Protect Against the Flu When You Have Psoriatic Arthritis

People with autoimmune diseases are more vulnerable to infections, including the flu. Find out how to protect yourself.

woman getting vaccine
Getting a yearly flu shot is key when you have psoriatic arthritis.Getty Images

The flu is unpleasant for anyone, but if you have?psoriatic arthritis (PsA),?an autoimmune disorder and inflammatory form of arthritis, you may be more susceptible to catching a virus and also be at a higher risk for developing complications.

“Psoriatic arthritis does increase the risk of getting the flu and COVID 19 — presumably because the immune system of someone with PsA is impaired because it is preoccupied with attacking itself,” says?Stuart Kaplan, MD, chief of rheumatology at Mount Sinai South Nassau Hospital in Oceanside, New York.

Plus, because some people with moderate to severe PsA take medication that suppresses their overactive immune systems — such as?disease-modifying anti-rheumatic drugs (DMARDs) and biologics?— they’re at higher risk for flu infection, says?Eric Ruderman, MD, a professor of medicine (rheumatology) at Northwestern University Feinberg School of Medicine in Chicago.

People with inflammatory forms of arthritis, according to the Centers for Disease Control, may be more likely to develop complications from the flu, including sinus and ear infections, bronchitis, and pneumonia.

Don’t Skip Your Vaccinations

Despite the potentially serious risks, and the fact that rheumatologists consistently urge those with any rheumatic disease to get an annual?flu shot, not everyone who has PsA does.

Research published in Rheumatology International?noted that some people with autoimmune rheumatic diseases are concerned about possible side effects, doubt the flu shot will be helpful, or haven’t been made aware that getting an annual flu shot was important. However, these researchers found that during the COVID-19 pandemic, the rate of annual flu vaccination in people with autoimmune rheumatic diseases rose from 76 to just over 83 percent.

While some people with PsA may worry about experiencing a flare after vaccination, these researchers also found that this happened in less than 0.7 percent of cases, consistent with other studies that have shown flu vaccination didn’t affect disease activity in people with autoimmune rheumatic diseases.

And a study published in the?Journal of Psoriasis and Psoriatic Arthritis?noted that while “psoriasis patients have exhibited a lower likelihood of receiving the influenza vaccine compared with patients with similar chronic diseases, despite recommendations for patients with psoriasis to follow vaccination recommendations,” those who got the?flu shot?were more likely to get the COVID-19 vaccine.

It’s especially important for people with PsA to stay up-to-date with COVID-19 vaccines because, as research has?found, people with?rheumatic diseases, including PsA, have a higher mortality rate from?COVID-19 infection?than the general population does.

Rheumatoid Arthritis and Psoriatic Arthritis: The Similarities and Differences

Rheumatoid Arthritis and Psoriatic Arthritis: The Similarities and Differences

Make the Flu Shot an Annual Habit

Getting a flu vaccine should be a yearly tradition if you have PsA, Dr. Ruderman says. The latest guidelines from the American College of Rheumatology (ACR) encourage this, too.

Make sure you get the injectable flu vaccine, not the nasal spray, especially if you are taking biologic therapy or strong immunosuppressive therapy, Ruderman says. The reason: The inhaled flu vaccine contains live viruses, which could make you sick if you are immune-compromised because you have PsA; by contrast, the injected flu vaccine contains the inactivated (or killed) strains of the virus, so it won’t make you ill.

Certain medications taken for PsA, such as methotrexate, can make the vaccine less effective. So the ACR recommends that you hold off taking methotrexate for two weeks after vaccination, if disease activity allows. Continuing immunosuppressive medications other than methotrexate around the time of influenza vaccination is conditionally recommended by the ACR.

Should You Ask for a High-Dose Flu Shot?

Talk to your doctor about whether you should get a high-dose influenza vaccine. The ACR guidelines suggest that people with rheumatic diseases who are 65 or older or those between ages 18 and 65 who are on immunosuppressive medication (which includes most PsA meds) get a high-dose influenza vaccine.

If you have PsA, “it makes sense to aim for the highest antibody levels possible with the high-dose vaccine if it’s available,” Dr. Kaplan says. “If it’s not, the standard vaccine is certainly better than nothing.”
Dosage issues aside, the sooner you get the influenza vaccine, the better, because it?takes about two weeks?for the shot to give you optimal protection against the flu.

(The seasonal flu shot is usually available from September or October through the winter months.)

Keep Up Other Flu-Fighting Measures

Don’t let your flu-protection efforts end with the shot. You can take?additional steps?to protect yourself from the flu as well as from?COVID-19:

  • Wash your hands?or use?alcohol-based hand sanitizers?regularly, making sure always to do so before you eat.
  • Avoid touching your mouth or eyes throughout the day, because this is often how germs enter your body.
  • Keep your distance from people who are noticeably sick. Assume the flu is out there and act accordingly.

Measures such as social distancing and mask wearing, widespread during the pandemic, “absolutely help prevent spread of any virus, not just COVID-19,” Ruderman says.

What About COVID-19 and Other Immunizations?

The short answer is: You should get them. According to the CDC, you can get the flu shot at the same time as your COVID-19 vaccine booster or other vaccines.

The injections should be given in different sites, separated by at least an inch if you’re having them on the same arm.

The CDC advises that people 65 and over receive one additional dose of any updated COVID-19 vaccine at least four months following the previous dose of updated COVID-19 vaccine.

In addition, the latest guidelines from the ACR advise people with PsA who are under age 65 and on immunosuppressive medication to get the pneumococcal vaccination (to protect against pneumonia) and those with PsA who are over 18 and taking immunosuppressive medication to get the recombinant zoster vaccine?for?shingles.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.


  1. FAQs About Arthritis. Centers for Disease Control and Prevention. October 4, 2023.
  2. Fragoulis GE et al. Increased Influenza Vaccination Rates in Patients with Autoimmune Rheumatic Diseases During the COVID-19 Pandemic: A Cross-Sectional Study. Rheumatology International. March 4, 2021.
  3. Gondo GC et al. Likelihood of COVID-19 Vaccination Among Individuals Living With Psoriatic Disease: Results From a Large Real-World Survey. Journal of Psoriasis and Psoriatic Arthritis. 2022.
  4. Al-Adhoubi NK et al. COVID-19 Mortality in Patients with Rheumatic Diseases: A Real Concern. Current Rheumatology Reviews. 2022.
  5. Bass AR et al. 2022 American College of Rheumatology Guideline for Vaccinations in Patients with Rheumatic and Musculoskeletal Diseases. Arthritis Care and Research. March 2023.
  6. Key Facts About Seasonal Flu Vaccine. Centers for Disease Control and Prevention. August 25, 2023.
  7. Interim Clinical Considerations for Use of COVID-19 Vaccines in the United States. Centers for Disease Control and Prevention. March 1, 2024.
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