Arthritis New Zealand-New Zealand Rheumatology Association position statement – COVID-19 vaccination in patients with inflammatory arthritis and related autoimmune diseases

November 2021

People with rheumatic disease should get vaccinated against COVID-19, and observe all public health measures (such as mask-wearing and handwashing) as recommended by the New Zealand Ministry of Health.

Studies published to date have shown that the use of oral disease-modifying anti-rheumatic drugs (DMARDs) and most biological therapies for arthritis do not increase the risk of infection, hospitalization or mortality caused by SARS-CoV-2 (the novel coronavirus).

Use of rituximab and prednisone greater than 10 mg per day was, however, associated with an increased risk of severe illness due to COVID-19. Studies have also shown that people with poorly controlled inflammatory disease are at increased risk of severe illness due to COVID-19.

It is therefore recommended that people with inflammatory arthritis continue to take their arthritis medications during the pandemic, and try to minimize use of corticosteroids such as prednisone.

COVID-19 vaccination can be given safely to people on DMARDs, and is strongly recommended for all eligible people with rheumatic disease.

Patients on rituximab, cyclophosphamide, and most oral DMARDs (including methotrexate, leflunomide, azathioprine, mycophenolate, tacrolimus, and cyclosporin) are now eligible for a third primary dose eight weeks after the second dose, in accordance with the Ministry of Health guidance (version 3).  Patients on long-term prednisone ≥10mg daily are also eligible for a third primary dose.  A booster vaccine dose should also be given six months after the third primary vaccine.

After the third primary vaccine dose and the booster dose, oral DMARDs (but not prednisone) should be withheld for 1-2 weeks, if disease activity allows. This recommendation is to increase the effectiveness of the vaccine rather than due to concerns about safety.