How to Receive Enough COVID-19 Immunizations if You Have Rheumatic Disease.

How to Receive Enough COVID-19 Immunizations if You Have Rheumatic Disease healthcareservices.vision

A COVID-19 infection increases the risk of major consequences in those who are moderately or severely immunocompromised. Because of this, the Centers for Disease Control and Prevention (CDC) advises that these individuals consider their primary series to be three doses of the Pfizer-BioNTech or Moderna mRNA vaccines — plus all required boosters, including the new one issued this autumn.

Even after receiving their two injections, this group—which includes those using standard drugs for rheumatic conditions including rheumatoid arthritis (RA) and psoriatic arthritis (PsA)—remains susceptible to becoming seriously ill from COVID-19.

The most recent booster dosage of an mRNA vaccine, which has been upgraded to target both the original strain and the presently circulating omicron variations, is now what the CDC advises that everyone receive.

The most recent update to the ACR’s clinical advice for physicians was made in August 2022, and it was intended to give doctors the knowledge they need to appropriately counsel their rheumatology patients.

The COVID-19 vaccinations are a topic of great interest to people with RA. We chatted with Juan J. Maya-Villamizar, MD, a rheumatologist at the Rheumatology Center of Palm Beach in Lake Worth, Florida, and a medical advisor to the online group CreakyJoints, to get answers to frequent queries.

Does everyone with rheumatoid arthritis need to receive the third dose of the mRNA vaccination that the CDC advises for immunocompromised individuals?

The problem isn’t that individuals have autoimmune disorders like RA; rather, it’s that most of them are treated with immunosuppressive medications.

Steroids, tumor necrosis factor inhibitors (TNFi), interleukin-6 inhibitors (IL-6), methotrexate, sulfasalazine, leflunomide, azathioprine, mycophenolate, and Janus kinase (JAK) inhibitors are a few drugs can cause the need for a third dosage. This category excludes those who solely take hydroxychloroquine or who are not taking immunosuppressive medications because they have little disease activity.

Why will the third injection help those using these medications?

Following the second dosage, antibodies against COVID-19 are frequently not produced. According to certain research, up to 50% of immunosuppressive medication-taking patients failed to produce antibodies. The proportion of patients who finally produce antibodies increases after receiving the third dosage. Some people won’t, despite this.

When ought one to provide the third dose?

It is advised to have the vaccination at least four weeks following the second dose of your Pfizer or Moderna vaccine. You ought to continue using your previous one if at all feasible. Aim to grab Moderna for your third shot if you used it for your first two. If you can’t obtain the same vaccination for any reason, you can have the other mRNA vaccine, the CDC’s use of the phrase “if possible” implies.

Do third vaccinations have any risks?

Other than the typical vaccination responses, such as localized arm soreness or reactions, or symptoms similar to a cold, such as muscular pains, fever, or chills, there have not been any concerns associated with immunocompromised people documented. It’s not a guarantee that you will experience one after the third shot if you experienced one after your first two shots, but it is conceivable.

Joint discomfort might occasionally flare up in people with RA. Use your regular drugs, such as acetaminophen, ibuprofen, or naproxen, according to the advice. If you believe you are experiencing a significant joint pain response, make sure to consult your rheumatologist.

Naturally, there is always a very tiny chance of unanticipated responses with any form of intervention. After the third injection, go to your doctor if anything arises that has you worried.

People 12 and older are now advised to receive a new, updated booster of the mRNA injections, according to CDC recommendations. Does this apply to immunocompromised individuals who have previously had the prescribed three doses and maybe one or two boosters?

Indeed, it does.

Before this time, every vaccination and booster available was directed against a virus with a young strain. The most recent vaccinations from Pfizer and Moderna also contain some spike protein-coding from the now widely circulating omicron versions. In comparison to the previous booster injections, it is hoped that this would offer better protection. Everyone above the age of 12 should presently receive an updated COVID-19 booster, according to the CDC. At least two months should pass since your last vaccination before you receive this.

Only the Pfizer vaccination is presently available to those aged 12 to 17, while the Moderna injection is only approved for those aged 18 and over. For this updated dose, you can choose between Moderna or Pfizer if you had Pfizer in your primary series or even your earlier boosters. Everyone else is free to mix their mRNA shots.

Additionally, boosters are available for kids aged 5 to 11. The revised Pfizer booster should be administered to healthy individuals at least five months after the two-dose main series has been finished.