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General Education, Podcast, Rheumer Has It

Rheumer Has It: Vaccines and Rheumatic Disease, with Dr Cuoghi Edens

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Summary:

On this episode of Rheumer Has It, hosts Cheryl Crow and Eileen Davidson speak with Dr. Cuoghi Edens, a rheumatologist trained in both adult and pediatric care, about vaccine myths and facts for people with autoimmune and rheumatic diseases. Dr. Edens debunks common misconceptions, such as vaccines causing autoimmune diseases or always triggering flares. She explains that while mild immune responses are normal, serious complications are extremely rare and the benefits far outweigh the risks. 

Dr Edens emphasizes that vaccines not only prevent infections but also certain cancers, making them an essential part of care for immunosuppressed patients. The discussion also explores vaccine timing with medications, the dangers of misinformation, and how to talk about vaccine hesitancy with empathy and evidence.

Episode at a glance:

  • Guest Expert: Dr. Cuoghi Edens, dual-trained adult and pediatric rheumatologist at the University of Chicago.
  • Myth #1: “Natural is better than vaccines” — Debunked; vaccines dramatically reduce child and adult mortality from infectious diseases.
  • Myth #2: “Vaccines cause autoimmune diseases” — Overwhelming evidence shows they do not.
  • Myth #3: “Vaccines always cause flare-ups” — Possible but uncommon; most patients tolerate vaccines well, and disease prevention outweighs brief discomfort.
  • Risk–Benefit Balance: Vaccines protect against infections and cancers (HPV, hepatitis B) that can worsen or complicate autoimmune diseases.
  • Timing & Medications: ACR guidelines suggest coordination with treatments like rituximab and high-dose steroids, but partial protection is better than none.
  • Health Literacy Tip: “Doing research” means reviewing credible scientific evidence—not social-media opinions or cherry-picked studies.
  • Social Stigma: Addresses misinformation, polarization, and “anti-vax” rhetoric, highlighting the need for compassion and critical thinking.
  • Trusted Resources: Children’s Hospital of Philadelphia vaccine education site and American College of Rheumatology guidelines.
  • Key Takeaway: Vaccines are safe, vital, and empowering tools for people with autoimmune diseases.

Medical disclaimer: 

All content found on Arthritis Life public channels (including Rheumer Has It) was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Episode Sponsors

Rheum to THRIVE, an online course and support program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. See all the details and join the program or waitlist now! 

Speaker Bios:

Dr Coughi Edens

Cuoghi Edens, MD is a rheumatologist trained to see both pediatric rheumatology and adult rheumatology patients. Dr. Edens treats patients suffering from systemic lupus erythematosus, mixed connective tissue disease, juvenile idiopathic arthritis, psoriatic arthritis, vasculitis, dermatomyositis and other more rare conditions. Due to her combined adult and pediatric training, she has a special interest in rheumatic diseases in children and ensuring their healthcare as they transition into adulthood. She is also interested in the interplay between reproductive health, pregnancy and rheumatic diseases and is currently conducting research in this area.

Aside from her clinical work, Dr. Edens is also the pediatric rheumatology fellowship director and involved in medical student and resident education.

Eileen Davidson Bio

Eileen Davidson, also known as Chronic Eileen, is a disability and chronic illness advocate from Vancouver BC Canada. Living with a diagnosis of rheumatoid arthritis, she spends a large focus on volunteering and creating awareness around arthritis. With The International Foundation for Autoimmune and Autoinflammatory Arthritis (AiArthritis) Eileen is the Educational Media Assistant. Along with AiArthritis, Eileen is a member of the Arthritis Research Canada patient advisory board, and author with over 100 published articles.

Cheryl Crow

Cheryl is an occupational therapist who has lived with rheumatoid arthritis for over twenty years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources.

Full Episode Transcript:

Eileen Davidson: Welcome to Rheumer Has It, the podcast that busts myths, highlights evidence, and inspires hope for those living with rheumatic disease

Cheryl Crow: Through plain language interviews with experts, we offer actual knowledge so you can thrive today.

Eileen Davidson: My name is Eileen, and my name is Cheryl. Join us as we bust myths and spotlight evidence.

Cheryl Crow: So today we are so happy to have Dr. Cuoghi Edens here to help us talk about myths and facts about vaccines when it comes specifically to rheumatology patients. So welcome Dr. Edens. Can you just let us first know a little bit about your training and your current work?

Dr Cuoghi Edens: Sure. I’m a little bit unique in that I’m trained to see both adults and kids with rheumatic diseases.

So I did my medical school at University of New Mexico where I’m originally from. Then I did a combined adult and pediatric, residency at University of [00:01:00] Michigan in Ann Arbor. Then I did a combined adult and pediatric rheumatology fellowship in Cleveland. And then I’ve now a assistant professor at University of Chicago where I’ve been for the last seven years.

So I have pediatric training, which is a lot of infectious and preventing infectious disease training as well, but certainly have adult training as well.

So I think that makes me also unique to talk about vaccines, ’cause to me those are things that kind of cross the spectrum of ages.

Cheryl Crow: That’s amazing. You’re already like one in a million being a pediatric rheumatologist and then also having being an adult rheumatologist too. I don’t know how many people there are that have that.

So you’re, we are so happy to have you to speak to these things.

Eileen Davidson: I also wanna say that I advocated for you to be our guest because of how much schooling you have gone through.

And I’ve had the pleasure of actually meeting you in person at the American College of Rheumatology conference as well, and that’s where you told me about all your training. So I was definitely [00:02:00] impressed.

And so we are going to jump into the first question today, which is one of the most common misconceptions that I keep encountering is that vaccines are harmful, and natural is better. Why is this myth harmful? And what are some ways you combat this in the clinic when talking one-on-one with patients?

Dr Cuoghi Edens: So I think this idea of natural, has some really good value and merit to it. There’s a lot of things that we should kind of get back to basics on. But I also, if we look back and say, you know, what did happen, before we had vaccines or before we had other things that some people may consider unnatural, for example, antibiotics ?People didn’t live for very long.

You know, the people used to have multiple children, not because there wasn’t birth control. That was one reason. But the main reason was actually that they needed so many children to actually be able to you know, [00:03:00] have enough to go into adulthood because the child mortality rate used to be very high.

And part of that was actually due to vaccine preventable illnesses and infections. And the same thing can be applied, you know, to adults as well in terms of adults didn’t live for very long because of infections that, you know, now are doing an excellent job of preventing or treating.

I think when we think about vaccines and how to treat some of our rheumatic diseases and some of our infections, that a lot of us have seen what it looks like to not have treatment or to have people treat things naturally.

And unfortunately it’s not very pretty.

Cheryl Crow: Yeah. And I know both Eileen and I have talked about like, family members we’ve had that have had rheumatic diseases prior to this current era of the, you know, quote unquote unnatural medications that are so effective and putting the disease in remission.

And you only have to go back a few decades and see how life changing some of these interventions [00:04:00] are.

Back to vaccines, you know, one of the other things that unfortunately has been in the news a lot is a lot of misconceptions around things maybe be quote unquote being caused by vaccines.

Like there’s this erroneous idea that vaccines caused autism, which has been debunked numerous times. And lately I’ve been hearing more and more people speculate or believe that their vaccination caused their autoimmune disease. And from your training and your expertise, is this a myth or is this a fact?

Dr Cuoghi Edens: So to me it is largely a myth. I certainly will not put it past that, when we get a vaccine, our immune system is activated and when our immune system is activated, again, whether it’s from an infection or some other process, it does have the potential to go a little haywire. So I think to say like, no, that never happens is really discrediting it, some of the research out there that does. Really show that maybe there is a very, very small incidence of autoimmune [00:05:00] diseases after vaccines.

But however, when you think about the numbers of people who are vaccinated in the United States as well as across the world, if vaccines cause autoimmune diseases, there would have to be hundreds of thousands more rheumatologists and GI doctors and endocrinologists to help take care of all the autoimmune diseases that would be caused by vaccines.

And so again, I think there are really rare instances where that does happen. But I think overall it’s very, very, very unlikely for someone to develop an autoimmune disease from a vaccine.

And again, I think we know that just looking at the population and the incidence of our diseases over time.

Cheryl Crow: That makes sense. Thank you. Yeah. If it was the only thing that caused autoimmunity, everyone who got vaccinated would have an autoimmune disease, which is not the case.

So yeah.

Dr Cuoghi Edens: There are also people you know, who are not vaccinated whether that’s for personal reasons or, you know, whatever the reasons may be, who still develop autoimmune diseases. Mm-hmm. And so again, that really [00:06:00] shows that vaccines are not really the NIUs to. The autoimmune diseases that we know of.

Eileen Davidson: Yes, I was diagnosed with rheumatoid arthritis before I ever even knew of COVID-19 and before my very first flu shot.

So we’re gonna go onto another myth about vaccines again, kind of going on and about the symptoms. Can you let us know if this is a myth or a fact?

Vaccines always cause flareups or worsening of existing rheumatic disease symptoms,

Dr Cuoghi Edens: So I think this is a big challenge. Because I think when, again, vaccines have the potential to definitely kind of stir up people’s immune system, and that’s like literally their job, right? There are proteins that are, you know, typically bound to something that makes their immune system react.

And again, most patients with autoimmune diseases have an immune system that’s already overactive. And then we give people medications to actually kind of like turn down the volume of their immune system is kind of how I talk about it with my patients

. [00:07:00] And so I think that yes, there is a potential for a flare up. And again, if a patient tells me like, you know, I had whatever vaccine that it was , and I felt really horrible for like the next week after, or they call me and say like, can I get some prednisone? I’m doing really poorly, I don’t discount that personal experience for them.

But again, I look at my practice as someone, you know, who takes care of hundreds of patients with rheumatic diseases. And to me, most of my patients when we’ve looked do receive their vaccines and very few of them actually have any sort of flareup after receiving them.

So again, I think it is possible, but in the research that’s out there, and then my own personal clinical experience, again across the ages of rheumatology patients, I think it’s very low likelihood that a flareup would happen after a vaccine.

Cheryl Crow: That, that makes a lot of sense. And it reminds me of the phenomenon that I’ve experienced too, where just [00:08:00] getting sick from whatever, because my immune system’s being activated can actually potentially cause that flare up too.

So potentially, would it be fair to say it’s not really the vaccine necessarily, it’s just the fact that you’re stimulating, for lack of a better word, your immune system?

Dr Cuoghi Edens: I mean, again, like we know like surgery stressful events, you know, travel, we know that all of these things can, you know, also cause people to flare.

So I agree, I think a vaccine is in the same category as all of those things. To me, a vaccine is very beneficial. And so I think you have to outweigh your risks. Obviously, if you’ve had one flare before, then that’s gonna make you a little, maybe less likely to want to receive other vaccinations.

But I think then it’s also important to remember that like every vaccine is not the same. You know, I personally, you know, don’t feel very good after my COVID-19 vaccines. I usually have to take it, you know, day off of work the next day or kind of relaxed versus like the flu shot, I’m fine and I don’t have any issues with it.

So again, I think there are [00:09:00] certainly differences on how you’re personally gonna respond, and you just have to realize that.

Eileen Davidson: I definitely wanna just agree with that and say like, as a rheumatic disease patient when I, we have our infusions, we kind of know that we’re gonna be feeling horrible for a few days after, so it’s kind of just, as you adapt and get used to living with a rheumatic disease, you know that sometimes the medications aren’t gonna make you feel so good for a few days, but that will pass and you learn how to kind of navigate it in your schedule.

Dr Cuoghi Edens: Right. And again, I think for you the benefits of your medication outweigh, you know, the day or two where you may not feel up to your full self.

Eileen Davidson: Exactly.

Cheryl Crow: And thinking about it as the cost benefit analysis, I think is so helpful when you’re looking at vaccines overall, right? Because you, you’re not just looking at the potential of maybe a short-term flare up post vaccine, but you’re looking at what’s the potential risk of getting this communicable [00:10:00] disease, right?

Getting polio or getting measles, that’s really bad for your immune system, right?

Dr Cuoghi Edens: And certainly, the flu flares up many people. You know, unfortunately COVID-19 I think if anyone talks to someone who has long haul COVID, they would not want to be in that person’s shoes.

And I think just thinking about that as well is like trying to prevent some of these diagnoses that can also flare up your autoimmune disease as well. So, and I think that’s important.

I think also, you know, we have two vaccines that prevent cancer. I think that gets like very underlooked at and kind of just forgotten that we have the hepatitis B vaccine which was and worldwide is still like one of the number one causes of liver cancer.

And to me to be able to vaccinate children and adults against that is, is huge, and a huge decrease in liver cancer related to it. We also have the HPV vaccine for the human papilloma virus again, which is the leading cause [00:11:00] of cervical cancer. And the rates of cervical cancer have just plummeted.

We’ve been implementing this vaccine not only in the United States but globally and again, really important for places in the world that may actually have a lot less access to women’s healthcare screening and things like that versus the United States.

So, again, I think, yeah, your disease flaring up is an unfortunate and rare issue, but preventing cancer I think is really important. And and again, we actually know that patients who have autoimmune disease are at increased risk for some of these cancers anyway, that these vaccines are preventing.

Cheryl Crow: Yeah, that’s incredible. The next myth, you’ve kind of touched on this, but just to drive the point home, the myth is that vaccines are unsafe for people with rheumatic disease? Is that true or false?

Or are, is there some gray area? Like are there some people who aren’t able to get a vaccine, who have an autoimmune disease?

Dr Cuoghi Edens: I would say there’s a very rare, [00:12:00] small population that cannot get. Certain vaccines, but I think if a patient tells me like, I can’t get any vaccines because of my autoimmune disease then to me that’s some time for me to spend with them and really dive a little bit deeper into why they have this idea.

I kind of think of it like: so many people are penicillin allergic. If you look at their medical records or if you ask them, but it’s like, you know, something happened when they were five years old and they have an ear infection and they got a rash and like their parent has just continued to tell them for their whole life that they were allergic to amoxicillin.

And probably they’re not, probably the rash was from a virus and they didn’t really have an infection anyway. So again, I think when we can give these blanket statements I think we just need to delve a little bit closer. Maybe someone did have a reaction as a kid, you know, to the whooping cough vaccine, for example.

But again, that shouldn’t like characterize all vaccines for the, for the foreseeable [00:13:00] future for their life.

Cheryl Crow: Yeah, that, that makes a lot of sense. Thank you. I think Eileen has the next question.

Eileen Davidson: I do, another question we have is about the timing of rheumatic disease medications and vaccinations. In my experience, I’m on rituximab, so I can only get vaccinated actually twice a year for COVID-19 and the flu vaccine I have to time it quite around my biologics, so is that something that you can kind of tell us a little bit about?

When is somebody recommended to kind of hold off medications and vaccines and I guess some things that they can do to kind of communicate that with others so that they understand?

Dr Cuoghi Edens: So, the American College of Rheumatology which again is like the overseeing organization of all rheumatologists in the United States has some vaccine guidelines that are actually fairly [00:14:00] helpful and do address a decent amount of this.

I will also say that there is a difference between live vaccines versus non-live vaccines. And some of that also comes to the timing as well.

So for live vaccines we try not to give those for patients who are on any sort of immunosuppressive medication. But most of the live vaccines are not given to adults; they’re given to young children who are under the age six with kind of the measles, mumps, and rubella vaccine kind of being the most famous of them.

And most recently, of course, in the news with our increasing measles numbers. So why do we care about people getting vaccines when they’re on rheumatology medications? If they’re not a live vaccine?

And that’s because we worry that we, if we give a vaccine, we want someone’s immune system to respond and to make antibodies and you know, mount a response. So that if you know, you do come into contact with the flu that your body has the ability to respond to it.

I [00:15:00] think sometimes, like making sure that the vaccines are timed appropriately is maybe a little bit especially for things like rituximab, like yours, to me, like just I get, I vaccinate my patients no matter like when they got their rituximab versus not. Because I think I’d rather them have be slightly vaccinated than not vaccinated at all. And kind of like miss the season for some the the vaccines. And again, getting flu, COVID, any of these can like, certainly flare up their autoimmune disease as well.

So I think that’s important. I will say high doses of steroids. So the ACR guidelines say over 20 milligrams of prednisone a day, or the equivalent of that or is also mayor, maybe we should think about, you know, holding the vaccine until we can get someone on lower doses of steroids. Again, and that’s really just to make sure that their body can form an appropriate response.

But if you’re someone’s on 60 and they’re not gonna be below 20 milligrams of prednisone until we’re at a flu season and it doesn’t make sense to wait for that patient. And to me, even like the small amount of protection that they [00:16:00] can get on a high dose of steroid is worth it versus them not getting vaccinated at all.

Eileen Davidson: Thank you for clarifying that and I actually really appreciate that you did bring up rather get it so that you miss that wave because I’m not due for mine until december and that’s like when everything’s already kind of full bloom and done.

So, yeah. Alright, so now we are kind of jumping into what I’m gonna say is my favorite myth, stigma ,misconception about vaccines and that have been going around quite a bit in conversations with people.

I was in the media a bunch about vaccines and I got random, I got even people telling me I should die just ’cause I was pro-vaccine. So it’s quite interesting to see where the hatred and like the anger for people who are pro-vaccine has gotten, and I’ve been seeing people lately who are calling vaccinated [00:17:00] people, weak or sheep and they were just listening to the masses.

This is something like I’ve seen on dating apps where men will say things like, I won’t date a natural unvaxxed woman or pure blood only, and people like Andrew Tate promoting that kind of attitude. And I’m just curious, it’s what is your opinion on that and like how would you kind of smash that stigma?

Dr Cuoghi Edens: I mean, I think we’ve used a lot of these terms to become very polarizing and hurtful, you know? And to me, again, these are sometimes conversations that are not worth having. You’re not gonna change that person’s opinion. And it sounds like also not someone that you’d be interested in dating.

I think people are using vaccines now as like a very polarizing topic. And it’s unnecessarily so. I think we follow all [00:18:00] sorts of things, right? If you, you know, if you buy your groceries at the grocery store, is that like being a sheep when like, maybe you should be like growing your own corn?

Cheryl Crow: Yeah, yeah. I do think that there, there are people who are so off the deep end, like you said, that they’re, you know, you’re not gonna see eye to eye with them.

But I think there also is, there’s room for helping people develop some of the tools of basic like scientific literacy or health literacy . For example, actually, I remember the moment I learned about correlation versus causation and that was in my statistics class, my freshman year of college.

And I was like, whoa, this is actually blowing my mind. Like I realized there had been so many, errors in my way of thinking, ’cause I’d think, well if two things go together, then the one thing must have cause other thing. But then the teacher had us do this thought experiment where it was like, well, if, you know, every time you see rain, you see umbrellas, then did those umbrellas cause the rain or, or did lack of umbrellas cause the lack of rain? You’re like, oh no, duh.

But then we realized we apply that logic around vaccinations and maybe the onset of [00:19:00] symptoms or traits of autism coming out around certain times, and people are realizing correlations that are actually just two variables that happen to be going at the same time , you know?

In the case of autism, like I can put a little chart in the chat, the autism rates have risen identically with avocado consumption in the us Yeah.

They’ve risen identically with cheese consumption, with yoga, with coffee, with all these things. They’re just random correlations, but I think it’s hard for people’s brains to see that.

So, sorry, Eileen, I think you wanted to say something too.

Eileen Davidson: Yeah. Just piggybacking on the whole, following the masses and listening to other people kind of thing like that: we are listening to other people. We’re listening to the researchers, the scientists, and the clinicians just like Cuoghi here, who has far more education than some of the people that are putting these vaccine’s down. Mm-hmm. I always find like i’m following my healthcare providers that know a lot more about my condition than somebody else who doesn’t know a thing about [00:20:00] my condition.

Dr Cuoghi Edens: I always love the doing your research term because, you know, I do research, right? So that means I’m gathering data, I am analyzing, I’m publishing and you know, someone else can find that data and read it. I don’t specifically do vaccine research but I do research in other areas in reproductive health and rheumatology specifically.

So when people always say like, oh, I did my research, and I’m like, looking online for other articles, is not doing research. Yeah, it’s just reading.

Researchers are people who are gathering the initial data and that’s, you know, who is writing manuscripts. And then you as a consumer of those, whether you have training or not, is, that’s- you’re not doing the research.

And so I always kind of point that out when people are like, well, I did my research. And I’m like, okay, did you have a lab? Like did you work for university? That’s great. Yeah. And again, it’s a little bit tongue in cheek, but I think it [00:21:00] didn’t, again, drives home that point.

Cheryl Crow: It’s, no, it’s, it’s a, it’s an important nuance point and like I think both Eileen and I, we know that patients who are activated and who like want to actively research their care and their treatments are, that’s, that’s a great thing, right? But not all research is created equal. Cherry picking data, finding the one study that supports what you want that to, to believe is not the same as actually being able to critically assess like a wealth of peer reviewed literature,

Eileen Davidson: yeah. And I just wanna comment, as a member of the Arthritis Research Canada Patient Advisory Board, since 2018, I have communicated with many researchers. I’ve been to the Canadian Rheumatology, the European Rheumatology, and the American Rheumatology conferences.

Mm-hmm. I would honestly never second guess these researchers and what they do. When I’m just comparing it to YouTube videos or doing my own research, because these people are trained in doing proper research, and I don’t [00:22:00] think people really realize how vigorous the research process is.

Cheryl Crow: They don’t, no, most patients don’t. But yeah, so just, just for sake of timing, this is something we could all know, both talk about all day long.

I do wanna put a quick plug. I did have a podcast episode with two peach one, Dr. Dave and Dr. Campbell. One’s a PhD researcher in immunology and one’s. A rheumatologist which was, “what do people with rheumatoid arthritis need to know about COVID-19?” This was in 2024, and that’s all about specifically like the safety and efficacy of the COVID vaccines and, and, and how they work and stuff like that.

So I recommend listening to that one too. But for today, we’re gonna wrap it up with you and ask in one sentence, what is the most important takeaway you would want a listener to take from this episode?

Dr Cuoghi Edens: So in patients who have rheumatic and autoimmune diseases vaccines are to me a pretty essential part of your care because you are often immunosuppressed and overall they’re safe and really don’t have [00:23:00] any evidence that they cause flares. Importantly also, we have vaccines that prevent infections but we also have vaccines that prevent cancer. And immuno autoimmune patients are already at risk for those. And so I think that’s, to me was some of the, the pearls. I think we have no evidence that vaccines are unsafe.

We have no evidence that vaccines cause autism. And I think very, very, very little. Information that vaccines cause autoimmune diseases. And so we should get vaccinated with confidence. Obviously I encourage everyone to talk with their healthcare providers about vaccines. There’s a ton of great websites out there, I will say, for people who are concerned about the additives and vaccines.

The Children’s Hospital of Philadelphia actually has really great information going through each of the different additives. That people may be concerned about either currently on vaccines or historically. But there are very reliable vaccine sources out there. And again, I think if you have a healthcare provider who’s also telling you [00:24:00] not to vaccinate then I would also just question why they’re doing that.

And potentially like putting your health or others at in jeopardy.

Eileen Davidson: Absolutely. And I think you summarized the key takeaways of this podcast episode perfectly in the message that we were trying to hopefully get out there.

I really appreciate that you’ve taken the time to explain it all and to put yourself out there like this.

So, if people wanted to connect with you or learn more, where do you recommend they go?

Dr Cuoghi Edens: Sure. So, certainly I’m a part of our American College of Rheumatology so I could be accessed there. Again, I work at University of Chicago currently and I certainly have a website there that also has my contact information.

It also has my background and my publications and current research as.

Cheryl Crow: That’s, that’s so wonderful. Well, and thank you again for coming on. This is a hard thing to talk about I know, right now, just given the [00:25:00] discourse, let’s just call it that. But thank and thank you to those who, who are listening and who made it to the end of another episode of Rheumer has it?

Dr Cuoghi Edens: No, thanks for so much for having me. I really appreciate it.

Eileen Davidson: Yes. Don’t forget to check out the show notes on the Arthritis Life website to get links to everything we’ve discussed and to know that we’ve included lots of reputable resources for you to understand vaccines.

Cheryl Crow: A hundred percent. Thanks again and let us know via social media under, you know, chronic Eileen or Arthritis Life Cheryl, if you have any topic ideas for future episodes. Bye-bye for now and thanks again, Dr. Edens. Yay.

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