Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Vaccination Against Influenza in Patients with Scleroderma.

Litinsky3,  Irena, Balbir2,  Alexandra, Zisman4,  Devy, Mandelboim1,  Michal, Mendelson1,  Ella, Anouk3,  Marina, Kaufman3,  Ilana

Central Virology Laboratory, Sheba Medical Center
Department of Rheumatology, Rambam Health Care Campus Background
Department of Rheumatology, Tel Aviv Medical Center
Rheumatology Service, Carmel Medical Center


To assess the efficacy and clinical safety of the influenza virus vaccine in patients with systemic sclerosis (SSc) in comparison with healthy controls.


The study population comprised 2 groups of patients. Group 1 included 26 SSc patients:12 (46.1%) with diffuse type,14 (53.9) with limited scleroderma, 22 (84.6%) women, 4(15.4%) men, mean age 51.7±12.9,disease duration 8.29±6.28 years, median 6.45years). Group 2 comprised 15 healthy controls: 13 women (81%),2 men (19%), mean age 44.5 ± 15.3.In group 1, 7 (26.9%) patients were on immunosuppressive therapy (2 prednisone, 2 cellcept, 2 methotrexate, 1 cuprimine) at the time of vaccination. All the participants were vaccinated with a trivalent influenza subunit vaccine including H1N1 A/Brisbane/59/2007(TGA 2008/81B) (H1N1, H3N2 A/Uruguay/716/2007 (A/Brisbane/10/2007-like, NIBSC 8/124) (H3N2) and B B/Brisbane/60/2008 (TGA 2009/82/B) (B).Disease activity was assessed by Rodnan score, number of ulcers, number of tender and swollen joints, changes of clinical signs (dyspnea, cough, dyspepsia and dysphagia), patient (PDAI) and physician (PHDAI) disease activity evaluation by VAS, ESR and CRP, on day of vaccination and 6 weeks after. The humoral response was tested by Hemagglutination inhibition (HI) antibodies against H1N1 and H3N2 by standard WHO procedure. Response was defined as >=4-fold rise in antibodies 6 weeks after vaccination, or seroconversion in patients with non-protective baseline level of antibodies (<1/40). Geometric mean titers (GMT) were calculated to assess the immunity of the whole group


At baseline, 62% of patients with scleroderma patients and 40 % of controls had protective levels against H1N1 while 15% of SSc patients versus 46% of controls had protective anti H3N2 antibodies. Six weeks after vaccination, in patients with SSc, the percentage of responders for H1N1 antigen achieved 78%. Surprisingly, the proportion of responders was significantly higher (p=0.0128) in SSc patients than in controls (33%). The proportion of responders against H2N3 was similar in the 2 groups (42% in group 1 vs 33% in group 2).SSc suffering from interstitial lung disease (ILD) demonstrated a significant lower response (p=0.02 for H1N1 AND P=0.03 for H3N1).(Table 1).

Table 1. Proportion of subjects with humoral response to H1N1 and H3N1

 SSc without ILDSSc with ILDP

Parameters of disease activity remained unchanged except for an increase in patient disease activity index (p=0.01)


Influenza virus vaccine generated a satisfactory humoral response in scleroderma patients. The presence of ILD seems to lower the humoral response. Influenza vaccine was found to be safe in this cohort of patients. Yearly, Influenza vaccination is recommended to patients with scleroderma

To cite this abstract, please use the following information:
Litinsky, Irena, Balbir, Alexandra, Zisman, Devy, Mandelboim, Michal, Mendelson, Ella, Anouk, Marina, et al; Vaccination Against Influenza in Patients with Scleroderma. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1238
DOI: 10.1002/art.29004

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