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New EULAR guidelines presented at ACR Convergence 2026 are reshaping how clinicians approach vaccination in patients with autoimmune rheumatic diseases. The updated recommendations emphasize early and regular immunization assessment, individualized plans, and timely vaccination — even during active disease. Key vaccines like influenza, pneumococcal, and recombinant zoster are strongly recommended, with nuanced guidance on live-attenuated vaccines and special populations.
Updated EULAR vaccination guidelines, presented at ACR Convergence 2026, are calling on rheumatologists to rethink how and when they vaccinate patients with autoimmune rheumatic diseases (ARDs). The new framework centers on five core principles: assess vaccination status early and regularly, develop individualized plans, vaccinate as soon as possible, recognize that non-live vaccines are safe during treatment, and consider live-attenuated vaccines only with caution.
One notable shift: active rheumatic disease alone should no longer automatically delay vaccination — a departure from previous practice. Timing relative to immunosuppressive therapy still matters, as some medications can blunt immune response. For example, a temporary methotrexate hold post-influenza vaccination may modestly improve immunogenicity.
Key Takeaways:
Why it matters: With immunosuppressed patients at heightened infection risk, these updated guidelines give clinicians a clearer, more proactive roadmap for protecting some of their most vulnerable patients.
