February 22, 2021
With vaccinations against COVID-19 underway, the American College of Rheumatology (ACR) has released its COVID-19 Vaccine Clinical Guidance Summary1, strongly recommending that those living with rheumatic conditions, such as spondyloarthritis, get the vaccine.
The ACR document provides an official recommendation to vaccinate those living with rheumatic diseases, including inflammatory, autoimmune, and musculoskeletal conditions.
“The benefit of COVID-19 vaccination outweighs any small, possible risks for new autoimmune reactions or disease flare after vaccination,” said Dr. Jeffrey Curtis, chair of the ACR COVID-19 Vaccine Clinical Guidance Task Force.2
A task force of nine rheumatologists, two infectious disease specialists, and two public health experts developed the document, which is intended to provide guidance to healthcare providers treating rheumatology patients.
Below are several key takeaways from the ACR’s clinical guidance:
Can those with SpA and other rheumatic diseases safely take either of the two currently available COVID-19 vaccines? Is one better than another for those with SpA?
- Yes, those with SpA and other rheumatic diseases can safely take either of the two vaccines currently offered, unless they have known allergies to vaccine components.
- There is no preference for one vaccine over another.
Will receiving a COVID-19 vaccine cause a flare in those with SpA, or aggravate symptoms?
- As we don’t yet have clinical trial data specifically on how those with SpA and other rheumatic diseases will react to the vaccine, we can’t say for sure. A theoretical risk exists for a disease flare or worsening of symptoms following COVID-19 vaccination. However, the benefit of COVID-19 vaccination outweighs potential risks for all in the SpA community.
Are there any SpA medications that should be stopped or delayed to get a COVID-19 vaccine?
- There are a few medications the ACR panel recommended delaying. The most common biologic drugs taken by those with SpA
(TNF inhibitors and IL inhibitors) can be taken regularly as scheduled with no modifications needed.
- Methotrexate: In those with well-controlled disease, the recommendation is to hold or delay Methotrexate for one week after each vaccine dose. Vaccinations can be given according to normal schedule.
- JAK inhibitors (such as Tofacitinib): For those taking one of these medications the recommendation is to hold or delay the medication one week after each vaccine dose. Vaccinations can be given according to normal schedule.
- Other medications with suggested modifications that are not commonly taken by those with SpA were: Abatacept SQ, Abatacept IV, Cyclophosphamide IV, Rituximab. Please see the full guidance document for details on these medications.
The ACR also recommended that patients still make their decisions regarding the vaccine in partnership with their rheumatologist or primary healthcare provider. “ACR guidance statements are not intended to supersede the judgement of rheumatology care providers nor override the values and perspectives of their patients. Guidance was based on weak and/or indirect evidence and required substantial extrapolation by an expert task force. All statements, therefore, should be considered conditional or provisional. The ACR is committed to updating this guidance document as new evidence emerges.”1