This group, which includes people on medications commonly used for rheumatic diseases such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), remains vulnerable to being severely sickened by COVID-19 even after they’ve had their two shots, the agency said. The CDC now recommends that everyone get the most recently formulated booster dose of an mRNA vaccine, which has been updated to target the currently circulating omicron variants in addition to the original strain. People with RA have many questions about the COVID-19 vaccines. For answers to common questions, we spoke with Juan J. Maya-Villamizar, MD, a rheumatologist at the Rheumatology Center of Palm Beach, in Lake Worth, Florida, and a medical adviser to the digital arthritis community CreakyJoints. Everyday Health: Does the CDC’s recommendation that people who are immunocompromised get a third shot of their mRNA vaccines apply to everyone with rheumatoid arthritis? Dr. Juan Maya-Villamizar: It isn’t the fact that people have an autoimmune condition like RA that is the issue, but rather that people with these diseases generally take immunosuppressive drugs. Some medications that trigger the need for a third dose include steroids, tumor necrosis factor inhibitors (TNFi), interleukin-6 inhibitors (IL-6), methotrexate, sulfasalazine, leflunomide, azathioprine, mycophenolate, and Janus kinase (JAK) inhibitors. People who are not on immunosuppressive drugs because they have low disease activity or who are only on hydroxychloroquine are not part of this group. EH: Why will people on these meds benefit from that third shot? JMV: The data is showing that antibodies against COVID-19 are often not generated after the second dose. In some studies, up to 50 percent of patients who are on an immunosuppressive medication did not make antibodies. By getting the third dose, the number of people who finally develop antibodies goes up. Even so, not everyone will make them. EH: When should a person get the third dose? JMV: The recommendation is to get the shot at least four weeks after the second shot of your Pfizer or Moderna vaccine. If possible, you should stick with the same one you had before. So if you had Moderna for your first two shots, you should try to get that for your third. The implication of the CDC’s words “if possible” is if you’re not able to get the same vaccine for some reason, you can get the other mRNA vaccine. EH: Are there risks to getting a third vaccine? JMV: For immunocompromised patients there have not been any risks reported, other than reactions that are expected for any vaccine: localized arm pain or reactions, or symptoms like you get with a cold, such as muscle aches, fever, or chills. If you had a reaction to your prior shots, that doesn’t mean you will have one after the third shot, but it is possible. People with RA may also get a little flare of joint pain. The recommendation is to use your typical medications, such as acetaminophen, ibuprofen, or naproxen. Be sure to talk to your rheumatologist if you feel you’re having a severe joint pain reaction. Of course, with any type of intervention there is always a very small percentage of unexpected reactions. If something comes up that concerns you after you get the third shot, speak to your doctor. EH: The CDC has now issued guidance that people 12 and older should get a new, updated booster of the mRNA shots. Does this apply to people who are immunocompromised who have already had the three-shot series and probably also one or two booster shots? JMV: Yes, it does. All the vaccines and the boosters available before now targeted an early strain of the virus. The currently updated vaccines from Pfizer and Moderna also include some spike protein code from the omicron variants widely circulating now. The hope is that this will provide better protection than the older booster shots. The CDC currently recommends that everyone 12 and older get an updated COVID-19 booster. This can be administered at least two months after your last vaccine. Those 12 to 17 can currently get only the Pfizer vaccine, because the Moderna shot is authorized for people 18 and older. Everyone else can mix their mRNA shots, so if you got Pfizer in your primary series and even your earlier boosters, you can get Moderna or Pfizer for this updated shot. Children ages 5 to 11 can also get a booster. Those who are not immunocompromised are advised to get an updated Pfizer booster at least five months after completing their two-dose primary series. Children that age who are immunocompromised should get the vaccine at least three months after completing the three-dose primary series. To help you know what COVID shots you are eligible for, the CDC has created a tool on its website where you can input individual information about your age, health, and vaccine status. Other recent guidance by the American College of Rheumatology noted that it’s fine for people to get more than one vaccine at the same time. So you can get your flu or pneumonia vaccine on the same day as the new COVID-19 booster. EH: The American College of Rheumatology recommends that people briefly shift the timing of some of their medications when they get the first or second shot if their disease is stable. For example, they suggest that JAK inhibitors should be delayed for a week after each COVID-19 vaccine dose. Do these same recommendations apply for subsequent shots, too? JMV: The task force agreed that certain medicines should again be held for one to two weeks around the vaccine, such as mycophenolate and JAK inhibitors. This recommendation applies to both primary vaccination and supplemental doses. They did not reach consensus about other medicines, including TNF inhibitors. I myself am telling my patients whose disease is stable to follow the same recommendations as for the other medications, since this may help improve response to the vaccine. Everyone should talk to their doctor about their own treatment situation. EH: Are there other things people with a rheumatic disease should know about the vaccines? JMV: Without question everyone should get vaccinated. Recent data shows that most hospital admissions for COVID-19 are in unvaccinated patients. It’s clear that getting vaccinated decreases your risk of a hospital admission and prevents you from getting stronger forms of the disease. Staying out of the hospital has additional benefits for immunocompromised people because of all the other infections that live there. If you have specific concerns that are holding you back from being vaccinated, be sure to share them with your doctor. Even after you get the three shots and the boosters, it’s still important for people who are immunocompromised to diligently follow other COVID-19 prevention measures when the disease is spreading, such as wearing a mask; avoiding large gatherings, especially in poorly ventilated spaces; and maintaining at least six feet of distance from other people.
