The U.S. Food and Drug Administration (FDA) approved the Pfizer and Moderna COVID-19 vaccines in December 2020. Guidelines released in early February by the American College of Rheumatology (ACR) COVID-19 Vaccine Clinical Guidance Task Force recommend that people with autoimmune and rheumatic diseases get vaccinated against the virus unless they have known allergies to vaccine components.
Many MySpondylitisTeam members still have questions about whether the COVID-19 vaccines will be safe and effective for people living with axial spondyloarthritis (axSpA) and ankylosing spondylitis, and particularly for those taking disease-modifying antirheumatic drugs (DMARDs). To help us address these questions, MySpondylitisTeam interviewed Dr. Siddharth Tambar. Dr. Tambar is a rheumatologist at Chicago Arthritis and Regenerative Medicine, where he has specialized in rheumatology and regenerative medicine since 2008.
I understand people's concerns. Frankly, I had those same concerns when COVID-19 first started and vaccine talk was first coming out. I have felt a lot more reassured as data has come out with the vaccines that are available in the United States, when it comes to safety and efficacy, how the vaccines are actually made, and how they work. They are very low-risk vaccinations.
The vaccine helps prevent getting the infection, but more importantly, it really does a great job in terms of preventing very bad consequences from COVID infections. So while I understand people's concerns, it’s a low-risk intervention with very high potential for positive results and benefits.
There is still a higher risk for severe COVID-19 disease in our autoimmune patients who are on medications, so there is still a definite need for people to get vaccinated. You should speak with your physician if you have an autoimmune condition, but with very few exceptions, I would say the vast majority of our patients should be getting vaccinated.
No, not in the ones that are currently approved here in the United States. You're not being exposed to the full virus, you're just being exposed to a very tiny bit of mRNA, which is a small bit of genetic code that your body then creates a key protein in COVID-19, and your body reacts to that protein. It helps your body develop a reaction to COVID. It is very low-risk.
That has not been shown to be the case. Currently there's no evidence, outside of the rare allergic reaction, that there are any other side effects. Unless we hear something different, I would again recommend proceeding with the vaccination.
Theoretically, some medications may reduce the effectiveness of the vaccination. But there's no thought that it would cause any other kind of untoward events if you get vaccinated while on these medications.
The American College of Rheumatology has come out with guidelines recommending some adjustments on the timing of certain medications. Holding some of these medications temporarily after getting vaccinated can [allow you to] avoid limiting the effectiveness of the vaccination.
The recommendations are:
For all the other medications, there are no recommendations to change the dosage schedule.
You should touch base with your rheumatologist to make sure that you can delay your treatment appropriately. It gets a little bit complicated when you talk about people who have active disease. But in coordination with your rheumatologist, try to schedule these medications if possible.
Is it possible that steroids such as prednisone could blunt the effectiveness of vaccination? Possibly — but you should still be vaccinated. At this point, I would not delay vaccination, and I definitely would not stop steroids. If you have a very active autoimmune issue that requires staying on medication, I would 100 percent continue medication and get vaccinated as well.
I haven't heard of that as a side effect. I haven't seen that in the small number of my patients who have already gotten vaccinated.
We don't have any evidence to suggest one over the other. Right now, I would say, go ahead and get vaccinated. There's no reason to wait to get a different vaccine.
The data comes from two doses, so I would do it correctly. The vaccination schedule is created in a certain way, and I would stick with that as much as possible unless there's very strong evidence to do it differently.
I was worried at first as well, and wanted to see a lot more evidence of safety and efficacy. But the reality is that the studies throughout the world have shown that these are low-risk interventions. For me personally, I feel comfortable getting vaccinated based on that evidence and that data.
I really would not wait for another six to 12 months. I would go ahead and get vaccinated. It's not only protecting you, it's protecting your family members, your friends, your co-workers.
The American College of Rheumatology came out with their statement to strongly recommend that our patients get vaccinated because the overwhelming benefits make sense. I get that people have concerns — I had that same concern — but the evidence coming out so far has looked very positive and safe, and so I would proceed.
If you've had a significant reaction to vaccinations in the past, speak with your doctor to see if it makes sense to get vaccinated. But even for those who have had anaphylaxis reactions to the flu vaccine, it's recommended to still proceed with the COVID vaccination.
Speak with your physician if you've had a bad reaction to vaccinations in the past, but the vast majority of people who have had moderate-level reactions should still proceed with their COVID vaccination. You tell the place where you're getting vaccinated, and they will watch you for a longer period of time after being vaccinated.
Beyond six months, we just don't have that data. We'll have to see what comes out over the next few years. But there's been nothing that's shown so far, at least over six months’ time, to indicate any problems.
The most important thing is understanding risk versus benefit. If you have an autoimmune issue, you've been dealing with these kinds of decisions for a long time already in a way that the general population does not have to. Take on this decision in that same manner — clear-headed and sensible. Think about the COVID vaccination in a similar way. It’s a low-risk intervention with a lot of benefits to the people who get it, and a lot of benefits to people who are close to you as well.
Don’t get too fearful with rumors and the unknown. Speak with your physicians, who have an understanding of your medical condition. Understand your risks that are for real and your benefits, and then make a conscious decision.
Some members of MySpondylitisTeam have already received one or both doses of the COVID-19 vaccine, while others are awaiting their turn or still considering their options.
Members who received their vaccinations have been sharing how it has lifted their mood. “Just received my first COVID vaccine,” wrote one member. “It’s the first thing that actually made me feel slightly optimistic in a very, very long time. I finally have something positive to share.” Another shared their views on risks: “Looking forward to getting mine. I am petrified, but it can't be as bad as a ventilator.”
Those who have scheduled their first vaccination or are still waiting for access also share their sense of anticipation. “I am looking forward to getting the first step done and the second appointment established,” wrote one MySpondylitisTeam member. “I am hoping that it's not too long before I'm offered the vaccine, which will go a long way to making me feel more hopeful about the future,” wrote another. A third member echoed this sentiment, writing, “Looking forward to being offered the immunization to move forward!”
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