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Vaccines, or immunizations, come in two broad forms. Most are ok to receive when you have an underlying rheumatic disease and on treatment for it, including methotrexate or even biologics. For that reason, rheumatologists generally encourage their patients to get the annual flu shot, and to receive the pneumonia vaccine as well. However, for those vaccines that may have a live component to them, patients may need to be cautious depending on which medication they are on, as you may be at increased risk for developing the condition you are trying to protect yourself from. While less concerning, these vaccines also may be less effective when on these medications. If you are able to receive the vaccine before starting them, all the better. It’s important to discuss the details of any live attenuated vaccine with your rheumatologist to ensure it’s right for you.