The U.S. Food and Drug Administration (FDA) approved the Pfizer and Moderna COVID-19 vaccines in December 2020. Guidelines released in early February by the American College of Rheumatology COVID-19 Vaccine Clinical Guidance Task Force recommend that people with autoimmune and rheumatic diseases get vaccinated against the virus — unless they have known allergies to vaccine components.
On February 27, the FDA approved Johnson & Johnson’s COVID-19 vaccine, creating a third option to the Pfizer and Moderna COVID-19 vaccines. This new vaccine requires a single dose and works in a different way than the first two vaccines. We will follow up soon with more information about this newest option. In the meantime, the following interview includes information on the Pfizer and Moderna COVID-19 vaccines.
Many myRAteam members still have questions about whether the COVID-19 vaccines will be safe and effective for people living with RA, and particularly for those taking disease-modifying antirheumatic drugs (DMARDs). To help us address these questions, myRAteam interviewed Dr. Siddharth Tambar. Dr. Tambar is a rheumatologist at Chicago Arthritis and Regenerative Medicine, where he has specialized in rheumatology and regenerative medicine since 2008.
I understand people's concerns. Frankly, I had those same concerns when COVID-19 first started and vaccine talk was first coming out. I have felt a lot more reassured as data has come out with the vaccines that are available in the United States, when it comes to safety and efficacy, how the vaccines are actually made, and how they work. They are very low-risk vaccinations.
The vaccine helps prevent getting the infection, but more importantly, it really does a great job in terms of preventing very bad consequences from COVID infections. So while I understand people's concerns, it’s a low-risk intervention with very high potential for positive results and benefits.
There is still a higher risk for severe COVID-19 disease in our autoimmune patients who are on medications, so there is still a definite need for people to get vaccinated. You should speak with your physician if you have an autoimmune condition, but with very few exceptions, I would say the vast majority of our patients should be getting vaccinated.
No, not in the ones that are currently approved here in the United States. You're not being exposed to the full virus, you're just being exposed to a very tiny bit of mRNA, which is a small bit of genetic code that your body then creates a key protein in COVID-19, and your body reacts to that protein. It helps your body develop a reaction to COVID. It is very low-risk.
That has not been shown to be the case. Currently there's no evidence, outside of the rare allergic reaction, that there are any other side effects. Unless we hear something different, I would again recommend proceeding with the vaccination.
Theoretically, some medications for RA may reduce the effectiveness of the vaccination. But there's no thought that it would cause any other kind of untoward events if you get vaccinated while on these medications.
The American College of Rheumatology has come out with guidelines recommending some adjustments on the timing of certain medications. Holding some of these medications temporarily after getting vaccinated can [allow you to] avoid limiting the effectiveness of the vaccination.
The recommendations are:
For all the other medications, there are no recommendations to change the dosage schedule.
You should touch base with your rheumatologist to make sure that you can delay your treatment appropriately. It gets a little bit complicated when you talk about people who have active disease. But in coordination with your rheumatologist, try to schedule these medications if possible.
Is it possible that steroids, such as prednisone, could blunt the effectiveness of vaccination? Possibly — but you should still be vaccinated. At this point, I would not delay vaccination, and I definitely would not stop steroids. If you have a very active autoimmune issue that requires staying on medication, I would 100 percent continue medication and get vaccinated as well.
I haven't heard of that as a side effect. I haven't seen that in the small number of my patients who have already gotten vaccinated. We don't have any evidence to suggest that our inflammatory arthritis patients are flaring when they get the COVID vaccine.
We don't have any evidence to suggest one over the other. Right now, I would say, go ahead and get vaccinated. There's no reason to wait to get a different vaccine.
The data comes from two doses, so I would do it correctly. The vaccination schedule is created in a certain way, and I would stick with that as much as possible unless there's very strong evidence to do it differently.
I was worried at first as well, and wanted to see a lot more evidence of safety and efficacy. But the reality is that the studies throughout the world have shown that these are low-risk interventions. For me personally, I feel comfortable getting vaccinated based on that evidence and that data.
I really would not wait for another six to 12 months. I would go ahead and get vaccinated. It's not only protecting you, it's protecting your family members, your friends, your co-workers.
The American College of Rheumatology came out with their statement to strongly recommend that our patients get vaccinated because the overwhelming benefits make sense. I get that people have concerns — I had that same concern — but the evidence coming out so far has looked very positive and safe, and so I would proceed.
If you've had a significant reaction to vaccinations in the past, speak with your doctor to see if it makes sense to get vaccinated. But even for those who have had anaphylaxis reactions to the flu vaccine, it's recommended to still proceed with the COVID vaccination.
Speak with your physician if you've had a bad reaction to vaccinations in the past, but the vast majority of people who have had moderate-level reactions should still proceed with their COVID vaccination. You tell the place where you're getting vaccinated, and they will watch you for a longer period of time after being vaccinated.
Beyond six months, we just don't have that data. We'll have to see what comes out over the next few years. But there's been nothing that's shown so far, at least over six months’ time, to indicate any problems.
The most important thing is understanding risk versus benefit. If you have an autoimmune issue, you've been dealing with these kinds of decisions for a long time already in a way that the general population does not have to. Take on this decision in that same manner — clear-headed and sensible. Think about the COVID vaccination in a similar way. It’s a low-risk intervention with a lot of benefits to the people who get it, and a lot of benefits to people who are close to you as well.
Don’t get too fearful with rumors and the unknown. Speak with your physicians, who have an understanding of your medical condition. Understand your risks that are for real and your benefits, and then make a conscious decision.
Some myRAteam members have already received one or both doses of the COVID-19 vaccine, and are eager to share the news. “I’m a happy camper — got my first COVID vaccine!” wrote one member. “I feel like a weight has been lifted, and there is light at the end of the tunnel.” Another reported relief after a long wait, writing, “I am so thankful I was able to get the vaccine.” A different member encouraged others, posting, “You will feel more secure after having it, knowing that it should alleviate symptoms of COVID.”
Many members share how they weighed the risks and benefits of the COVID-19 vaccine. “I believe I made a great decision,” wrote one. “I'm a nurse and have seen too many deaths.” Another member who decided to get the vaccine posted, “I’m thinking that I’d much rather take my chances with the vaccine than to get COVID.” Those who have been through a coronavirus infection have another perspective. One myRAteam member and COVID-19 survivor wrote, “I already had coronavirus, and I do not want it again, so I will take the vaccine.”
The availability of the vaccines and rising numbers of those vaccinated are giving many myRAteam members hope that pandemic conditions could improve in the near future. As one member wrote, “My prayer is that everyone will get vaccinated as soon as possible so that we can turn what is today 500,000 deaths in the United States to ZERO deaths from here on out.”
On myRAteam, more than 145,000 people come together to ask questions, provide advice, and share their stories with others who understand life with rheumatoid arthritis.
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