Arthritis and COVID-19

Arthritis New Zealand – New Zealand Rheumatology Association position statement

Updated February 2024

• General advice during the COVID-19 pandemic

People with rheumatic disease should get vaccinated against COVID-19, including any recommended booster vaccinations, 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 most oral disease-modifying anti-rheumatic drugs (DMARDs) and most biological therapies for arthritis do not increase the risk of infection, hospitalisation or mortality caused by SARS-CoV-2 (the novel coronavirus).

Studies have 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 disease continue to take their medications during the pandemic and try to minimise the use of corticosteroids such as prednisone.

Use of rituximab, mycophenolate, sulfasalazine, or prednisone greater than 10 mg per day has been associated with an increased risk of severe illness due to COVID-19. It is very important to have well-controlled inflammatory disease, so do not stop these medicines and discuss this with your rheumatologist.

• COVID-19 vaccination advice

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

People with inflammatory arthritis and related disease who are taking DMARDs and immuno-suppressive medication should stay up to date with their COVID-19 vaccinations, and should receive any updated vaccines that target new variants as they become available.  

Patients taking methotrexate should withhold the dose that is due immediately after the vaccine, but should resume taking it the week after that, if disease activity and severity allow. This recommendation is to increase the effectiveness of the vaccine rather than due to concerns about safety.

For patients on Rituximab, if disease activity allows, patients should aim to receive their vaccine 2- 4 weeks before Rituximab, and/ or at least 5-6 months after their last Rituximab infusion.

• Evusheld (tixagevimab with cilgavimab) for pre-infection prophylaxis

Evusheld is now funded for people who are severely immunocompromised to protect them from getting COVID-19 or from becoming very sick if they get COVID-19. People with rheumatic disease who have received rituximab in the previous 12 months or high dose cyclophosphamide within previous 6 months are eligible for Evusheld, and can discuss this with their rheumatology team. Evusheld is given by injection every 6 months.

• Advice for people who develop COVID-19 infection

The New Zealand Ministry of Health provides advice for all New Zealanders about how to look after themselves while they have COVID-19.

Oral DMARDs (but not prednisone) should be withheld until you have recovered from the acute stages of COVID-19 infection (usually one week), and should be withheld during treatment with Paxlovid. Biologic therapy can be continued, but you should skip a dose or delay the next dose if you have feverish symptoms and/or a high temperature. 

Anti-viral therapies such as Paxlovid are now funded for those people who were eligible for the third primary dose of the COVID-19 vaccine who have COVID-19 infection. Most people who are on DMARD therapy are eligible for this treatment, which should be initiated as early as possible and within five days of symptom onset.

There are important drug-drug interactions between Paxlovid and medications used in rheumatology care, including cyclosporin, tacrolimus, colchicine, upadacitinib, sildenafil, and prednisone.

For some people on high doses of immunosuppression, particularly rituximab, prolonged COVID-19 infection may occur. The care of these people should be discussed with a specialist infectious diseases team.

More information:

• Pdf: How to report your RAT results
• Video: How to report your RAT result