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COVID Vaccine and Autoimmune Conditions - to Vaccinate or not to Vaccinate

Autoimmune Conditions and COVID Vaccine

Recently, the CDC (Centers for Disease Control) advanced its COVID vaccine rollout, and, now, all individuals who are immunocompromised and/or suffer from autoimmune conditions are eligible to get that sought-after injection”.

 COVID Vaccine Center

Putting aside whether you were able to put your hands on a timeslot to be vaccinated or not (took me endless browser refreshing), opinions are being voiced from both sides of the fence - the yays and the nays.

Personally, suffering for many years from an autoimmune condition, Rheumatoid Arthritis (my immune system attacks my joints), I had no doubt I was going to get the injection.

In fact, as I’m writing these lines, I am already two weeks after my second dosage. The first shot gave me a sore shoulder for three days, and, surprisingly, the second dose went unfelt. Zero side effects whatsoever.

Taking COVID Vaccine Shot

The actual moi taking the second shot


But why did I choose to get vaccinated? After all, many voices out there are claiming that individuals with autoimmune conditions and those who are taking medications that weaken, or modify, the immune system are at a greater uncertainty in terms of what risks the vaccine might pose.

COVID Vaccine - Risk vs. Reward

Like with many things in life, making this decision is also about managing risks. As an individual with an immune system that is totally messed up, I know that if COVID were to meet me, it would have probably been ugly.

True, the shot was put on an FDA-approval super fast track, therefore there’s not much experience with at-risk populations, like those who are  immunocompromised and/or suffer from autoimmune conditions.

Nonetheless, the CDC states that clinical trials demonstrated similar safety and efficacy profiles in people with some underlying medical conditions like conditions that place them at increased risk for severe COVID-19.

In other words, it’s the severe (and proven) COVID-19 risk for immunocompromised individuals vs. the vaccine risk, which is basically non-existing as far as science knows and as far as clinical evidence shows.

Some theorize that if you are taking medications that affect your immune system, the protection you’ll get from the shot will not be as effective. But guess what, in the worst case, it will just not be as effective…dah. But it’s still a better option than the alternative of the potential risks in not taking it.

Simply put - no one died from any conditions directly associated with the vaccine, while millions died from COVID and from its complications.

But who am I to judge?

To get some scientific approval, I turned to a dear friend, Prof. Lior Zangi, from the Department of Genetics & Genomic Sciences at Mount Sinai New York with a Ph.D in immunology.


Lior’s view is that EVERYONE should get vaccinated, regardless of age or of having any underlying condition. He goes even further and answers a fundamental question that has been surfacing quite a lot lately: should healthy young people be vaccinated?

His answer in brief: YES. The reward is greater than the risk and the risk is nonexistent.

Furthermore, he strengthens his point by saying that whoever chooses to not get vaccinated is basically offering a fertile ground for the virus to mutate and create new variants. And that's not good. To that extent, that's why even young healthy people must also get vaccinated!

 

ACR COVID-19 Vaccine Clinical Guidance

 So let’s get into the specifics of the recommendations of the ACR (American College of Rheumatology) relating COVID-19 vaccine clinical guidance for patients with rheumatic and musculoskeletal diseases (RMD).

Before that, please remember that these recommendations are still a ‘work in progress’ and will evolve as more data comes in. Therefore, patients should continue and monitor information about available mRNA vaccines and other types that are under development.


Key Takeaways:

COVID-19 risk factors:

  •         Autoimmune inflammatory rheumatic diseases (AIIRD) patients (e.g., RA, PsA, axSpA, gout, lupus, vasculitis) are at a higher risk for COVID-19 hospitalization and worse outcome compared to the general population.
  •         Based on their COVID-19 risk, AIIRD patients should be a priority group to be vaccinated vs. the general population of similar age and sex.

 

Considerations:

  •         Based on available data, there is no preference for one COVID-19 vaccine over another.
  •         There is no direct evidence about mRNA COVID-19 vaccine safety and efficacy in RMD patients. However, there is no reason to expect that adverse effects from the vaccine will outweigh the benefits to RMD patients.
  •         There are no known additional contradictions to COVID-19 vaccines beyond known allergies to the its ingredients.
  •         Rheumatology patients taking systemic immunosuppressive medications may experience lesser response to a COVID-19 vaccine and the protection may not last as long as in the general population. Nevertheless, the vaccine is still very likely to provide meaningful protection, and RMD patients should be vaccinated.
  •         There is a theoretical risk that AIIRD patients may experience a disease flare after getting a COVID-19 vaccine, but the benefits of the vaccine’s protection outweigh the risks.

 

And now for the real nitty gritty – Medication Timing

It may be helpful to alter the timing of the following medications in consultation with a rheumatologist, when following a COVID-19 vaccine schedule*:

  •         Methotrexate, Cyclophosphamide
  •         JAK inhibitors – Baricitinib (Olumiant), Tofacitinib (Xeljanz), upadocitinib (Rinvoq)
  •         Abatacept (Orenica), rithuximab (Rithuxan, Rexience, Truximo)

*Click here for the ACR complete document

The purpose of doing so would be to maximize vaccine response; there were no safety concerns raised related to medication or vaccine timing.

Following COVID-19 vaccination, RMD patients should continue to follow all public health guidelines, including mask-wearing, hand hygiene, physical distancing, and other preventative measures.


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