Spondylitis and COVID-19 Vaccines: Q&A With Dr. Tambar

• Most people with inflammatory arthritis, including axial spondyloarthritis and ankylosing spondylitis, are recommended to be vaccinated against COVID-19.
• Those taking certain medications are advised to schedule their treatments to maximize the effectiveness of the vaccines when possible.
• The COVID-19 vaccines are considered safe, effective, and low-risk for most people with autoimmune and inflammatory conditions.
• Your doctor is the best person to help you understand your potential risks versus the potential benefits of the COVID-19 vaccines.

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.

The COVID-19 vaccines are so new that there is not yet any specific data on results or side effects in people with spondylitis. How can we know whether it’s safe and effective for this population?

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.

The Pfizer and Moderna vaccines are both messenger RNA (mRNA) vaccines, a brand new type of vaccine. Is there any live coronavirus in these vaccines?

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.

Is it a possibility that the mRNA in the vaccines will interact with human DNA?

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.

Can medications taken to treat spondylitis cause interactions or impact the effectiveness of the vaccinations?

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:

• If you're on methotrexate, hold your methotrexate for one week after getting each vaccination dose.
• For those on JAK inhibitors [i.e., Xeljanz], hold for one week after each vaccination dose.
• For rituximab, it's recommended to get the first vaccination dose four weeks before an infusion, and hold for two to four weeks after the second vaccination dose.
• For those taking Orencia injections, hold for one week before and one week after the first vaccination dose only.

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.

What about people taking high-dose corticosteroids for an active spondylitis flare?

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.

Is there any reason to think that the COVID-19 vaccines might trigger or worsen a disease flare for someone who's currently dealing with one?

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.

Is either the Pfizer or Moderna vaccine considered safer or more effective for people with spondylitis?

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.

Two of the currently approved COVID-19 vaccines require two doses, timed 21 days after the first for Pfizer and 28 days later for Moderna. Is it important to get the second dose?

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.

Some of our members have expressed worry about how quickly the COVID-19 vaccines were developed, leading them to say they want to wait a few years before getting the vaccines. Do you have similar concerns, and if so, should people with spondylitis wait before getting vaccinated?

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.

Are there any benefits to waiting to get vaccinated?

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 someone experienced a bad reaction following a flu vaccine in the past, should they also be cautious about getting the COVID-19 vaccine?

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.

Do you have any concerns about potential long-term side effects of the COVID-19 vaccines?

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.

What is the most important thing for people with spondylitis to know about COVID-19 vaccines, in your opinion?

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.

“Feeling More Hopeful About the Future”

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!”

Talk With Others Who Understand

On MySpondylitisTeam, more than 61,000 people come together to ask questions, provide advice, and share their stories with others who understand life with spondylitis.

Are you living with spondylitis and curious about the COVID-19 vaccine? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References

1. COVID-19 Vaccines — U.S. Food and Drug Administration (FDA)
2. COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases — American College of Rheumatology
3. Why are mRNA vaccines so exciting? — Harvard Health Letter
4. FDA Statement on Following the Authorized Dosing Schedules for COVID-19 Vaccines — U.S. Food & Drug Administration (FDA)
5. Anaphylaxis — Mayo Clinic