Are People With Rheumatoid Arthritis Higher Risk for COVID-19?

Medically Reviewed on 2/19/2021

RA Home Remedies
Most inactivated or non-live vaccines (vaccines that do not carry a living virus) can be administered to individuals with rheumatoid arthritis (RA) and are highly recommended.

Most inactivated or non-live vaccines (vaccines that do not carry a living virus) can be administered to individuals with rheumatoid arthritis (RA) and are highly recommended.

Rheumatoid arthritis (RA) is chronic (long-term) multisystem disorder that affects various joints, particularly of the hands and feet, causing severe pain and deformities. Advanced RA can also attack the eyes, heart, lungs, kidneys, and nerves, resulting in severe disability and distress.

Individuals with RA have poor immune responses because of the disease itself and the medications they are on. This puts them at a higher-than-average risk of COVID-19 infection and complications. COVID-19 complications in these individuals may include acute respiratory distress syndrome (ARDS; a type of severe dysfunction of the lungs), myocarditis (swelling of the heart muscles), and secondary bacterial sepsis (a severe infection).

Although there is much about the COVID-19 virus that we do not know, doctors all over the world agree that vaccination against the virus is an important measure to stay safe in this pandemic.

Are COVID-19 vaccines safe in individuals with RA?

Most inactivated or non-live vaccines (vaccines that do not carry a living virus) can be administered to individuals with rheumatoid arthritis (RA) and are highly recommended. Based on current research, two non-live vaccines by Moderna and Pfizer appear to be safe in individuals with RA. The active content of these vaccines is mRNA that poses little to no risk to the affected individual. The only contraindications to these vaccines are as follows:

  • If you have a history of severe allergies to any vaccine in the past
  • If you are pregnant
  • If you are less than 18 years of age.
  • If you are on blood thinners such as Acitrom or have any bleeding disorders, you must talk to your doctor before going for the shot.

The vaccine may be less effective in individuals with RA compared with the general population because of drugs against rheumatoid arthritis (DMARDs) administered to these patients. Still, some protection is better than no protection. The potential for benefit from a complete dose of vaccination likely outweighs most vaccine uncertainties. Other preventive measures such as wearing a mask, maintaining social distancing, frequent hand washing, avoiding unwanted traveling, and social distancing must be practiced even after the vaccine is administered. 

The degree to which the vaccine is effective depends upon your RA medication schedule and the type of medicines you take. Riabni, Rituxan, Ruxience, and Truxima (rituximab) are associated with the greatest decline in response to vaccinations followed by Otrexup, Rasuvo, Rheumatrex, and Trexall (methotrexate), and Orencia (abatacept). However, even this slightly less effective vaccine may help prevent the severe disease that otherwise requires hospitalization or intensive care unit (ICU) admission.

What is the right schedule for getting vaccinated?

COVID-19 Vaccine
Most of the COVID-19 vaccines consist of two shots given intramuscularly. J&J vaccine is a one-shot vaccine.

Most of the COVID-19 vaccines consist of two shots given intramuscularly. The first shot is to start building protection. The second shot is to boost the protection level. Currently, we do not know exactly how long the immunity conferred by the vaccines will last. The Pfizer vaccine is given in two doses 21 days apart, and the Moderna vaccine is given as two shots 30 days apart. Both these are mRNA types of vaccines that cause our white blood cells to mount a response against a COVID-19-specific protein. These vaccines have no live germs in them that can pose danger to your body.

The non-live vaccines (Moderna and Pfizer) must be given at least 2 weeks prior to the start of immunosuppression therapy.

For individuals already on therapy, withholding immunosuppression therapy drugs, especially rituximab, methotrexate, and abatacept, temporarily around the time of vaccination and substituting these with nonsteroidal anti-inflammatory drugs (NSAIDs), hydroxychloroquine, or prednisone may be attempted. This may increase the vaccine efficacy, but this approach may also cause rheumatoid arthritis (RA) to flare up. Opinions about this differ among different specialists. You must seek advice from your treating physician regarding what will be the best for you. Depending on your disease severity and blood markers for RA, your physician will suggest what works for your body. Never change your medications without consulting your doctor.

SLIDESHOW

What Is Rheumatoid Arthritis (RA)? Symptoms, Treatment, Diagnosis See Slideshow

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Medically Reviewed on 2/19/2021
References
https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/other-diseases/covid-19-faqs-medication-treatment-and-vaccines

https://www.uptodate.com/contents/immunizations-in-autoimmune-inflammatory-rheumatic-disease-in-adults?search=covid%2019%20vaccine%20and%20RA&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1