Why is the flu risk higher when you have autoimmune or inflammatory rheumatologic disease?

Influenza can be higher risk in autoimmune and inflammatory rheumatologic disease because infections may trigger symptom flares, recovery can take longer, and complications can be more likely—especially for patients taking immune-modifying medications.

Does taking immunosuppressive medication automatically mean I should stop it during flu season?

Not necessarily. The article notes an important nuance: uncontrolled autoimmune disease can also increase vulnerability, and stopping medications does not restore immune strength overnight. Any pause or medication change should be done with your rheumatology team.

Should people with autoimmune disease get the flu vaccine?

For most people with autoimmune or inflammatory rheumatologic disease, the flu vaccine is strongly recommended unless there is a clear medical reason not to receive it. Even when vaccine effectiveness is not perfect, vaccination can reduce illness severity, hospitalization risk, and complications like pneumonia.

What prevention steps help most during flu season if you are high risk?

Practical prevention strategies include staying up to date on vaccination, washing hands regularly, avoiding touching your face, considering masking in crowded indoor spaces or high-risk settings, and limiting close contact with people who are ill.

What should I do if I’m exposed to someone with the flu?

If you have been exposed—especially in your household—the page recommends early action rather than waiting it out. Antivirals such as oseltamivir (Tamiflu) may lower viral load, shorten illness duration, lessen symptom severity, and reduce transmission.

What if I’m on rituximab or another CD20 inhibitor?

CD20 inhibitors (such as rituximab/Truxima/Ruxience) can reduce antibody production, so vaccine responses may be diminished and viral infections may take longer to resolve. The page advises a lower threshold for early antiviral use after exposure, prompt testing when symptoms start, and messaging your care team right away.

When should I seek medical care for flu symptoms if I have autoimmune disease?

Reach out promptly if you develop fever, chills, body aches, sudden overwhelming fatigue, new cough, sore throat, or shortness of breath. Seek urgent evaluation if symptoms are severe, rapidly worsening, or there are concerns about breathing, hydration, or confusion.

I got sick soon after a flu shot—did the vaccine cause the flu?

Flu vaccine protection is not immediate and can take a couple of weeks to build. Getting sick shortly after vaccination more often means exposure happened before immunity had time to develop.

Is this guidance available for patients in Colorado?

Yes. UnabridgedMD is based in Colorado and is a rheumatology practice that emphasizes proactive prevention and early treatment for high-risk patients, including those across Colorado.

Understanding the Flu When You Have Autoimmune Disease

Dr. Isabelle Amigues
1 day ago
4 min read

Updated: 14 hours ago

Flu season is here—and this year it’s hitting harder than many people remember. If you live with an autoimmune or inflammatory rheumatologic condition, influenza is more than an inconvenient virus. It can raise the risk of complications, trigger symptom flares, and lead to longer recovery—especially if you’re on immune-modifying medications.

The good news: a few proactive steps (and early treatment when needed) can make a big difference.

Why this flu season feels more intense

A newly dominant flu strain is driving a large share of infections this year. It’s not a “super strain,” but small genetic changes can still lead to:

More pronounced symptoms
Higher rates of hospitalization
Reduced (but still meaningful) vaccine effectiveness compared with some prior seasons

Millions of people across the U.S. have already been affected, with a clear increase in severe cases. People with rheumatologic disease—particularly those on immune-modifying therapies—are among the groups we watch most closely.

Autoimmune disease, medications, and infection risk

It’s completely understandable to worry that immunosuppressive or immune-modifying medications increase your risk of infections.

But there’s an important nuance: uncontrolled autoimmune disease can also increase vulnerability. Chronic inflammation puts ongoing stress on the immune system, and when disease activity is high, your immune response can be less coordinated and less effective.

Key takeaways:

Ongoing inflammation can weaken immune resilience
Stopping meds doesn’t “restore” immune strength overnight
Stable disease control often supports better overall immune balance

If you’re considering pausing or changing a medication because of flu season, it’s best to do that in partnership with your rheumatology team.

Flu vaccination: what to know (and why it still matters)

For most patients with autoimmune or inflammatory rheumatologic disease, the flu vaccine is strongly recommended unless there’s a clear medical reason not to receive it.

Even in years when the vaccine isn’t a perfect match, it often still helps by:

Reducing the severity of illness
Lowering the risk of hospitalization
Decreasing complications like pneumonia
Shortening recovery time

Some people notice mild, temporary symptom flares after vaccination—these are usually manageable. Severe influenza is often much harder to treat.

Vaccination is especially important for:

People with autoimmune/inflammatory disease
Patients on biologics, DMARDs, steroids, or other immune-modifying therapies
Pregnant patients
Older adults
Healthcare professionals

How easily the flu spreads (and what prevention actually helps)

Influenza is highly contagious—especially in winter when we’re indoors more often.

Practical prevention strategies:

Stay up to date on vaccination
Wash hands regularly (and avoid touching your face)
Consider masking in crowded indoor spaces or high-risk settings
Limit close contact with people who are ill

What to do after exposure

If you’ve been exposed to someone with confirmed or suspected influenza—especially in your household—don’t wait it out. Early action can reduce complications.

Antivirals such as oseltamivir (Tamiflu) may:

Lower viral load
Shorten illness duration
Lessen symptom severity
Reduce transmission

For immunocompromised patients, antivirals may still help even if started later than the typical “48-hour window,” but earlier is usually better.

Special considerations: CD20 inhibitors (Rituximab/Truxima/Ruxience)

B-cell depleting therapies (CD20 inhibitors) can reduce antibody production. That means:

Vaccine responses may be diminished
Viral infections may take longer to resolve

If you receive a CD20 inhibitor plus IVIG or subcutaneous immunoglobulin, you may have added protection through antibody replacement.

If you’re on a CD20 inhibitor without immunoglobulin replacement, consider a lower threshold for:

Early antiviral use after exposure
Testing promptly when symptoms start
Messaging your care team right away

In some cases, preventive antiviral treatment may be appropriate even before symptoms appear—your clinician can help decide what fits your situation.

When to seek care

Reach out promptly if you develop:

Fever
Chills
Muscle/body aches
Sudden, overwhelming fatigue
New cough, sore throat, or shortness of breath

In children, flu can look different—sometimes starting with GI symptoms like stomach pain, nausea, vomiting, or diarrhea.

If symptoms are severe, rapidly worsening, or you’re worried about breathing, hydration, or confusion, seek urgent evaluation.

Timing matters with vaccination

Flu vaccine protection isn’t immediate. It can take a couple of weeks for your immune system to build its response.

Getting sick shortly after vaccination doesn’t mean the vaccine caused the flu—more often it means exposure happened before immunity had time to develop.

Everyday steps that make a difference

Hydrate consistently
Prioritize sleep and recovery
Use a high-quality mask (like an N95) when appropriate
Encourage sick household members to mask and isolate when possible
Reach out early if exposure or symptoms occur

If you have autoimmune disease and you’ve been exposed—or you’re starting to feel sick—message your care team early. Early intervention can significantly reduce the risk of serious outcomes.

UnabridgedMD Rheumatology continues to accept new patients, with pediatric services coming soon. Our care is centered on proactive management, personalized treatment, and long-term disease stability! Reach out if you have a rheumatologic condition and you develop the flu!

Are you in need of a compassionate rheumatologist who will listen and work with you toward disease remission? If you're searching for the best direct-care rheumatologist in Denver, UnabridgedMD is here for you. Click here to get in touch https://www.unabridgedmd.com or call 303-731-4006