JointHealth™ express   March 22, 2021

Important arthritis patient information about the COVID-19 vaccination

Although there is limited data from large population-based studies, it appears that patients with autoimmune and inflammatory diseases and conditions (such as rheumatoid arthritis, axial spondyloarthritis and lupus) are at a higher risk for developing COVID-19 that result in hospitalization compared to the general population. They also can have worse outcomes associated with the infection, most notably, an increased risk of death especially in those with poorly controlled disease and underlying complications related to their disease.

People living with forms of inflammatory arthritis have questions and concerns on whether they should take the COVID-19 vaccine. The Canadian Rheumatology Association (CRA) and the American College of Rheumatology have published evidence-based recommendations that the benefit of COVID-19 vaccination outweighs any small, possible risks for new autoimmune reactions or disease flare after vaccination, as well as advice on how to best include it into their treatment plans to maximize vaccine efficacy.

Here are the recommendations:

  1. All adult inflammatory arthritis patients should receive the COVID-19 vaccine unless there are known allergies to vaccine components. Patients on immune suppressing medications (such as those listed below) should receive the vaccine. The CRA does not recommend adjusting these medications; however, in individual cases, medication adjustment may be appropriate.

  2. There is no preference for one manufacturers’ vaccine over another.

  3. For inflammatory arthritis patients on the following medications, there is no need to adjust or delay the medication:
    • Anti-inflammatory medications (or “NSAIDs”)
    • Hydroxychloroquine (Plaquenil)
    • Prednisone less than 20mg/day
    • IVIG
    • Sulfasalazine
    • Leflunomide (Arava)
    • Mycophenolate (CellCept)
    • Azathioprine
    • Oral cyclophosphamide
    • Cyclosporin
    • Tacrolimus (Protopic)
    • Adalimumab (Humira)
    • Anakinra (Kineret)
    • Belimumab (Benlysta)
    • Certolizumab (Cimzia)
    • Etanercept (Brenzys, Enbrel, Erelzi)
    • Golimumab (Simponi)
    • Infliximab (Avsola, Inflectra, Remicade, Renflexis)
    • Ixekizumab (Taltz)
    • Sarilumab (Kevzara)
    • Secukinumab (Cosentyx)
    • Tocilizumab (Actemra)
    • Ustekinumab (Stelara)
  4. For patients on the following medications, there are two options:

    Option 1:
    Do not change medication dosing (Canadian Guidelines).

    Option 2:
    Adjust medication dosing to optimize the immune response to the vaccine (American Guidelines). For this option, the guidelines make the following medication specific recommendations:
    • For patients on weekly methotrexate, an option is to skip the MTX dose the following week after each vaccine dose.
    • For patients on tofacitinib, baricitinib, upadacitinib, an option is to skip the medication for 1 week following each vaccine dose.
    • For patients on abatacept weekly injections, an option is to skip the abatacept one week before and one week after the first dose of vaccine. Continue abatacept through the second dose of vaccine. For IV abatacept, consider timing the 1st dose of vaccine 4 weeks post dose and postpone next infusion x 1 week. No IV Abatacept adjustments needed for 2nd vaccine dose.
    • For patients on IV cyclophosphamide, an option is to take each vaccine dose at least 1 week prior to the next cyclophosphamide infusion.
    • For patients on rituximab (Rituxan, Ruxience, Riximyo, Truxima) or ocrelizumab, the COVID-19 vaccination should ideally be timed 4-5 months after your last infusion and 2-4 weeks prior to their next infusion, when possible, in order to optimize vaccine response. However, in patients who require immediate infusion or who are unable to optimize timing of infusion product and vaccine, it is likely more important to have the COVID vaccine earlier than to delay based on timing of B-cell therapy.
    • For patients on prednisone 20mg/d or higher, consider waiting until the prednisone dose is tapered to below 20mg/d to receive both vaccine doses.
  5. How to get your vaccination:

    Here is the information posted under Phase 3 and 4 on the BC Ministry of Health’s web site:

    “The process to get immunized will happen in three steps.

    Step 1: Registration

    British Columbians in Phase 3 and 4 will register through HealthConnect, a simple online registration system, or by phone.

    Registration will help us book appointments quickly and easily. When it's time for you to register, you will select your preferred method of communication. This is how we will contact you to book a vaccine appointment.

    Registration opens in April. No action is required yet and no one will be able to book their appointment before the registration system is launched.

    Step 2: Book an appointment

    When you are contacted to book a vaccine appointment, you will be asked to:
    • Complete a pre-screening
    • Select a location, date and time
    You will be able to make your appointment online or by phone.

    Step 3: Appointment day

    Come prepared to your appointment and arrive a few minutes before your scheduled time. At the immunization clinic you will:
    • Complete a check-in process
    • Get your vaccine dose
    • Wait in an observation area for about 15 minutes
    Getting the second dose
    People who get their first vaccine dose will be notified by email, text or phone call when they are eligible to book an appointment for their second dose.”
ACE will send a JointHealth™ express to when registration opens, or you can check the BC Ministry of Health’s web site frequently beginning April 1, 2021.

1Canadian Rheumatology Association Recommendation on Covid-19 Vaccination in Persons with Autoimmune Rheumatic Disease. February 2021
2American College of Rheumatology Covid-19 Vaccine Clinical Guidance Summary for patients with Rheumatic Disease. February 8, 2021