Arthritis and COVID-19 – What you need to know
COVID-19 advice for people with inflammatory arthritis and related autoimmune diseases
Arthritis New Zealand – New Zealand Rheumatology Association position statement
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 on rituximab, cyclophosphamide, and most oral DMARDs (including methotrexate, leflunomide, azathioprine, mycophenolate, tacrolimus, and cyclosporin) are eligible for a third primary dose of the Comirnaty (Pfizer) vaccine eight weeks after the second dose, in accordance with the New Zealand Ministry of Health guidance (version 3). People on long-term prednisone ≥10mg daily are also eligible for a third primary dose. A booster vaccine dose should also be given 3 months after the third primary vaccine. It is possible that further vaccine doses will be recommended in future.
After the third primary vaccine dose and the booster dose, oral DMARDs (but not prednisone or hydroxychloroquine) should be withheld for 1-2 weeks, if disease activity and severity allow. This recommendation is to increase the effectiveness of the vaccine rather than due to concerns about safety.
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 and biologics (but not prednisone) should be withheld until recovery from COVID-19 infection if rheumatic disease activity and severity allow.
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, as longer periods of isolation and additional testing may be needed in this situation.
Support from Arthritis New Zealand
Follow our Page to get updates about arthritis in New Zealand and access to helpful advice and information for living well with arthritis.
Peer Support Service
Speak to someone who knows what you’re going through. This service links trained volunteers who have arthritis with people needing peer support through lived experiences. Click here for more information or phone 0800 663 463.
Online Support Groups
We now have several online private support groups on Facebook. A place to ask questions and talk to people who understand. Arthritis Educators keep an eye on the group activity and can answer questions. Click here to find a suitable group.
Get Us To Call You
Fill in our online form so that we can be more prepared with answers to your questions when we call you back. Click here to fill in the form.
COVID-19 & Children with Arthritis
Children 5 to 15 years old are approved to have the COVID-19 Pfizer vaccine. Children with chronic health conditions like arthritis should check with the paediatric rheumatology team first if they are on immune suppressive medications as the timing may need to be managed.
Starship Children’s Hospital regularly updates the advice and information on its website about COVID-19 in children and what to expect. Contact your specialist or Healthline if you have any questions.