5 Things People with Rheumatoid Arthritis Need to Know About the COVID-19 Vaccines

The good news is that COVID-19 main and booster doses are generally accessible for US residents 6 months and older. The Centers for Disease Control and Prevention says they're free for all Americans at registered drugstores, physicians' community health centers, offices, and other venues, regardless of immigration or health insurance status (CDC).

It implies most People can obtain these doses and avoid the most catastrophic viral illness problems.

The CDC reports that one-fifth of eligible Americans have never received a vaccination, even though they prevent illness and death. This article should answer your questions, particularly if you have rheumatoid arthritis (RA).

Five things RA patients should know about COVID-19 vaccinations based on research and expert opinions.

Rheumatoid Arthritis (RA) Patients Need the COVID-19 Vaccination and All Boosters

COVID-19 is serious. According to the CDC, it has killed over a million of Americans and left some with lengthy COVID symptoms including excessive tiredness, shortness of breath, and cognitive fog. COVID-19 does not appear to be more lethal in people with RA or other inflammatory conditions.

RA patients on immune-weakening medications and those with cardiovascular disease, a possible consequence, are different. The CDC says such conditions raise the chance of severe COVID-19 outcomes.

The ACR (American College of Rheumatology) recommends vaccinating all RA patients. The ACR's North American Task Group, comprising of 13 specialists, provided recommendations in February 2021 and amended it many times, most recently in August 2022, emphasizing that the COVID-19 vaccination is safe for RA patients unless they are allergic to its components.

Pfizer-BioNTech or Moderna's mRNA vaccines are preferred over Johnson & Johnson's or Novavax's for RA patients. mRNA vaccinations are advised for unvaccinated AIIRD patients. No mRNA vaccination is recommended.

Vaccine recipients should have well-controlled RA. The ACR task team advises vaccination regardless of illness status. The committee also recommends immunizations for all COVID-19 survivors.

You May Need a Third Shot (and Boosters) If the First Two Don't Work

Importantly, this third dose is not a booster. The CDC recommends a full-strength third shot.

The third injection is needed because compromised persons, especially those on immuno-suppressing medicines, don't usually develop a strong immune response after the two-dose series.

A study of Israeli RA patients showed this. Rituximab greatly lowered the immune response, whereas abatacept (Orencia), mycophenolate mofetil, and glucocorticoids (at 6.7 ± 6.25 mg/day) somewhat reduced it.

The third injection appears to help Rituxan patients, particularly (rituximab).

The CDC advises all 12-year-olds and older to obtain the latest booster at least two months after their last immunization.

New Pfizer and Moderna boosters work against both the early and omicron strains of the virus. These updated boosters should guard against the germs you're most likely to meet.

The CDC recommends an updated ‘Pfizer’ booster for non-immunocompromised children aged 5 to 11 at least 20 weeks after finishing their two-dose main series. Immunocompromised children should get the vaccination 12 weeks after finishing the 3 dose initial series. Children under 5 cannot get boosters.

Those who received the single-dose J&J injection should get a second shot with a more potent mRNA vaccine and a booster two months later.

Novavax, approved for 12-year-olds, is a two-shot regimen with no booster.

Change RA Meds with Your Doctor

The ACR task force suggests that patients collaborate with their physicians to alter the timing of several popular RA drugs when possible to boost their immune response following a COVID-19 injection. Some RA medications may interfere with this immune response.

These suggestions are not meant to substitute medical advice.


Methotrexate − If the condition is effectively managed, they suggest stopping 7 days after each mRNA vaccine dosage and 14 days after the Johnson & Johnson vaccination.

JAK − Regardless of condition, wait a week after each dosage.

Abatacept (Orencia) − Pause just one week before and after the first dosage for subcutaneous administration. IV administration requires a five-week delay between the drug's infusion and the first immunization. Subcutaneous or intravenous abatacept should not be started until one week following the first vaccination dose.

Rituximab (Rituxan) − If feasible, schedule vaccination 1 month before next cycle and medication upto 1 month following vaccine series.

cyclophosphamide (Cytoxan) − provide cyclophosphamide (Cytoxan) 7 days after each vaccination dose.

Mycophenolate − If your illness is stable, wait a week between vaccines.

Acetaminophen/NSAIDs Vaccinate 24 hours after illness stabilisation. (Symptom-treating post-vaccination is allowed.)

Hydroxychloroquine, prednisone < 20mg per day, intravenous immunoglobulin (IVIG), cyclophosphamide, azathioprine, sulfasalazine, mycophenolate, leflunomide, belimumab, TNF inhibitors, oral calcineurin inhibitors, IL-1, IL-6R, IL-17, IL-23, or IL-12/23 should not be changed.

Worrying Too Much May Cause Irreversible Damage

Research have reassured RA patients regarding COVID-19 vaccination adverse effects.

In February 2022, JAMA reported that injections caused little complications for more than 5,000 rheumatic disease patients in 30 nations. (The data came from a European Alliance of Associations for Rheumatology volunteer registry.)

70% of the registrants received the Pfizer-BioNTech vaccination, 8% received Moderna, and the remainder received Oxford-AstraZeneca, which is not accessible in the US.

Just 4% had a rheumatic illness flare, most of which were mild or severe. Most persons have muscular discomfort or fever. 1.5% required a new medication or higher dosage to address flare symptoms. Just 0.5% of vaccinees had significant adverse events.

The CDC stressed that the approved COVID-19 vaccinations are safe and effective, even for persons using numerous medicines. “Millions of individuals in the United States have received COVID-19 vaccinations under the most extensive safety monitoring in U.S. history,” the agency says, adding that all approved doses fulfil the FDA's high scientific requirements for safety and manufacturing quality.

Tiredness, muscular soreness, headaches, chills, fever, and nausea are common COVID-19 vaccination adverse effects.

It's important to maintain your other safety precautions as well

Immunocompromised patients are more likely to acquire severe COVID-19 illness, even if they've been vaccinated.

“People who have an illness or are taking drugs that weaken their immune system may not be protected even if they are up to date on their vaccines,” states the CDC.

That's why the CDC advises immunocompromised persons to take all COVID-19 measures. This is also stressed in ACR advice.

Preventative prophylaxis entails wearing a well-fitting mask inside near others, opening a window or ventilating, maintaining six or more feet from others, washing your hands frequently, and having a COVID-19 test if you have symptoms or suspect exposure.

If your neighborhood has a high coronavirus transmission rate, these procedures are very crucial.

Protecting your respiratory system from various respiratory disorders is also beneficial. The American College of Rheumatology (ACR) released a summary of new vaccine guidelines for pneumococcal pneumonia, flu, and other illnesses for rheumatic patients in August.

Updated on: 23-Feb-2023


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