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What Rheumatoid Arthritis Patients Need to Know About the COVID-19 Vaccine-nologo
Credit: Tatiana Ayazo/iStock

If you live with rheumatoid arthritis, an inflammatory and autoimmune form of arthritis, you may understandably have many questions and concerns about getting the COVID-19 vaccine.

Here’s the bottom line: Especially if you have rheumatoid arthritis, most rheumatologists and public health experts recommend you get the COVID-19 vaccine. In fact, guidance from the American College of Rheumatology (ACR) states that autoimmune and inflammatory rheumatic disease patients (AIIRD) should receive the vaccine when they’re eligible.

While getting the vaccine would ideally occur in the setting of well-controlled disease, you should get the COVID-19 vaccine as soon as possible regardless of disease activity and severity, with the exception of extreme cases — say, in the intensive care unit.

Here’s everything you need to know about getting the COVID-19 vaccine if you have rheumatoid arthritis.

Is It Safe to Get the COVID-19 Vaccine with Rheumatoid Arthritis?

The short answer: Yes. Having rheumatoid arthritis is not a contraindication (a medical reason to avoid) the vaccine. In fact, getting the vaccine when you have rheumatoid arthritis may be especially important, given the disease may put you at higher risk for COVID-19 or severe outcomes. (Research is mixed and ongoing; current data suggests coronavirus complications may have more to do with age, other comorbidities, and taking steroid medications than RA alone.)

Many patients with autoimmune conditions who take medications that affect immune system function are concerned that certain vaccines could give them the virus. This could theoretically occur with vaccines like the MMR vaccine for measles and mumps, which is a “live” vaccine. That means it is a weakened form of the virus intended to cause a harmless infection that your immune system rapidly eliminates.

However, none of the COVID-19 vaccines currently authorized in the U.S. — Pfizer, Moderna, and Johnson & Johnson — are live vaccines. The COVID-19 vaccine cannot infect you with coronavirus. It is safe for people with rheumatoid arthritis, including those who take immunosuppressant medication.

According to the U.S. Centers for Disease Control and Prevention (CDC), the only contraindications to receiving the COVID-19 are:

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the COVID-19 vaccine.
  • Immediate allergic reaction of any severity to a previous dose or known (diagnosed) allergy to a component of the vaccine. See the ingredients in each vaccine here.

The CDC considers a history of an immediate allergic reaction to any other vaccine or injectable therapy (say, your injectable biologics) a precaution but not a contraindication to vaccination. In this case, you will need to be monitored for 30 minutes instead of 15 minutes after receiving the vaccine. For more information, refer to our full guide: Can You Safely Get a COVID-19 Vaccine If You Have a History of Allergic Reactions?

“The risks of getting COVID-19 infection far outweigh any possible risks of the vaccine itself, unless the patient knows they’re allergic to vaccines or something in the vaccine,” says Stuart D. Kaplan, MD, Chief of Rheumatology at Mount Sinai South Nassau in Oceanside, New York. “Otherwise, basically everybody should get the vaccine.”

Will the COVID-19 Vaccine Be Less Effective if You Have Rheumatoid Arthritis?

It’s possible you could have a weaker immune response to the COVID-19 vaccine (and therefore less protection from the virus) if you have rheumatoid arthritis, but it’s still worth it to get the vaccine.

“There is not yet data that shows this, but from a theoretical standpoint, we think rheumatoid arthritis patients may have a less robust response to the vaccine,” says Dr. Kaplan. “Certainly if they’re on immunosuppressants like steroids, methotrexate, or biologics, we’re assuming their immune system is impaired and they would likely mount less of a response to the vaccine.”

Even without medications, your autoimmune condition could hamper your body’s ability to have as strong response to the vaccine as someone who is otherwise healthy.

However, experts agree that you should still get the vaccine if you have rheumatoid arthritis or are taking immunomodulatory drugs, because any protection against the virus is better than none. Although more research is needed to determine how autoimmune conditions and medications impact the effectiveness of the vaccine, that protection could potentially be the difference between mild and severe COVID-19 or even hospitalization and death.

Are There Any Specific Vaccine Side Effects to Be Aware of with Rheumatoid Arthritis?

Some COVID-19 vaccine side effects could mirror those of a disease flare. It’s important to carefully track your symptoms and talk to your doctor if you have any concerns. Typically, vaccine side effects only last a few days (one way to differentiate them from an RA disease flare).

The CDC lists the following common side effects from the COVID-19 vaccine:

  • Pain on the arm where you got the shot
  • Redness on the arm where you got the shot
  • Swelling on the arm where you got the shot
  • Tiredness
  • Headache
  • Muscle pain
  • Chills
  • Fever
  • Nausea

“Some vaccine side effects that can overlap with rheumatoid arthritis disease activity may include muscle aches, joint pain, temporary fever, and fatigue,” says clinical rheumatologist Magdalena Cadet, MD, Associate Attending Physician at NYU Langone Health in New York City.

“Nausea may be present in some individuals after the vaccine, but rheumatoid arthritis patients may also experience that symptom with medications used to treat rheumatoid arthritis, like methotrexate or sulfasalazine,” she adds.

Another common symptom of the vaccine is swollen lymph nodes under the arms on the side of the body where you received the vaccine, per the Cleveland Clinic. The swollen lymph nodes typically appear a few days after the vaccine and tend to subside within a few days to a few weeks. Although uncommon, swollen lymph nodes can also appear with rheumatoid arthritis.

For more information on differentiating flares from vaccine side effects, here’s our guide on what to do after getting a COVID-19 vaccine if you’re immunocompromised or have an autoimmune condition.

Could the COVID-19 Vaccine Cause a Disease Flare?

There’s a chance that the COVID-19 vaccine could trigger a rheumatoid arthritis flare, but the ACR guidance notes that the benefit of getting vaccinated outweigh the risk.

Currently, there’s no data to indicate that the COVID-19 vaccine causes flares in rheumatic disease patients.

“We don’t have great data on this, but I would refer back to our experience with the flu vaccine — it’s not a live virus, so it’s not very likely it’s going to trigger a disease flare,” says Dr. Kaplan. “Usually, we associate disease flares with being triggered by viruses, whether they’re naturally-acquired viruses or viruses given as part of a vaccine.”

The ACR guidance also states that disease activity or severity is not a contraindication to getting the vaccine. If you have any concerns about getting the vaccine during a flare, talk to your doctor.

In severe cases — say, you’re hospitalized or taking a very high level of IV steroids that you’ll be able to taper off of soon — your doctor may recommend you wait to receive the vaccine to bolster your response. In the best-case scenario, you would have the opportunity to reach a state of lower disease activity, switch to a non-steroid therapy, and decrease your dosage of steroids under the guidance of a doctor before receiving the COVID-19 vaccine (which should then take place as soon as possible).

Do You Need to Modify Rheumatoid Arthritis Medications Before or After Getting the Vaccine?

Temporarily stopping certain immunosuppressant medications after receiving the vaccine, or timing when you get the vaccine in the course of your treatment, might help increase the effectiveness of the COVID-19 vaccine if you have RA.

But whether this is right for you depends on a number of factors, including which medications you take and your overall health. For example, if your RA is not well-controlled and skipping medications is likely to cause you to flare, your doctor may suggest that you keep taking them. You and your doctor should decide together about making any medication changes. You should not stop taking any of your rheumatoid arthritis medications on your own.

Most disease-modifying antirheumatic drugs, including biologics, should not be stopped for those with rheumatoid arthritis. Here are the RA drugs for which the ACR guidance suggests changes may be recommended:

  • Methotrexate: Skip for 1 week after each vaccine dose
  • JAK inhibitors (ex: Xeljanz, Olumiant, Rinvoq): Skip for 1 week after each vaccine dose
  • Abatacept (Orencia), injectable form: Skip one week before and after the first vaccine dose only
  • Abatacept (Orencia), IV form: Get COVID-19 vaccine 4 weeks after your last infusion, then skip a week and get next infusion
  • Rituximab (Rituxan): Get COVID-19 vaccine approximately 4 weeks before next infusion, then delay next infusion by 2-4 weeks after second vaccine dose — if possible
  • Cyclophosphamide infusion: Time administration so it’s one week after each COVID-19 vaccine dose

Are People with Rheumatoid Arthritis at Greater Risk for COVID-19?

Yes, but this is an ongoing area of research. It’s believed that autoimmune and inflammatory rheumatic disease patients are at higher risk for being hospitalized due to COVID-19 and having worse outcomes compared to the general population, according to the ACR.

However, this is likely affected by factors such as age, other comorbidities — such as heart or lung disease, which is common in RA, and taking steroid medications, rather than simply having RA alone.

“The medical community does consider patients living with rheumatoid arthritis to be at a greater risk for COVID-19, based on their inflammatory response from their condition,” says Dr. Cadet. “The medications used to treat the disease can also suppress the immune system.”

In other words, when your body is preoccupied by fighting its own cells, it doesn’t attack invaders as well as it should. Medications that affect immune system function can also affect the body’s ability to fight off viruses like the coronavirus.

For more information, check out this summary of research on inflammatory arthritis and rheumatic disease patients and their risk for COVID-19 complications.

When Can You Get a COVID-19 Vaccine with Rheumatoid Arthritis?

It will be up to your state’s guidelines, but the ACR is pushing for RA patients to be prioritized for vaccination before the general population of similar age and sex. The White House recently declared that all adults in the United States will be eligible for vaccination no later than May 1 — so either way, you may not need to wait long.

Government officials are working to make sure every adult will actually be able to get the vaccine by May 1 by increasing the number of locations where people can get vaccinated (including community health centers, pharmacies, and community vaccination centers), expanding the professionals who can administer shots (including dentists, optometrists, podiatrists, veterinarians, medical students, and more), and providing tools to make it easier to find vaccines (like websites and a call center), per The White House.

As soon as you have the opportunity to get the vaccine, experts are urging rheumatoid arthritis patients — and everyone else — to do so. As for which vaccine to get? “The official recommendation is to get whatever vaccine you’re offered,” says Dr. Kaplan.

Once you get your vaccine, you still need to be careful to follow standard mitigation efforts. For more information, here’s what immunocompromised people should know about the CDC recommendations for fully vaccinated people.

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COVID-19 Task Force Guidance Statements. National Psoriasis Foundation. March 4, 2021. https://www.psoriasis.org/covid-19-task-force-guidance-statements/.

COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases. American College of Rheumatology. February 8, 2021. https://www.rheumatology.org/Portals/0/Files/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdf.

Don’t Be Alarmed by This COVID-19 Vaccine Side Effect That Could Be Confused With Breast Cancer. Cleveland Clinic. February 25, 2021. https://health.clevelandclinic.org/dont-be-alarmed-by-this-covid-19-vaccine-side-effect-that-could-be-confused-with-breast-cancer/.

Fact Sheet: President Biden to Announce All Americans to be Eligible for Vaccinations by May 1, Puts the Nation on a Path to Get Closer to Normal by July 4th. The White House. March 11, 2021. https://www.whitehouse.gov/briefing-room/statements-releases/2021/03/11/fact-sheet-president-biden-to-announce-all-americans-to-be-eligible-for-vaccinations-by-may-1-puts-the-nation-on-a-path-to-get-closer-to-normal-by-july-4th/.

Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States. Vaccines & Immunizations. U.S. Centers for Disease Control and Prevention. March 5, 2021. https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html.

Interview with Magdalena Cadet, MD, a clinical rheumatologist and Associate Attending Physician at NYU Langone Health in New York City

Interview with Stuart D. Kaplan, MD, Chief of Rheumatology at Mount Sinai South Nassau in Oceanside, New York

Measles, Mumps, and Rubella (MMR) Vaccination: What Everyone Should Know. Vaccines and Preventable Diseases. U.S. Centers for Disease Control and Prevention. January 26, 2021. https://www.cdc.gov/vaccines/vpd/mmr/public/index.html.

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