For Your Patients: Special Concerns About COVID

The pandemic of COVID-19 has affected millions worldwide, with certain groups of individuals having increased risk not only for infection but also for serious complications including hospitalization and death. Patients with rheumatoid arthritis (RA) have been recognized as being one of those groups, with one large study suggesting that RA patients have a 25% greater risk of infection and a 35% increased risk for being hospitalized or dying.

That increased risk relates to the underlying problems with your immune system associated with the disease, and also to the effects of the immunosuppressive medications needed to control joint symptoms and other disease manifestations.

But there are certain measures you can take to help minimize your risks.

Should I get the vaccine?

The answer is definitely yes. Experts now recommend that all rheumatic patients be given one of the two-dose vaccines (Pfizer or Moderna) as soon as possible, and if you are receiving immunosuppressive treatments such as methotrexate or TNF inhibitors, a third dose may be needed before you are given a booster shot. Additional booster shots may be needed in the future, depending on the patterns of COVID variants. Your rheumatologist can advise you on this.

How will the vaccine affect my RA treatment?

The latest recommendations from rheumatology experts is that doses of certain medications such as methotrexate, abatacept, and JAK inhibitors should be withheld for a week or two after each dose of the COVID vaccine. It remains uncertain, however, if changes in the timing of other medications such as TNF inhibitors are needed. These concerns should be addressed in conversations with your rheumatologist.

What about disease flares?

Questions have been raised about whether taking the COVID vaccine might lead to a flare of your disease. A recent study found that about 10% of patients reported a worsening of their symptoms, but none experienced a severe flare. In most cases, the symptoms included pain at the site of the injection, fatigue, and myalgia.

These reactions were consistent with what can be expected with the vaccine and typically did not interfere with routine activities. The findings were reassuring, the investigators noted.

Should I take monoclonal antibodies?

These agents have been beneficial both after exposure to the virus and as a treatment after a person becomes infected. However, because of the rapidly changing pattern of COVID variants, particularly with the Omicron variants, recommendations have been changing, with only monoclonal antibodies that are effective against these variants currently being used.

The FDA is regularly updating its recommendations for which medications can be used, and this again is a matter for you to discuss with your rheumatologist.

Similarly, there is evidence that RA patients most at risk for serious adverse outcomes from COVID as well as for poor responses to COVID vaccines are individuals receiving rituximab and other B cell-depleting agents. Talk to your doctor about whether "PrEP" – i.e., preexposure prophylaxis – might be right for you.

Read previous installments in this series:

What Is Rheumatoid Arthritis?

How Is Rheumatoid Arthritis Diagnosed?

Starting Treatment for Rheumatoid Arthritis

Beyond the First RA Treatments

"Medical Journeys" is a set of clinical resources reviewed by doctors, meant for physicians and other healthcare professionals as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.