DEAR DR. ROACH: Recently, you wrote that people who were born before 1957 are likely to have had measles and don’t need to get the measles vaccine. I was born in 1954 and had measles in 1959 (with photographs to prove it). Last year, I had an MMR (measles, mumps, rubella) titer test, which showed that I had sufficient antibodies for mumps and rubella (both of which I had as a child) but insufficient antibodies for measles.

I’m concerned because I can’t receive the live measles vaccine unless I suspend my biologic medication for rheumatoid arthritis (RA). This would suppress my immune system for at least two months and cause me to relapse into severe joint pain. I was told that if I did receive the vaccine without stopping the biologic, I’d certainly develop measles.

Also, sometimes after restarting the biologic, it’s not as effective as it was before it was temporarily suspended, which is a major consideration. If I were to contract measles again, would my “insufficient” antibodies at least make the case less severe? — G.C.K.

ANSWER: Fortunately, for you, the answer is clear. With a proven case of measles, you don’t need another vaccine, even if your antibody titer is low and you are on a medication that suppresses your immune system. Although the antibodies in your blood may be low, your immune system is capable of rapidly and dramatically increasing them if you are exposed to measles again, even more than 60 years later.

For a person who was born after 1957 without clear evidence of two live measles vaccines and has inadequate titers from the laboratory, the situation is much more difficult. You are right that the live MMR vaccine can’t be given to a person with high-level immunosuppression.

So, this hypothetical person would need to weigh the risk of measles against the risk of stopping their RA medication. The exact type of medication needs to be considered, as some have a greater risk of relapse when stopping them than others.

It also depends on how likely a measles exposure might be. Measles is among the most contagious diseases known, and close contact with a susceptible person is likely to spread the disease. So, in the case of a measles outbreak within a person’s community, it may be worth the risk of an RA relapse to hold the medication and get the vaccine.

If a person with immunosuppression has a known exposure to measles, there’s a post-exposure treatment of immune globulin that can be given to reduce the risk of contracting measles. The recurrence of measles in the United States is a public health tragedy that needs to be aggressively countered. Fortunately, the recent outbreak in the Carolinas is reported to have ended, mostly thanks to increased vaccination.

DR. ROACH WRITES: A recent column on the risks of side effects with statin drugs versus PCSK9 inhibitors prompted several readers to write in. Even though PCSK9 inhibitors are supposed to have a low incidence of muscle and bone side effects, I had readers write in about their debilitating hip pain.

I also had a reader mention a skin reaction called keratosis pilaris (“chicken skin”), which I didn’t find previously reported. I’ve certainly seen redness and itching after the injection in one of my own patients, who responded well to taking diphenhydramine (Benadryl) before the injection. The literature supports a much lower risk of muscle and joint pains with PCSK9 inhibitors compared to statins.