Before Rheumatoid Arthritis Medicines Begin: Vaccines, Infections and Pregnancy Plans

The letter from rheumatology arrives with a list: a chest X-ray, a blood test with an unfamiliar name, a note about the shingles vaccine, a question about whether you are planning a family. For someone whose hands have ached for months, the list can feel like one more delay standing between them and relief.

It is worth understanding why the list exists. Living with rheumatoid arthritis before starting biologics means entering a short but consequential window. The immune system is about to be deliberately quieted, and anything already hiding inside it, from a dormant tuberculosis infection to a long-forgotten hepatitis exposure, can wake up once the brakes come off. The checks are not bureaucracy. They are the part of treatment that happens before the first injection.

This explainer walks through what is usually tested, which vaccines matter and when, who starts promptly and who is asked to wait, and how pregnancy plans change the conversation. Throughout, the decisions belong to the team who knows your history.

What actually happens before a biologic is started?

A biologic is a protein-based medicine, usually given by injection or infusion, that blocks one specific messenger or cell type driving joint inflammation. Because it works so precisely, it also removes a precise piece of your immune defense. The pre-treatment period is designed around that trade-off.

In practice the sequence runs in three strands that often overlap. The first is screening: a clinician looks for infections that are silent now but could flare once immunity is dampened. Tuberculosis and the hepatitis B and C viruses are the standard targets, and a chest X-ray is often added to the blood work (Mayo Clinic). The second strand is baseline measurement: full blood count, liver enzymes and kidney function, so later changes can be recognized as changes rather than guessed at. The third is prevention: updating vaccines, reviewing other medicines, and asking about contraception and pregnancy plans.

None of this is unique to one product. The same logic applies to targeted synthetic DMARDs, oral tablets such as JAK inhibitors that interrupt signaling inside immune cells, and to conventional DMARDs like methotrexate, though the emphasis shifts. (A DMARD is a disease-modifying antirheumatic drug, a medicine that slows the disease itself rather than only easing pain.)

How long this window takes depends on what is found. When screening is clear and vaccines are already current, it can be a matter of weeks. When a live vaccine is needed or latent tuberculosis requires treatment first, it stretches longer. Your rheumatologist sets the order and the pace; the aim is to start once starting is safe, not to start as fast as possible.

Why infections dominate the rheumatoid arthritis before starting biologics checklist

Rheumatoid arthritis is an autoimmune disease: the immune system, built to attack invaders, turns on the lining of the joints. Medicines that quiet that misdirected attack cannot fully distinguish it from the useful kind. The result is a modest but real rise in infection risk, and that risk is what most of the pre-treatment work addresses (NHS).

Three features of infection risk shape the checklist. First, dormant infections behave differently from new ones. Tuberculosis bacteria can sit walled off in the lungs for decades, kept in check by a signaling protein called TNF, or tumor necrosis factor. Several biologics block TNF directly. Remove the guard, and the walls can come down. That is why latent TB screening is routine even in people who feel entirely well.

Second, viruses that live quietly in the liver or nerves can reactivate. Hepatitis B can flare dangerously when immunity drops; the varicella-zoster virus that causes chickenpox can re-emerge as shingles, a painful rash following a nerve’s path. Knowing your status before treatment lets the team protect you rather than react.

Third, the disease itself raises infection risk before any medicine is given. Active inflammation, reduced mobility, smoking, diabetes and long-term steroid use all add to it (MedlinePlus). Untreated rheumatoid arthritis is not the safe option it can appear to be from the waiting room.

Holding those three ideas together explains the shape of what follows: test for what is hiding, vaccinate against what is common and preventable, and measure the baseline so trouble is caught early.

Which blood tests before starting biologics are usually ordered?

The blood work is less about the arthritis and more about the body the medicine is entering. Panels vary between services, but a typical set includes the following, each with a plain purpose.

• Full blood count. Measures red cells, white cells and platelets. A low white count can signal that immunity is already stretched; a baseline lets later drops be spotted.
• Liver function tests. Enzymes that leak from stressed liver cells. Methotrexate and some biologics can affect the liver, so the starting point matters.
• Kidney function. Creatinine and estimated filtration rate, because some medicines are cleared by the kidneys and doses may be adjusted by the prescriber.
• Hepatitis B and C serology. Antibody and antigen tests showing past exposure, current infection, or immunity from vaccination.
• HIV testing. Offered in many services, since untreated HIV changes the risk calculation for immunosuppression.
• Latent tuberculosis test. Either a skin test or an interferon-gamma release assay, a blood test described in the next section.
• Inflammatory markers. CRP and ESR, proteins that rise with inflammation, to document how active the disease is before treatment.

Some teams add a lipid profile, because a few targeted medicines can raise cholesterol, and a varicella antibody test if you are unsure whether you have had chickenpox. Where a mammogram or cervical screening is overdue, the appointment is a natural prompt to catch up, since routine cancer screening is recommended for everyone and becomes easier to organize before treatment than during it (Mayo Clinic).

Results rarely stop treatment altogether. More often they change the order of events: a hepatitis B carrier may be started on antiviral protection first; someone with borderline liver enzymes may be steered toward a different class. The interpretation, and any change of plan, sits with the prescribing clinician.

Do I need a TB test before biologics, and what does a positive result mean?

Almost always, yes. Tuberculosis screening is one of the few pre-treatment steps recommended across guidelines for essentially every biologic and JAK inhibitor, because the cost of missing latent TB is high and the test is simple.

Latent TB means the bacteria are present but inactive. There is no cough, no fever, no spread to others, and a chest X-ray may look normal. Around a quarter of the world’s population is estimated to carry latent infection, according to the CDC, and most will never become ill. Blocking TNF changes those odds, which is why the test is done before, not after, the first dose.

Two tests are in common use. The tuberculin skin test involves a small injection under the skin of the forearm, read two to three days later for swelling. The interferon-gamma release assay is a blood test that measures how your immune cells respond to TB proteins; it needs one visit and is not confused by prior BCG vaccination, which makes it the preferred option in many adults who were vaccinated as children (CDC). Neither test distinguishes latent from active disease, so a positive result is followed by a chest X-ray and a symptom review.

A positive latent result does not end the conversation about biologics. The usual path is a course of preventive antibiotics, and many clinicians begin the biologic partway through that course once it is clearly being tolerated. The exact sequencing is a specialist decision and depends on how active the arthritis is.

Two practical notes. Tell the team if you have lived in, worked in or traveled to regions with high TB rates, or had close contact with someone treated for TB. And because a negative test can become positive years later, some services repeat screening periodically for people with ongoing exposure risk.

Which vaccines before biologics should be up to date?

Vaccines work by teaching the immune system. A medicine that quiets the immune system can weaken the lesson, so the aim is to teach before the quieting begins. The CDC advises that inactivated vaccines be given at least two weeks before immunosuppressive treatment begins where possible, and live vaccines at least four weeks before.

The table below summarizes what is commonly reviewed. It is a guide to the conversation, not a schedule; your clinician will tailor it to your age, history and local recommendations.

Vaccine	Type	Usual approach before immunosuppression
Influenza (injected)	Inactivated	Recommended every season; can continue during treatment
Pneumococcal	Inactivated	Recommended for adults on immunosuppressants; series per age and prior doses
COVID-19	Non-live	Recommended; timing relative to treatment discussed with clinician
Shingles (recombinant)	Non-live	Recommended for immunocompromised adults; usually two doses, ideally started beforehand
Hepatitis B	Inactivated	Offered if not immune, particularly with risk factors
Tetanus, diphtheria, pertussis	Inactivated	Kept current per standard adult schedule
Human papillomavirus	Inactivated	Per age eligibility
MMR, varicella, yellow fever, live nasal flu	Live	Give ≥4 weeks before; generally avoided once treatment starts

The shingles vaccine deserves a particular mention. Shingles risk rises with age, with rheumatoid arthritis itself, and further with several treatments, notably JAK inhibitors. The current recombinant vaccine contains no live virus and is recommended for immunocompromised adults from age 19 (CDC). Finishing the two-dose series before treatment is ideal, but it can also be given during treatment if needed.

Inactivated vaccines remain safe once biologics begin; the concern is reduced response, not danger. That is why the pre-treatment window is used to get ahead rather than to catch up.

Live vaccines and the timing rule that catches people out

A live vaccine contains a weakened version of the germ it protects against. In a healthy immune system that weakened germ multiplies briefly, provokes a strong response, and is cleared. In a suppressed immune system it may not be cleared, which is why live vaccines are generally avoided once biologics, JAK inhibitors or higher-dose steroids are on board (CDC).

The vaccines that fall into this category are a short but consequential list: measles-mumps-rubella, varicella (chickenpox), the live nasal influenza spray, yellow fever, oral typhoid, and BCG. Most adults with rheumatoid arthritis will not need any of them. The people who do tend to fall into predictable groups: those planning travel to yellow fever regions, adults who never had chickenpox and have no antibodies on testing, and anyone whose childhood records are missing.

The four-week rule exists because that is roughly how long the body needs to finish responding to the live vaccine and clear it before immunity is dampened. Starting a biologic sooner risks both a weaker response and, in theory, a prolonged vaccine infection. Conversely, once treatment has started, guidance generally suggests waiting a period after stopping before a live vaccine can be given, and that period depends on the medicine and how long it lingers in the body. Your prescriber will know the figure for your treatment.

Methotrexate at the low doses used for arthritis is treated differently in some guidance, but the safest assumption is that any live vaccine question goes to your rheumatology team first.

Travel plans deserve early mention for this reason. If a yellow fever certificate is required for a trip months away, raising it before treatment begins gives the team room to sequence the vaccine and the medicine, rather than facing a choice between the two later.

Who usually starts biologics promptly, and who is usually asked to wait?

Biologics are rarely the first medicine offered. In most national guidance, including the pathway described by the NHS, they are considered when disease remains active despite an adequate trial of conventional DMARDs, usually including methotrexate, or when those medicines cannot be tolerated. Disease activity is measured with a composite score that combines tender and swollen joint counts, a blood inflammation marker and the patient’s own rating.

People who tend to move forward without much delay share a few features: screening tests are clear or already addressed, vaccinations are current, there is no active infection, and there are no unresolved questions about pregnancy timing. In that situation the pre-treatment period is short.

People who are usually asked to wait, or to change the plan, include those with:

• A positive latent TB test, until preventive treatment is established.
• An active infection of any kind, including an untreated skin ulcer or dental abscess, until it has resolved.
• Active hepatitis B, until antiviral cover is arranged.
• A recent live vaccine, until the four-week window has passed.
• Uncontrolled heart failure, where certain TNF-blocking biologics are generally avoided.
• A history of certain cancers or a demyelinating condition such as multiple sclerosis, which shift the choice of class rather than necessarily ruling treatment out.
• Surgery scheduled in the near future, where timing is coordinated so wound healing is not compromised.

Waiting is not the same as being refused. In most of these cases the delay is measured in weeks and the purpose is to remove a specific hazard. Age alone is not a barrier, and neither is having several other conditions, though each adds to the conversation.

The one group where the calculus is genuinely different is people who are pregnant or planning pregnancy, which is why it has its own section below. In every case the decision to start, and when, belongs to the treating rheumatologist.

Biologics and pregnancy planning: why the conversation starts early

Rheumatoid arthritis affects women roughly two to three times as often as men and frequently begins during childbearing years (MedlinePlus). Pregnancy planning therefore belongs in the first treatment discussion rather than being raised after a positive test.

The medicines split into three groups. Some conventional DMARDs, methotrexate and leflunomide in particular, are known to harm a developing fetus and must be stopped before conception, with a washout period set by the prescriber that for leflunomide can involve a specific procedure to clear the drug from the body. Others, including hydroxychloroquine and sulfasalazine, have long records of use in pregnancy and are often continued. The third group, biologics, is more nuanced. Several TNF-blocking biologics have accumulated substantial registry experience in pregnancy, and specialist guidance increasingly supports continuing some of them into pregnancy when disease control depends on it, often stopping at a point in the third trimester chosen to limit how much reaches the baby. One TNF blocker has a molecular structure that crosses the placenta only minimally, which makes it a frequent choice when treatment throughout pregnancy is needed. Newer classes, and JAK inhibitors, have far less pregnancy data and are generally avoided.

Why not simply stop everything? Because a flare during pregnancy carries its own risks, including preterm birth and lower birth weight, and because untreated inflammation makes conception itself harder for some women. Roughly half of women see their arthritis improve during pregnancy and many flare afterward, so the postpartum plan matters as much as the antenatal one.

Contraception is part of the same discussion, since several of these medicines require reliable prevention while they are being taken. The right combination, and the timing of any switch, is individualized by the rheumatologist working with an obstetric team.

Fathering a child, breastfeeding and your baby's vaccines

Men are often surprised to be asked about family plans. Historically, men on methotrexate were advised to stop it for a period before trying to conceive. Accumulated evidence has been reassuring about low-dose methotrexate and sperm, and many current specialist guidelines no longer require men to stop, though practice varies and the advice you receive should come from your own prescriber. Leflunomide advice for men is more cautious. For biologics, the available evidence has not shown harm to a pregnancy fathered while on treatment.

Breastfeeding is more permissive than people expect. Biologics are large proteins; very little passes into breast milk and what does is largely broken down in the infant’s gut rather than absorbed. Several TNF blockers are considered compatible with breastfeeding in specialist guidance. Methotrexate is generally avoided during breastfeeding. Hydroxychloroquine and sulfasalazine are commonly continued. Because recommendations differ by medicine, the specific plan should be confirmed with the rheumatology team before delivery.

One issue is easy to miss: the baby’s own vaccines. If a biologic was continued into the later part of pregnancy, some of it may still be circulating in the infant for months after birth. The CDC advises that infants exposed to biologic immunosuppressants in utero have live vaccines, such as rotavirus and BCG, deferred for a period after birth, while inactivated vaccines proceed on schedule. This is a decision for the pediatric team, but they can only make it if they know. Writing the medicine and the timing of the last dose into the maternity record, and telling the baby’s clinician directly, closes the gap.

Postpartum flares are common. Having a plan agreed in advance for which medicine to restart, and when, spares a new parent from making that decision alone during the exhausted weeks after birth.

Which is safer, biologics or methotrexate? An honest comparison

The question assumes a single answer, and the evidence does not provide one. The two carry different risks, at different frequencies, and the balance depends on the person.

Methotrexate is the anchor drug of rheumatoid arthritis treatment worldwide. Taken weekly, it dampens rapidly dividing immune cells. Its common effects are nausea, mouth soreness, fatigue and hair thinning; its serious but less common effects involve the liver, the bone marrow and, rarely, the lungs. It is teratogenic, meaning it can cause birth defects, so it must not be taken in pregnancy. Regular blood monitoring is standard, and folic acid is prescribed alongside it to reduce side effects (NHS). Alcohol needs to be limited because both stress the liver.

Biologics are more targeted, and daily side effects tend to be fewer. The characteristic risk is infection, including reactivation of latent tuberculosis and hepatitis B, which is why screening dominates the pre-treatment work. Injection-site reactions are common and usually mild. Infusion reactions occur with some products. Long-term registry data have examined cancer risk, particularly lymphoma and skin cancers, and the picture is complicated by the fact that active rheumatoid arthritis itself raises lymphoma risk; most analyses have not shown a clear additional signal for TNF blockers, though skin cancer surveillance is advised. JAK inhibitors, which are not biologics but often sit in the same conversation, carry specific warnings about blood clots, cardiovascular events and shingles in certain higher-risk groups.

Importantly, the two are often used together. Methotrexate improves how well several biologics work and reduces the chance of the body forming antibodies against them, so combination is common rather than either-or.

The fair summary: methotrexate’s risks are more often about tolerability and monitoring; biologics’ risks are more often about infection. Which weighs more heavily depends on your history, and your rheumatologist is the person to weigh it.

What the first weeks after starting usually look like

The pre-treatment checks end with a first dose, and people are often unsure what comes next. The honest answer is that the early weeks are usually undramatic, which is not the same as uneventful.

Biologics are given either as a self-administered injection under the skin, on a schedule ranging from weekly to monthly depending on the product, or as an intravenous infusion in a clinic, typically every several weeks after an initial loading period. The first injection is usually done under supervision so you can learn the technique and be watched for immediate reactions. Infusions involve monitoring during and briefly after.

Symptom improvement is not immediate. Some people notice less stiffness within a couple of weeks; more commonly the effect builds over one to three months, and clinicians generally wait about three months before judging whether a biologic is working (NHS). In the meantime, any conventional DMARD you were already taking is usually continued, and a short course of steroids may bridge the gap.

Monitoring continues. Blood tests are typically repeated at intervals set by the prescriber, more frequently early on, then less often once stable. A follow-up appointment is usually scheduled to reassess disease activity with the same composite score used at baseline.

Practical adjustments are small. Injections are usually stored in the refrigerator and brought to room temperature before use. If you develop a fever or an infection needing antibiotics, most services advise holding the next dose and calling; the medicine is paused, not abandoned. Planned surgery and dental procedures involving the gums are worth flagging, since timing around a dose may be adjusted.

Nothing about this period requires heroics. It requires noticing, and reporting what you notice.

What people often get wrong about starting biologics

“The tests mean they think something is wrong with me.” Screening is universal, not suspicious. Everyone starting these medicines is tested for the same short list, regardless of how healthy they appear.

“Once I am on a biologic I cannot have any vaccines.” Only live vaccines are generally avoided. Flu, pneumococcal, COVID-19 and the recombinant shingles vaccine are recommended for people on immunosuppressants and can be given during treatment (CDC).

“There is one best biologic and I should ask for it.” Head-to-head trials and registry comparisons have not identified a single class that outperforms the others for people in general. Choice is guided by your other conditions, pregnancy plans, injection versus infusion preference, prior responses and local availability. Asking for the “most successful” product misunderstands how the evidence is shaped.

“Biologics are too dangerous to be worth it.” The infection risk is real and modest. So is the harm of uncontrolled inflammation, which damages joints permanently and raises cardiovascular risk. Guidelines recommend biologics for active disease precisely because, for that group, the balance favors treatment. Whether it favors treatment for you is an individual judgment.

“Traditional Chinese medicine treats rheumatoid arthritis.” Acupuncture and herbal formulas are widely used, and some people report symptom relief. Systematic reviews have found the evidence for changing the course of the disease to be of low quality, and certain herbal products have been linked to liver injury and to interactions with prescribed medicines. These approaches have not been shown to replace disease-modifying treatment. If you use them, tell your rheumatologist so interactions can be checked.

“I feel fine, so I can skip the follow-up bloods.” Liver and marrow changes are usually silent until they are advanced. Monitoring exists to catch them while they are reversible.

Questions to ask your care team before the first dose

Consultations are short and the list of checks is long. Arriving with questions written down changes the dynamic from being processed to being informed. These are the ones that tend to matter most.

• Which infections have I been screened for, and what did the results show?
• If my TB or hepatitis test is positive, what happens to the treatment plan and in what order?
• Which vaccines am I missing, and which need to be given before treatment rather than during it?
• Do I need the shingles vaccine, and should both doses be finished before I start?
• Am I planning to travel anywhere in the next year that needs a live vaccine?
• Am I planning a pregnancy, or could I become pregnant? Which of my medicines would need to change, and how far in advance?
• For men: does anything about my treatment affect plans to father a child?
• Will I stay on methotrexate or another DMARD alongside the biologic, and why?
• How will I take this medicine, how often, and who teaches me the injection?
• How long before we expect to know whether it is working, and what is the plan if it is not?
• Which blood tests continue, how often, and who reviews them?
• What should I do about a dose if I develop a fever, need antibiotics, or have surgery or dental work scheduled?
• Are there any of my other conditions, or medicines from other prescribers, that change the choice of class?
• Whom do I call, and how quickly, if something feels wrong?

Bring a current list of every medicine and supplement, including herbal products, and your vaccination record if you have one. If you do not know whether you had chickenpox, say so; a blood test can settle it. The team cannot plan around information they have not been given, and the pre-treatment window is the moment when that information changes decisions rather than merely being noted.

When to call your doctor: red-flag signs before and after starting

Most of the pre-treatment period passes without incident, and most people on biologics do well. The medicines still ask something of you: a lower threshold for making contact than you might otherwise have. Because immunosuppression can blunt the usual signs of infection, a problem that looks minor can be further along than it appears.

Contact your rheumatology team or primary care clinician promptly, and hold your next dose until you have spoken with them, if you develop:

• A fever, chills or sweats, especially if there is no obvious cause.
• A cough lasting more than a couple of weeks, coughing up blood, unexplained weight loss or night sweats, which can signal tuberculosis.
• A skin infection that is spreading, hot or producing pus, or a wound that is not healing.
• Yellowing of the skin or eyes, dark urine, pale stools or pain under the right ribs, which can indicate liver trouble or hepatitis reactivation.
• A painful, blistering rash on one side of the body or face, which may be shingles; early treatment matters most in the first days.
• Unusual bruising, bleeding gums, or persistent sore throat and mouth ulcers, which can reflect low blood counts.
• New numbness, weakness, vision change or difficulty with balance.

Seek emergency care immediately for difficulty breathing, swelling of the face or throat, a widespread rash with feeling unwell, chest pain, sudden calf pain and swelling, or confusion. A severe allergic reaction to an injection or infusion is uncommon but can progress quickly.

Before treatment begins, call if you develop any infection between screening and the planned first dose, or if you learn you are pregnant. Neither necessarily cancels treatment, but both change the timing.

Where signs are less clear, the right instinct is still to ask. Your team would far rather hear about a symptom that turns out to be nothing than miss one that is not. Every decision about pausing, continuing or changing your medicine rests with them.

Frequently asked questions

Do I need a TB test before biologics if I feel completely well?

Yes. Latent tuberculosis causes no symptoms and a normal chest X-ray, yet it can reactivate when TNF is blocked. Screening uses either a skin test read after two to three days or a single blood test called an interferon-gamma release assay. A positive result usually leads to preventive antibiotics rather than cancelling treatment, with sequencing decided by your rheumatologist.

Which vaccines before biologics are most important to complete?

Inactivated vaccines, including influenza, pneumococcal, COVID-19 and the recombinant shingles vaccine, are recommended for people who will be immunosuppressed and ideally given at least two weeks beforehand. Live vaccines such as MMR, varicella and yellow fever need at least four weeks before treatment and are generally avoided afterward. Your clinician tailors the list to your age and history.

Can I have the shingles vaccine once I am already on a biologic?

Usually yes. The current recombinant shingles vaccine contains no live virus, so it can be given during immunosuppressive treatment, though response may be somewhat weaker than beforehand. It is recommended for immunocompromised adults from age 19 as a two-dose series. Timing relative to your doses is worth discussing with your rheumatology team.

What blood tests before starting biologics are standard?

A full blood count, liver and kidney function, hepatitis B and C serology, a latent TB test and often HIV testing form the core panel. Inflammatory markers document baseline disease activity, and some services add lipids or varicella antibodies. Results usually change the order of events, such as arranging antiviral cover, rather than ruling treatment out.

How does biologics and pregnancy planning change my treatment?

It shifts the choice of medicine early. Methotrexate and leflunomide must be stopped before conception with a washout set by your prescriber. Hydroxychloroquine and sulfasalazine are often continued. Several TNF-blocking biologics have substantial pregnancy registry data and may be continued under specialist guidance, sometimes stopped in the third trimester. Raise plans before starting, not after a positive test.

Which is safer, biologics or methotrexate?

Neither is uniformly safer; they carry different risks. Methotrexate’s concerns are mainly tolerability, liver and marrow effects, and harm in pregnancy, all managed with monitoring. Biologics’ characteristic risk is infection, including reactivation of latent TB and hepatitis B. The two are often used together because methotrexate improves how well several biologics work. Your rheumatologist weighs the balance for you.

What is the most successful biologic for rheumatoid arthritis?

There is no single winner. Head-to-head trials and registry comparisons have not shown one class to be consistently superior for people in general. Selection depends on your other conditions, pregnancy plans, prior responses, preference for injection or infusion, and availability. A medicine that is right for one person may be unsuitable for another, which is why the choice is individualized.

Are biologics worth the risk?

For active rheumatoid arthritis that has not responded to conventional DMARDs, guidelines recommend them because uncontrolled inflammation damages joints permanently and raises cardiovascular risk, while the added infection risk is modest and reduced by screening and vaccination. Whether that balance holds for you depends on your history, and it is a decision to make with your treating team.

How do Chinese medicine approaches treat rheumatoid arthritis?

Acupuncture and herbal formulas are widely used and some people report symptom relief. Systematic reviews have found the evidence for altering the disease course to be of low quality, and certain herbal products have been linked to liver injury and interactions with prescribed medicines. They have not been shown to replace disease-modifying treatment. Tell your rheumatologist about anything you take.

Can I breastfeed while taking a biologic?

Often yes. Biologics are large proteins that pass into breast milk in very small amounts and are largely broken down in the infant’s gut. Several TNF blockers are considered compatible with breastfeeding in specialist guidance, while methotrexate is generally avoided. If a biologic was continued into late pregnancy, the baby’s live vaccines may be deferred, so tell the pediatric team.

References

• CDC: Altered Immunocompetence: General Best Practice Guidelines for Immunization
• CDC: Testing for Tuberculosis
• CDC: Shingles Vaccination
• NHS: Rheumatoid arthritis: Treatment

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.