New COVID-19 Vaccination Recommendations For People With Rheumatic Diseases

Rheumatic conditions affect approximately 25 percent of the U.S. adult population according to the American College of Rheumatology (ACR). These conditions can range anywhere from osteoarthritis to lupus, rheumatoid arthritis to potentially blinding conditions, like temporal arteritis. With COVID vaccinations underway across the nation and the world, new guidelines and recommendations are being published on a regular basis.

The American College of Rheumatology recently released guidance on COVID-19 vaccination in patients with rheumatic conditions, claiming, "People with rheumatic diseases should get vaccinated against SARS-CoV-2 as soon as possible." It is believed that because of the autoimmune nature of rheumatic conditions, people affected by them may be at an increased risk of developing severe COVID infection and complications. Currently there are three COVID-19 vaccines which have been approved for emergency use authorization by the U.S. Food and Drug Administration: Pfizer/BioNTech, Moderna, and Johnson & Johnson. While the ACR does recommend that their patients get vaccinated with either the Pfizer or Moderna vaccines as soon as possible, they also offered some insight on who should avoid or delay their vaccinations.

Since many patients being treated for rheumatological conditions are on immunosuppressive medications, timing of the vaccine and modifications in routine medicinal infusions or injections may be necessary.

For example, in patients taking methotrexate with otherwise well controlled disease, the ACR recommends holding methotrexate one week after each vaccine dose. The same is true if on the oral medication Xeljanz. The full recommendations offer more guidance on a wide array of anti-rheumatic medications, including commonly used IV medications. If you are under the care of a medical provider for your rheumatic conditions, be sure to talk with them about when you should get your vaccine and what modifications to your treatment plan may be necessary.

Under normal conditions, patients with rheumatic diseases are advised against receiving live vaccines, as this may trigger an exacerbation of the disease. This is not the case however with the Pfizer and Moderna vaccines which are not live, but rather mRNA vaccines. At the time these recommendations were made, the Johnson & Johnson vaccine, an adenovector vaccine, was not approved yet and further recommendations will likely follow. It's important to talk with your rheumatologist or healthcare provider about which vaccine is right for you, and when would be an appropriate time to get it.