The American College of Rheumatology COVID-19 Vaccine Recommendations

Recently the American College of Rheumatology (ACR) released its recommendations for autoimmune patients (including rheumatoid arthritis) for the COVID-19 vaccines.

Their conclusion was that although there is limited data, autoimmune patients are at higher risk for being hospitalized and having worse outcomes from COVID-19.1 They determined that the benefit of vaccination outweighs the risk of possible autoimmune reaction or flares from receiving the vaccine.

Guidance from an expert panel

ACR created a guidance summary developed by a multi-disciplinary panel of nine rheumatologists, two infectious disease specialists, and two public health experts for giving healthcare providers guidance on vaccination for rheumatology patients.

More on this topic

They focused on the two vaccines currently available and approved in the U.S., which are the mRNA type. As more data becomes available, ACR expects to update the guidance appropriately.

A peer-reviewed manuscript with additional details on clinical studies, data, and discussion points will be published soon in Arthritis & Rheumatology and on the ACR website.

Consult with your doctor about the COVID-19 vaccine

Not surprisingly, ACR stresses that patients should consult with their doctor about COVID-19 vaccination:1

“The ACR has voiced that recommendations in the guidance should not replace clinical judgment, and decisions about individual patients should be made as part of shared decision-making with patients that considers their underlying health condition(s), disease activity level, current treatments, risk of exposure to SARS-CoV-2 and geography. Patients are also encouraged to continue following all public health guidelines regarding mask-wearing, physical distancing and other preventive measures even after vaccination.”

Guidance on RA medications & the mRNA vaccine

Perhaps the most significant statement was that they found no support for the need to change most medication timing (or pause them temporarily) around vaccination for improving the efficacy of the vaccines.1 Although patients should consult with their doctor on their specific treatment regimens, generally ACR says there is no need to stop, pause, or change the timing of taking most rheumatoid arthritis treatments.

The guidance does support vaccinating autoimmune disease patients before the general public, which has also been supported by the CDC in their vaccine guidance to states.1

Additionally, excluding the already-known possible allergic reactions to vaccines, they found no other contraindications for vaccinating rheumatology patients.1 However, they did acknowledge that it is possible that the immune response from the vaccine may be less than what it is for people without autoimmune conditions (general public).

Continue following public health guidelines after vaccination

ACR advised that, following vaccination, autoimmune patients should continue to follow the public health guidelines (such as wearing masks and social distancing).1 They also said it may be helpful for household members and frequent close contacts to also become vaccinated whenever possible to protect the patient from virus exposure.1

This is a standard recommendation for immunocompromised people (or even infants) for increasing their safety from infectious diseases.

Consult with your doctor about the details

Page three of the guidance document has a helpful chart with medication types and recommendations for adjusting medications around vaccination.1

For example, there were no change recommendations for those taking less than 20 mg of prednisone a day, anti-TNFs, and several IL-inhibitors. For patients with well-controlled disease, they recommended pausing methotrexate for one week after each vaccine dose. Other medications involved scheduling the vaccine at certain times between treatments.

Consult the chart with your doctor to determine the recommended course of action for your disease treatment.

This vaccine guidance is helpful

Overall, it’s helpful to have the ACR review the known data from the perspective of treating autoimmune disease patients and providing some broad guidance on COVID-19 vaccination.

It’s good to know there are no known issues with receiving an mRNA vaccine and that they support the idea that getting vaccinated is likely the best course for most patients. It’s also good they stressed consulting with our doctors on our own unique circumstances so that we can make the best decision for our overall health.

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