Vaccinations in Patients with Systemic Sclerosis

The autoimmune rheumatic diseases (ARDs) are associated with higher rates of serious infection caused by the dysregulated immune responses inherent within the diseases themselves and the widespread use of immunomodulatory treatments across this heterogenous group of diseases. This is particularly pertinent for systemic sclerosis (SSc), given the high prevalence of pulmonary complications. Rheumatologists have an important role in advocating and encouraging vaccine uptake in patients with SSc. The available evidence suggests that routinely used vaccines are not responsible for initiating ARDs or leading to flares of existing ARDs. Immunomodulatory therapies blunt serological responses to many vaccines but, for most, seroprotection is conferred despite lower antibody responses. The timing of vaccination is important for B cell depleting therapies, owing to their specific role on B cell maturation and humoral responses. Studies have shown that pneumococcal and influenza vaccinations are both safe and immunogenic in patients with SSc. Rheumatologists should encourage their SSc patients to receive all recommended vaccinations. The recent emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to renewed attention to vaccination programmes. Patients with SSc, particularly those in high-risk groups with respect to age, immunosuppressive medication use, and established pulmonary complications, should be prioritized for vaccination against SARS-CoV-2.