To determine the ability of patients with rheumatoid arthritis to respond to pneumococcal vaccination and whether age or methotrexate affects this response, we studied 40 patients with rheumatoid arthritis who received pneumococcal vaccination. Patients were equally divided into four groups according to age and whether or not they were taking methotrexate. Pneumococcal antibody levels were drawn prevaccination and 6 weeks post-vaccination.Eighty percent of rheumatoid arthritis patients vaccinated achieved protective levels of antibodies. The age of the patient did not affect this response, but methotrexate-treated patients responded less well than those not taking methotrexate (p = 0.03).In general, patients with rheumatoid arthritis respond well to the pneumococcal vaccine. Pneumococcal vaccination of rheumatoid arthritis patients before initiating methotrexate therapy is strongly recommended.