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Hi all. I started sulfasalazine in mid March (1g/day) and started methotrexate 10 July (started 10mg, tapering up to target of 20mg) due to a flare.

Currently on 30mg prednisilone tapering down to 20 > 10 > 0.

I'm travelling this Friday and went to my GP who is aware of the above and advised to get vaccinated as I'm at a risk, travelling South East Asia.

So got vaccinated and the nurse agreed and said she would have insisted on me being vaccinated.

Vaccine 1 - Hepatyrix injection

Main use: Prevention of hepatitis A and typhoid

Active ingredient: Inactivated hepatitis A virus and Vi polysaccharide of Salmonella typhi bacteria

Vaccine 2 - Revaxis injection

Main use: Booster vaccination against diphtheria, tetanus and polio

I'm so worried after reading about the possibility of another flare due to the immune response! And angry my GP/nurse didn't mention this!

Usually take 3 weeks to recover from a flare but I still have a puffed knee and painful feet, and a flu!

Question I have is, did I do the right thing or not?

And is the flu because of my body getting used to the mtx or the vaccines. Any advice would be appreciated!

12 Replies

I've had several vaccines over the years I've been on MTX +other DMARDs, as I like to travel, and never had a problem with any of these as they are inactivated ones. And you really don't want hep A, especially in combination with RA.

When you say flu, do you mean high temperature, all over muscle aches and complete lethargy? If so, then do speak to GP. My rule of thumb is a temperature over 100 for 24 hours and I'm off to GP, especially if you're travelling soon.

Presume you've got a travel kit? Copies of your prescriptions, aNtibacterial hand gel and so on? And depending on how far off the beaten track you're going then the full works.


Hi Helix, not so much a temperature but runny nose and sore throat, not to mention my feet absolutely ache and I can't walk as the pain alternates between left and right.

Wasn't sure if this was due to the side effects of mtx or the vaccination.


Sore throat and runny nose doesn't sound like flu, so could just be a coincidental cold? If you're worried that it's a vaccine response then go see GP. Less likely to be MTX as you've been on it for several weeks now.


I think you did the right thing. You are immunosuppressed so need protecting more than anyone. The only vaccines you can't have our live ones.

I once spend 12 hours in KL airport on way to NZ unable to eat or drink anything local as back then ( 2000) you needed yellow fever vaccine for Malaysia and I couldn't have it because it was live. Was glad to get to NZ!

Hope you have a great time.

Ps I usually ask for a steroid drop before holidays/ long trips to give me a boost.

Kiki x


I have an appointment with rheumy in 2 hours. When you say steroid drop? You mean injection?


Yes sorry I meant depo. As in depomedrone but some units use kenalog.


Great thanks will mention it to him. Not sure he will agree because from what I've read steroids can interact with vaccinations, will confirm though. Thanks for your advice!


I did not know that x


Rheumy confirmed that high dose steroids and/or DMARDs could in theory render the vaccination ineffective : /

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Bummer! Awh well. What did he/ she say about your knee and feet?


He said it's a recurring reactive arthritis and is 98% certain it isn't RA. I asked why and he said the pain and inflammation is moving from one joint to the other and it is asymmetrical, and the pain in the feet is a common feature of that. I asked him to give me a boost, he said I because I had one 3 weeks ago and it still hasn't settled down this particular flare is aggressive, and thought the risk outweighed the benefit so advised me to stay on 30mg prednisilone as opposed to tapering down, and slowly reduce once I'm back from holiday. Thanks for your advice earlier very much appreciated I know in he future I won't be making plans for months ahead as there is no predicting how you will feel!

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It's very hard isn't it. Sometimes life calls for long term planning. I always say to family health permitting I will be there and when booking hotels I try to get rooms on late room,, where you can cancel up to 1pm of day of arrival. If going abroad I always get health insurance that covers pre existing conditions. I've had a few holiday refunded I can tell you. I wish you enjoyable and safe travels and hope the Pred keeps you well ( ish). Take care Kiki x


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