Papp KA, Haraoui B, Kumar D, et al. Vaccination guidelines for patients with immune-mediated disorders on immunosuppressive therapiesJ Cutan Med Surg. 2019;23(1):50-74. doi:10.1177/1203475418811335

  17. American College of Rheumatology. ACR vaccine information for members to share with patients.

  18. Dagnew AF, Rausch D, Hervé C, et al. Efficacy and serious adverse events profile of the adjuvanted recombinant zoster vaccine in adults with pre-existing potential immune-mediated diseases: a pooled post hoc analysis on two parallel randomized trialsRheumatology (Oxford). 2021;60(3):1226-1233. doi:10.1093/rheumatology/keaa424

  19. Heydari-Kamjani M, Vante I, Uppal P, Demory Beckler M, Kesselman MM. Uveitis sarcoidosis presumably initiated after administration of Shingrix vaccineCureus. 2019;11(6):e4920. doi:10.7759/cureus.4920

  20. Izurieta HS, Wu X, Forshee R, et al. Recombinant zoster vaccine (Shingrix): real-world effectiveness in the first 2 years post-licensureClin Infect Dis. 2021;73(6):941-948. doi:10.1093/cid/ciab125

  21. Department of Health and Human Services. Vaccine types.

  22. Centers for Disease Control and Prevention. Adjuvants and vaccines.

  23. Centers for Disease Control and Prevention. What everyone should know about Zostavax.

  24. Cao Y, Zhao D, Xu AT, Shen J, Ran ZH. Effects of immunosuppressants on immune response to vaccine in inflammatory bowel diseaseChin Med J (Engl). 2015;128(6):835-838. doi:10.4103/0366-6999.152683

  25. Centers for Disease Control and Prevention. Clinical considerations for use of recombinant zoster vaccine (RZV, Shingrix) in immunocompromised adults aged >19 years.

  26. Centers for Disease Control and Prevention. Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines.

  27. Food and Drug Administration. Shingrix.

  28. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Rheumatoid arthritis: diagnosis, treatment, and steps to take.

  29. Food and Drug Administration. Clinical review, October 20, 2017 - Shingrix.