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. 

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

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:

• Disease-modifying antirheumatic drugs (DMARDs), such as Rheumatrex (methotrexate)
• Tumor necrosis factor (TNF) inhibitors, such as Humira (adalimumab)
• Janus kinase (JAK) inhibitors, such as Xeljanz (tofacitinib)
  

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. 

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.
  

Summary

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.