Getting a child ready for preschool, kindergarten or middle school usually requires immunizations. In fact, laws in all 50 states mandate that children cannot attend school unless their immunization status is up-to-date. But if your child has arthritis or another rheumatic disease, even routine immunizations may not be so, well, routine.

While vaccines are important for controlling disease, for years, doctors have had concerns about immunizing children with arthritis and other rheumatic diseases, says Harry L. Gewanter, MD, a pediatric rheumatologist at Pediatric and Adolescent Health Partners in Richmond, Va.

There are several reasons; two of biggest are that some vaccines may not work for them and that they might even cause the child to catch the disease the vaccine was aimed at preventing.

Surprisingly, new research is showing that perhaps vaccines once deemed off-limits for children with arthritis might not be off the table. However, Dr. Gewanter says it is important to be cautious. Learning how vaccines work and talking to your child’s doctor about what might be right for him or her is the smartest course of action.

A Cautious History

The traditional apprehension about vaccines for children with arthritis is based on the science behind vaccines. For vaccines to be successful the recipient must have a healthy immune system. Vaccines work by exposing a person to a small dose of a virus or bacteria so their immune system will learn to recognize it and be ready to fight it off, if exposed to it later. “They trick the immune system into thinking it has been exposed to that germ, and it responds as if it had encountered the real (wild) germ,” says Dr. Gewanter.

While less than 10 percent of children may typically have adverse effects from any vaccine (e.g., fever, rash, aches, etc.), the potential for a more serious problems exist if the child’s immune system is suppressed by their arthritis and/or medications. Corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate and biologic response modifiers (biologics) are examples of medications that can alter the immune system’s response to an immunization.

Whether caused by arthritis or its treatment, if your child’s immune system is altered it may not mount the proper response to a vaccine. That could cause vaccines to fail and not prevent disease if he is ever exposed; or it could result in him possibly developing the disease the vaccine was designed to prevent. It may even cause an arthritis flare.

Vaccines, for the most part, can be broken up into two main categories – live attenuated and inactivated. In the case of live attenuated vaccines, the vaccine recipient is injected with a live but weakened strain of a disease, virus or bacteria.