Patients with rheumatoid arthritis (RA) are at increased risk of infections, and pneumococcal vaccination is recommended. With some evidence that pneumococcal vaccinations are not as effective when administered after starting disease-modifying antirheumatic drugs (DMARDs), in particular methotrexate,1 guidance on when best to vaccinate, in relation to DMARDs, has become more consistent in recent years. Early European League Against Rheumatism guidelines (2011) only referred to B-cell depleting biological DMARDs, but more recent guide�lines (2019)2 recommend vaccination prior to commencement of all DMARD types. Since 2011, British Society for Rheuma�tology (BSR) guidance advises vaccination prior to starting any DMARD.3 4 The aims of this study were to explore the timing of pneumococcal vaccination in patients with RA in relation to starting conventional synthetic DMARDs (csDMARDs) and examine whether this has changed over time.