Psoriatic Arthritis and the COVID-19 Vaccine: What You Need to Know

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If you live with psoriatic arthritis, an inflammatory and autoimmune form of arthritis that affects about 30 percent of people with psoriasis, you may understandably have many questions and concerns about getting the COVID-19 vaccine.

Here’s the bottom line: Especially if you have an autoimmune condition like psoriatic arthritis, most rheumatologists and public health experts recommend you get vaccinated against COVID-19. In its COVID-19 Task Force Guidance, the National Psoriasis Foundation says that in most cases, patients with psoriatic disease who don’t have contraindications should take the first authorized COVID-19 vaccine that becomes available to them.

Similarly, the American College of Rheumatology (ACR) states that autoimmune and inflammatory rheumatic disease patients (AIIRD), which includes people with psoriatic arthritis, should receive the vaccine when they’re eligible.

The ACR also states that disease activity and severity should not delay you from getting the vaccine except in extreme cases (say, the intensive care unit). That said, vaccination would ideally take place in the setting of well-controlled disease.

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

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

The short answer: Yes. Having psoriatic arthritis is not a contraindication (a medical reason to avoid) the vaccine. In fact, getting the vaccine when you have psoriatic 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 PsA 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. You cannot get coronavirus from the COVID-19 vaccine. It is safe for people with psoriatic 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 vaccine 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.

If you have had an immediate allergic reaction to any other vaccine or injectable therapy — like your injectable biologics — it is a precaution but not a contraindication to receiving the vaccine, per the CDC. You may simply need to be monitored for 30 minutes after getting the vaccine rather than 15 minutes.

For more information, refer to our full guide: Can You Safely Get a COVID-19 Vaccine If You Have a History of Allergic Reactions?

“Not only is the COVID-19 vaccine safe and effective, but it is also strongly recommended for psoriatic arthritis patients,” says Samar Gupta, MD, FACR, a rheumatologist at Michigan Medicine. “People with psoriatic arthritis are often on immunosuppressive medications, which may make them susceptible to COVID-19 infection.”

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

More research is needed to determine whether or not psoriatic arthritis patients have a less robust response to the vaccine, and therefore less protection from the coronavirus.

“The COVID-19 vaccine could be less effective in patients with psoriatic arthritis who are taking certain immunosuppressive medications,” says Lisa Zhu, MD, a rheumatologist at Ronald Reagan UCLA Medical Center. “It’s important to note that we don’t have direct data on this question, but this is a concern based on data on other vaccines.”

Experts agree that you should still get the vaccine if you have psoriatic arthritis or are taking immunomodulatory drugs. Remember that some protection from the virus is better than none, and could potentially mean the difference between staying healthy or hospitalization and death.

“Our experience from other vaccines administered in psoriatic arthritis patients supports that they should get enough protection from COVID-19 vaccines,” says Dr. Gupta.

However, once you get your vaccine, you should still follow the standard mitigation efforts you did before getting the vaccine. For more information, here’s what immunocompromised people should know about the CDC recommendations for fully vaccinated people.

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

Some COVID-19 vaccine side effects could resemble those of a psoriatic arthritis 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 PsA 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

Muscle aches, joint pain, fever, and fatigue can all be common with PsA flares. Nausea can also occur after the vaccine and some PsA patients may experience nausea after taking certain medications like methotrexate.

Some vaccine recipients also reported a delayed (on or after day eight) skin rash after receiving the Moderna vaccine in its phase 3 clinical trial, per a March 2021 letter to the editor published in the New England Journal of Medicine. The reactions typically resolved over the next four to five days. These types of reactions are not contraindications to getting another vaccine, so all participants were encouraged to finish their vaccine source (and half did not have a recurrence of large local reactions).

For more information on distinguishing disease 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?

The ACR guidance notes that there’s a chance for autoimmune and inflammatory rheumatic disease flare or disease worsening after COVID-19 vaccination, but that the benefit of getting vaccinated outweighs the risk.

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

“There is a theoretical risk that the COVID-19 vaccine could cause a flare of autoimmune disease, as there are reports of this occurring with other vaccines,” says Dr. Zhu. “However, we believe the risks of getting COVID-19 infection are significantly greater than the risks of a disease flare.”

In fact, getting the coronavirus is considered a risk for disease flare itself. The NPF notes that infection with SARS-CoV-2 may result in a flare of psoriasis, based on case reports. However, the clinical significance of this is still unknown.

The ACR guidance says 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 extreme cases — say, you’re hospitalized or taking a very high level of steroids that you’ll be able to taper off of soon — your doctor may recommend you wait to receive the vaccine to improve your body’s response. Ideally, you would have the opportunity to get to lower disease activity, transition to a non-steroid therapy, and decrease your dosage of steroids under your doctor’s guidance before receiving the COVID-19 vaccine (which should then take place as soon as possible).

Do You Need to Modify Psoriatic 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 PsA.

But this only applies to a select few psoriatic arthritis medications. “It is recommended, in most cases, that PsA patients who are to receive a COVID-19 vaccine continue their biologic or oral therapies for psoriatic arthritis,” says Dr. Gupta.

The American College of Rheumatology and National Psoriasis Foundation guidance differs on this matter, which is why it’s important to discuss this with your doctor and make a decision that’s right for your situation.

Here are the psoriatic arthritis drugs for which the ACR guidance suggests changes may be recommended:

• Methotrexate: Skip for 1 week after each vaccine dose
• JAK inhibitor (Xeljanz): 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

The NPF guidance recommends that patients continue their biologic or oral therapies for psoriatic arthritis in most cases. For the Johnson & Johnson COVID-19 vaccine, which is only one dose, the guidance says that certain patients can consider holding methotrexate for two weeks after getting the vaccine:

“Patients 60 or older who have at least one comorbidity associated with an increased risk for poor COVID-19 outcomes, and who are taking methotrexate with well-controlled psoriatic disease, may, in consultation with their prescriber, consider holding it for two weeks after receiving the Ad26.COV2.S vaccine [Johnson & Johnson] in order to potentially improve vaccine response.”

Clearly, there’s no one-size-fits-all answer about whether or not to skip medications. The treatments you take and your overall health will play a role in this. For instance, if your psoriatic arthritis is not well-controlled and you’re likely to flare by skipping medications, your doctor may recommend you keep taking them. Don’t stop taking any of your psoriatic arthritis medications on your own.

“This should be an individualized decision made together with your rheumatologist,” says Dr. Zhu.

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

This is an ongoing area of research.

The National Psoriasis Foundation’s guidance says that “it is not known with certainty if having psoriatic disease meaningfully alters the risks of contracting SARS-CoV-2 (the virus which causes COVID-19 illness) or having a worse course of COVID-19 illness.” It notes that “existing data, with some exceptions, generally suggest that patients with psoriasis and/or psoriatic arthritis have similar rates of SARS-CoV-2 infection and COVID-19 outcomes as the general population.”

The ACR’s guidance says 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.

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

Some data suggests that patients with inflammatory rheumatologic diseases who get COVID-19 may have higher risk of developing serious complications, depending on their disease activity and other medical conditions such as high blood pressure, diabetes, and chronic kidney and lung disease, adds Dr. Zhu.

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 Psoriatic Arthritis?

It will be up to your state’s guidelines. The NPF notes that, as a psoriatic disease patient, you may be in a high-priority group for vaccination if you have psoriasis-associated comorbidities. These may include those known to increase COVID-19 risk (chronic kidney disease, COPD, heart disease, obesity, type 2 diabetes, or smoking) or those that might increase COVID-19 risk (hypertension, liver disease, or overweight).

You may also be prioritized if you take medications classified by the CDC as lowering your body’s ability to fight some infections, such as corticosteroids.

Either way, you likely don’t need to wait long: The White House recently declared that all adults in the United States will be eligible for vaccination no later than May 1.

To help ensure every adult will have access to the vaccine by May 1, government officials are 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.

“I encourage all my psoriatic arthritis patients to get the COVID-19 vaccine as soon it is available to them,” says Dr. Gupta. “Patients should take the first COVID-19 vaccine — any of those currently approved — for which they are eligible and offered based on federal, state, and local guidance.”

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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