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The COVID-19 Vaccine and Rheumatic Diseases: What to Know

Medically reviewed by Susan Kerrigan, MD, Marianne Madsen, Ananta Subedi, MD, and Rubaiya Mallay, DO on January 18, 2023

The COVID-19 vaccines have been proven safe, but, nonetheless, many are hesitant to get vaccinated. Some are concerned about potential side effects, others worry about whether there have been enough safety studies, and others buy into conspiracy theories like the vaccine causing sudden death, or possibly even worse, containing a microchip. 


Even people with no health conditions are concerned about the vaccine. So people living with autoimmune diseases might have significantly increased concerns related to it. Since individuals with these conditions often rely on medications to stay healthy, they may wonder if the vaccine will interfere with their medications, or if the vaccine will cause their autoimmune condition to worsen, or if the medications they are taking might make the vaccine less effective? These questions–and others–are valid. Here are the answers.


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COVID-19 Vaccine

COVID-19 Vaccine

I have an autoimmune inflammatory rheumatic disease. Can I get the COVID-19 vaccine?


There have been limited studies to examine the safety and effectiveness of the COVID-19 vaccines in patients with autoimmune diseases (for example: lupus and rheumatoid arthritis). But there are plenty of studies showing that people who have underlying medical conditions–including rheumatic diseases–have worse outcomes when they get infected with COVID-19. This is much more important for patients on immunosuppressive medications. The Centers for Disease Control and Prevention (CDC) recommends vaccination of patients with autoimmune conditions unless contraindicated by other factors. They suggest the benefits of the vaccine outweigh the potential risks. Various experts in the area of vaccine and autoimmune diseases do not suspect any major concern with the vaccine. In their recently released guidelines, the American College of Rheumatology’s Vaccine Clinical Guidance Task Force states:


There is no direct evidence about mRNA COVID-19 vaccine safety and efficacy in rheumatic and musculoskeletal disease patients. Regardless, there is no reason to expect vaccine harms will trump expected COVID-19 vaccine benefits.


The Arthritis Foundation appears to be in agreement. A quote from its website states:


Experts say there is no reason to believe that the current COVID-19 vaccines on the market will be unsafe for [people with autoimmune diseases].


None of the three approved vaccines contains any live virus, and they do not pose any risk of COVID-19 infection.


So the vaccine is safe. Which one should I get?


Patients with rheumatic diseases will be relieved to know that they can get any of the three approved COVID-19 vaccines. The three approved vaccines in the US (Moderna, Pfizer, and Johnson & Johnson) are considered to be safe in rheumatic disease patients, and studies have shown that they are effective in preventing severe COVID-19 infection. 


Does the vaccine interact with immunomodulating medications?


Based on studies of other vaccines ( e.g. pneumonia, yearly flu ) the use of immunosuppressive medication could decrease the effectiveness of different vaccines including the COVID-19 vaccine. But that doesn’t mean getting vaccinated won’t benefit you. Simply put, you’ll still have some level of immunity after receiving your shot. If you do end up contracting COVID-19 anyway, being immunized could mean the difference between experiencing a mild fever and cough (likely with immunity provided by the vaccine) and being hospitalized and possibly being on a ventilator (with no immunity). 


Will I experience a disease flare after getting vaccinated?


It is possible that patients with rheumatic diseases could experience a minor flare after getting the vaccine. But consider that getting infected with COVID-19 could lead to significant flares and could make you much sicker, even leading to hospitalization. Dr. Ananta Subedi, a practicing rheumatologist, says “Based on my experiences in the last several months, we have not had any major flares with any of our autoimmune disease patients after being vaccinated. Most of the vaccine side effects have been easily manageable.” 


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COVID mRNA Vaccine

COVID mRNA Vaccine

Does the COVID-19 vaccine affect my medication dosing regimen?


Depending on the medication(s) you take, you may need to adjust your dosing intervals. It’s best to talk to your rheumatologist about this topic in depth, but here is a list of general guidelines for some common medications. Note that these are just recommendations, and that you should ask your rheumatologist before following through with any of them. 


  • Methotrexate. If you have a stable autoimmune disease, the American College of Rheumatology recommends that you stop methotrexate one week before and one week after each dose of COVID-19 vaccine. This could improve the vaccine’s effectiveness. 
  • Abatacept. If you are on an Abatacept infusion, get the COVID-19 vaccine four weeks after your last infusion.  Wait a week before getting your next infusion, then continue as normal.
  • Rituximab. Rituximab reduces the function of the immune system, thus potentially reducing the effectiveness of the vaccine. The best time to get the vaccine is a month prior to a Rituximab infusion. After you get the vaccine, it’s best to wait 2-4 weeks before you get the next Rituximab infusion. 
  • JAK inhibitors. If you are taking any of the JAK inhibitors (tofacitinib, baricitinib, upadacitinib), do not take it for 1 week after getting the vaccine.
  • Cyclophosphamide Infusion. You should schedule the vaccine 1 week after your last infusion of Cyclophosphamide.


It’s important to note that an adverse reaction to the vaccine is NOT a concern with these medications–rather, these medications could lower immune system function, making the vaccine less effective in providing COVID-19 immunity. 


There are multiple other rheumatic medications that need no changes for vaccination.  These include:


  • Hydroxychloroquine 
  • IVIG
  • Low-dose glucocorticoids (for example, prednisone, daily dose < 20 mg)
  • Sulfasalazine
  • Leflunomide
  • Mycophenolate 
  • Azathioprine
  • Cyclophosphamide (oral)
  • Most of the other biological medications
  • Oral calcineurin inhibitors


Do I really have to keep following safety measures after getting vaccinated?


You may argue that getting vaccinated means you can take off your mask and “get back to normal.” But that’s not the case. The CDC recommends continuing COVID-19-related precautions even after getting the vaccine because there is still uncertainty related to whether the virus can be transmitted by fully vaccinated people. Keep your mask on, maintain social distancing, and wash your hands frequently to keep yourself and others healthy.


Written by Natan Rosenfeld

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