It’s almost flu season and, like many people, you might be planning to get your annual flu shot. Flu and back pain might not seem to have any clear connection, but new research shows that some back pain medications seriously reduce the effectiveness of the flu vaccine.

The seasonal flu vaccine works by exposing your body to small amounts of inactive strains of the influenza virus. Your body then creates antibodies that target and destroy the flu virus. If you’re then exposed to the active strains of those viruses, your body already knows how to fight off those strains of flu. This can help prevent you from getting sick.

Researchers in Sweden, at the Skåne University Hospital in Lund, recently published a study that might cause alarm in anyone taking medications for rheumatoid arthritis or spondyloarthropathy (SpA), both of which can cause back pain and neck pain. According to the results of this study, certain medications for RA and SpA may result in a “severely reduced antibody response to pH1N1 influenza vaccine.”

The drugs investigated in this study appeared to significantly decrease the antibody response to the flu vaccine, which would leave patients with rheumatoid arthritis (RA) or SpA at an increased risk for the flu.


The study noted that the flu vaccine resulted in persistent antibodies against the flu for up to 22 months in people who weren’t taking RA or SpA drugs. Patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics responded to the vaccine in 59% of cases.

In contrast, protective effects of the vaccine were only seen after 8 months in:

  • 53% of patients treated with anti-tumor necrosis factor (TNF) monotherapy
  • 50% of people taking tocilizumab
  • 43% of patients taking anti-TNF plus methotrexate for RA
  • 42% for those taking methotrexate alone
  • 20% of patients with RA or SpA treated with abatacept
  • 10% of patients taking rituximab.

To try to overcome this problem, the researchers looked at the effects of a double dose of the flu vaccine. Administering a double dose can sometimes help trigger a greater immune response. In this case, however, the scientists found no improvement after a double dose of the vaccine in those taking methotrexate or rituximab.

The results of double-dosing were slightly better in patients taking the other medications. For anti-TNF medications and anti-TNF plus methotrexate, 76% and 47% of patients had a protective antibody response.

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What should you do, then, if your back pain is connected to rheumatoid arthritis or spondyloarthropathy? Well, if you’re about to begin taking medications such as rituximab or abatacept it may be best to first get the current vaccine for seasonal flu. This gives your body a better chance to produce a strong antibody response.

If you are already taking these medications for RA or SpA, talk to your physician. You may be able to schedule your flu shot between your rounds of medications, helping improve your chances of protection against the flu and back pain.


Kapetanovic, M.C., Kristensen, L.E., Saxne, T., et al. (2014). Impact of anti-rheumatic treatment on immunogenicity of pandemic H1N1 influenza vaccine in patients with arthritis. Arthritis Res Ther, Jan 2;16(1):R2.