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Just a few short years ago, rheumatologists managed rheumatic musculoskeletal disease (RMD) without immunosuppressants. However, the current availability of biologics has changed the outcome of so many rheumatic diseases. As a result, we are encountering the complications of severe inflammation less frequently. But the advent of biologics has also brought along a new wave of complications. For the current day rheumatologist, avoiding the dreaded side effect of infection comes with the territory of treating inflammatory disease.

Vaccines remain our only beacon of hope that we are actively curbing some of the risk.

The American College of Rheumatology has released a based on medications, type of vaccines, and steroid use. The most reassuring point of the guideline is that patients with RMD can be vaccinated almost like patients without RMD with very few restrictions. Suddenly it seems our small beacon of hope may be burning brighter.

As we continue to investigate vaccines, it would be important to determine how each rheumatic disease responds to vaccines. In a recent study by , patients with SLE had a lower IgG level compared with healthcare workers (the healthy control group), regardless of background immunosuppressants. There are several other studies evaluating IgG antibody measurements of patients with rheumatic disease compared to healthy controls; however, vaccine schedules remain consistent with the general healthy population.

Will patients with different RMDs benefit from alterations in the vaccine schedule? Will this also find its way into the guidelines in the future?

Patil Injean, DO, is a second year rheumatology fellow at Cedars-Sinai Medical Center in Los Angeles.

Read the guideline here and a Q&A with the guideline's first author here.