Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation of the joints. People with RA may be at higher risk of severe COVID-19 symptoms, and getting a COVID-19 vaccination is important protection.
People may need to adjust their RA medication regime in relation to their vaccination schedule. This can help give the body the best response to the vaccine.
This article looks at the safety and effectiveness of COVID-19 vaccines with RA, possible medication changes, and potential side effects to expect from the vaccines.
The American College of Rheumatology stresses the importance of anyone with RA becoming fully vaccinated against COVID-19, as people with RA may have a greater risk of severe COVID-19, hospitalization, and worse outcomes than the general population.
According to a 2020 article, people with inflammatory rheumatic and musculoskeletal diseases are more likely to have a severe COVID-19 infection if they also have certain factors that increase the risk of serious COVID-19 symptoms, including:
According to a 2021 study, the COVID-19 pandemic may indirectly contribute to RA flares. This may be due to the pandemic resulting in certain changes, such as:
All data and statistics in this article are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub and follow our live updates page for the most recent information on the COVID-19 pandemic.
According to the Arthritis Foundation, there is no evidence to suggest the current COVID-19 vaccines pose any risk to people with autoimmune conditions such as RA.
Both the Pfizer-BioNTech and Moderna vaccines use mRNA technology, which experts believe to be safe for people with autoimmune conditions and those taking immunosuppressive drugs.
A 2021 study of 5,493 people with RA found no evidence that the mRNA or inactivated virus vaccines for COVID-19 increased the risk of RA flares.
The Arthritis Foundation states that COVID-19 vaccines may not offer as effective protection for people with compromised immune systems as for those with healthy immune systems.
People with a compromised immune system may have a “blunted” vaccine response. This means the vaccines may offer less protection and for a shorter time for people with RA than the general population.
If people are taking any immunosuppressive drugs to treat RA, the vaccine may have reduced protection.
In addition to getting vaccinated, people with RA can continue wearing masks indoors in public places and speak with a doctor before traveling to check safety. Close contacts receiving vaccinations will also help protect people with RA.
Some research suggests disease-modifying drugs to treat autoimmune arthritis conditions may decrease the response of the Pfizer-BioNTech and Moderna vaccines. There is currently no data on the Johnson & Johnson (J&J) vaccine.
A non-peer-reviewed study looked at the effects of immunosuppressive drugs in 133 people who were fully vaccinated against COVID-19. Neutralization of the virus and antibody levels were three times lower than in those not taking immunosuppressive drugs.
There was also a lower response in people taking:
- tumor necrosis factor inhibitors
- methotrexate and sulfasalazine
- JAK inhibitors
- regular corticosteroids
- B cell inhibitors
However, most people in the study had antibody responses to the COVID-19 vaccine.
Discuss any medication changes with a doctor
The American College of Rheumatology recommends that people with RA talk to their doctor about changing the timing of certain medications in relation to their vaccination schedule. These medications include:
- JAK inhibitors, including baricitinib, tofacitinib, and upadacitinib
- abatacept (Orencia)
- rituximab (Rituxan)
People will also need to avoid taking acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) in the 24 hours before getting a COVID-19 vaccination. There are no restrictions on taking either acetaminophen or NSAIDs after a COVID vaccination to treat RA symptoms.
People who are already on scheduled acetaminophen or NSAIDs should talk to a doctor before stopping scheduled medications.
People with RA will need to discuss their medication regime with a doctor before getting a COVID-19 booster vaccination.
If people are taking rituximab or any other anti-CD20 drugs, they will need to discuss the timing of taking the medications with a doctor before getting a booster.
After getting a booster vaccination for COVID-19, people may need to stay off all immunomodulatory or immunosuppressive medications for 1–2 weeks, except glucocorticoids, anti-cytokine therapies, and most biologics.
This can help create a stronger response in the body to the COVID vaccine. Temporarily coming off medication may not be suitable for everyone, but most people are not at risk of a severe flare if they hold off medication for 1–2 weeks.
The best time to receive doses of a COVID-19 vaccine will depend on the type.
Individuals getting mRNA vaccines typically have two doses. They can get the second dose of the Pfizer vaccine 3 weeks after their first and a second Moderna vaccination 4 weeks after the first.
Most people taking immunosuppressive or immunomodulating medications will require a third dose as part of their primary vaccination series.
Individuals with RA who received an mRNA vaccine, such as Pfizer-BioNTech or Moderna, can get a third dose of the same vaccine type at least 4 weeks after their second.
Anyone aged 18 or older who received the Pfizer-BioNTech or Moderna vaccine and completed their primary vaccine series at least 6 months previously is eligible for a booster shot.
People who received a J&J vaccination who are 18 or older can have a second J&J or an mRNA vaccination at least 2 months after receiving their first dose.
People with a compromised immune system who have had the J&J vaccine are not currently eligible for a third booster vaccine.
A GUIDE TO COVID-19 VACCINES
- The Pfizer vaccine for coronavirus
- Everything to know about the Moderna COVID-19 vaccine
- How does the Sputnik V COVID-19 vaccine work?
- Oxford-AstraZeneca vaccine: What to know about side effects
- Johnson & Johnson COVID-19 vaccine: What are the side effects?
- Covaxin COVID-19 vaccine: What to know about side effects
Research so far suggests that the side effects of COVID vaccines are similar in people with autoimmune or inflammatory rheumatic conditions as in the rest of the population.
COVID-19 vaccines can cause side effects that are normal responses from the body as it reacts and protects itself against the virus. These side effects can include:
- flu-like symptoms
- body aches
- fever and chills
- pain, swelling, or redness at the site of injection
- muscle and joint pain
Some people may experience more side effects after their second dose of the vaccine. These effects usually occur in the first 3 days after getting the vaccine and often only last 1–2 days.
People getting a COVID-19 vaccination, including booster shots, can speak with their doctor about any RA medications they are taking and whether they need to adjust medication timings around their vaccination schedule.
People can also discuss with a doctor whether they require a booster vaccine and whether additional doses will provide them with further protection.
If a person has any history of severe allergic reactions, they can ask their doctor which vaccine is safe.
People who experience any severe side effects after receiving a vaccine should contact their doctor straight away.
Having RA can increase the risk of severe COVID-19 infection and poorer outcomes, and it is important for people with RA to get fully vaccinated.
COVID-19 vaccines are safe for people with RA and effectively increase protection.
To increase the response against COVID-19, people with RA may need to change their medication regime around their vaccinations temporarily. They can discuss any changes with a doctor before getting a vaccination.