Latest Advice About the COVID-19 Vaccine When Living with Rheumatoid Arthritis

The pandemic is over, but COVID isn’t gone. Here’s what you should know when scheduling a COVID-19 vaccine with RA.

Vaccines can play an important role in protecting you against serious infections and their complications.

Experts still recommend that most people get a COVID-19 vaccine, even as COVID-19 has transitioned from a pandemic disease to an endemic one. This means that the virus is still circulating through certain populations and will likely not go away, much like the annual flu.

Vaccinations help reduce your chances of becoming ill or hospitalized. This is even more important for people with compromised immune systems — like anyone living with rheumatoid arthritis (RA).

But before you rush out to get vaccinated, you need to consider a few factors if you’re living with RA.

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Should you get the COVID-19 vaccine if you’re living with RA?

The general answer is yes, you should get a COVID-19 vaccine if you’re living with RA. But exactly when it’s appropriate may depend on your current medications.

Many people with RA take one or more types of immunosuppressants to help suppress their immune system. This helps reduce overall inflammation or target specific parts of the immune system responsible for RA symptoms.

But these medications can also make it harder for your immune system to fight off infections and can complicate vaccination schedules.

The American College of Rheumatology (ACR) last updated its guidelines on COVID-19 vaccination schedules or recommendations in August 2022. These guidelines are based on the medications you take to manage RA symptoms.

Here’s what the guidelines suggest:

If you take: abatacept (taken intravenously)
Example brand name: Orencia
Guidance suggests: Vaccination should happen one week before your next dose of abatacept.

If you take: abatacept (taken subcutaneously)
Example brand name: Orencia
Guidance suggests: Stop using abatacept for 1 to 2 weeks after each COVID-19 vaccine dose (as your disease activity allows) before starting again.

If you take: acetaminophen or NSAIDs
Example brand name: Tylenol, Advil
Guidance suggests: If your RA disease activity is stable, stop these medications for 24 hours before vaccination. Continue using after vaccination as normal.

If you take: tumor necrosis factor inhibitors (TNFi) and cytokine inhibitors
Example brand name: Remicade, Enbrel, Humira, Cimzia, Simponi, Actemra, Kineret
Guidance suggests: There’s no consensus on when or if to stop taking these medications related to vaccination. Discuss the timing of your dose and vaccination with a doctor.

If you take: cyclophosphamide (taken intravenously)
Example brand name: Cytoxan
Guidance suggests: You should time your medication approximately 1 week after each COVID-19 vaccine dose when possible. The timing may depend on your starting lymphocyte count, so make sure to discuss this with your doctor.

If you take: hydroxychloroquine (taken as an intravenous immunoglobulin)
Example brand name: Plaquenil, Quinoric
Guidance suggests: You do not need to make modifications to the dosing or vaccination schedule for this medication.

If you take: rituximab or other anti-CD20 B-cell depleting agents
Example brand name: Rituxan
Guidance suggests: Discuss the best timing of your dose and COVID-19 vaccine with a rheumatologist before getting vaccinated.

If you take: other conventional and targeted immunomodulatory or immunosuppressive medications (e.g., JAK inhibitors, mycophenolate mofetil)
Example brand name: Xeljanz, CellCept, Mycortic
Guidance suggests: Stop using these medications for 1 to 2 weeks after each COVID-19 vaccine dose (as your disease activity allows) before starting again.

A note about medications and brand names: This guidance includes example brand names and is not exhaustive. There are many biosimilars available for the drugs listed above, which will have various brand names by different manufacturers. Reach out to your doctor or pharmacist to know exactly what medication you may be receiving based on your insurance formulary or tiered pharmacy plan.

There have been no known changes to these recommendations in the past few years. These guidelines apply for both primary and booster COVID-19 vaccines.

The CDC updated its COVID-19 vaccination recommendations in March 2024. They recommend that everyone 6 months and older with a moderate or severely compromised immune system needs at least one dose of a 2023–2024 updated COVID-19 vaccine.

If you haven’t had any COVID vaccines so far, you’ll likely need additional booster doses as well.

In the United States, you can receive any of the three brands currently offering vaccination: Pfizer-BioNTech, Moderna, or Novavax.

How effective is the COVID-19 vaccine when living with RA?

There’s some evidence that any vaccine response can be lower in people who are immunocompromised, including people living with RA.

Yet, being immunocompromised also means that you’re more likely to contract an infection like COVID-19. If you do, it can have significant effects — especially if you don’t have any antibodies from a vaccine to help your body fight the disease.

The COVID-19 vaccines have helped people lower their chances of getting sick and helped reduce the severity of COVID-19 if they did get sick.

If you’re living with RA, it can have similar benefits. All current guidance and medical authorities suggest COVID-19 vaccines are safe and effective for people living with RA.

The main thing to remember is that some types of medications for RA may alter when you get the vaccine and how effective the vaccine is.

According to a 2024 study, people living with RA had similar immune responses to the primary and booster shots for COVID-19 as the general population did.

But they found that older people and people taking some immunosuppressive medications — such as abatacept or JAK inhibitors — may have a limited reaction to vaccination. This means these people could have a higher chance of contracting COVID-19, but the vaccines still provide some essential protection.

It should be noted that samples in these types of studies are usually small, and more research is still needed.

Research findings like this are taken into account when organizations create guidelines about when to schedule a vaccine based on your medication. Any impacts on your current medications should be minimized.

Potential side effects

The COVID-19 vaccines, like other vaccinations, can cause side effects. These side effects can vary from person to person, so just because your friend had a side effect, it doesn’t mean you will too.

Some commonly reported side effects include:

• nausea
• chills
• pain, swelling, and redness at the injection site
• muscle pain, headache, or tiredness
• fever

Most people can relieve these side effects at home with over-the-counter medications, as needed.

If you’re living with RA or taking immunosuppressants, it’s natural to worry about severe side effects. Though no study can predict how you specifically will respond, a 2024 study found that people living with RA did not have an increased rate of adverse events or medical care following COVID-19 vaccination.

In other words, living with RA does not increase your chances of having more severe side effects than the rest of the world.

Nevertheless, if you have previously had side effects with a vaccine — including RA flares or an immune-triggered event — it’s a good idea to weigh the risks and benefits with your doctor.

Read more about Cheryl’s experience with the third COVID-19 dose while living with RA.

Other considerations when getting vaccinated

Before you get a COVID-19 vaccine or booster, you may want to reach out to a healthcare professional familiar with your current medications and health conditions. They can help ensure you make adjustments to medications as needed and monitor you for any side effects.

If you do experience serious side effects, you should contact a doctor or seek emergency services as soon as possible.

COVID-19 vaccination is free under the majority of major health plans as well as Medicare and Medicaid plans in the United States. However, if your insurance does not cover it or you don’t have insurance, the Bridge Access Program will provide free vaccinations to all people over the age of 18 until the end of 2024.

A free program for children also exists. It’s known as the Vaccines for Children (VFC) Program. This program allows children without insurance to get free vaccines like COVID-19.

Find places offering COVID-19 vaccinations.

The takeaway

If you’re living with RA, COVID-19 vaccination is a safe and effective way to prevent getting sick and reducing the severity if you do get sick.

The COVID-19 vaccination schedule is similar for anyone, whether they live with RA or not. But you may need to make adjustments based on your medications.

If you have questions, your prescribing doctor should be able to recommend when to get your first or booster shots. And you should be able to get vaccinated at no cost to you, whether you have insurance or not.

If you do have any COVID-19 vaccine side effects, reach out to your doctor. If they’re severe, seek emergency services as soon as possible.