Arthritis and COVID-19 – What you need to know
Updated 19 August 2021
There are confirmed cases of community transmission of the Delta variant of COVID-19 in New Zealand and Arthritis New Zealand encourages people to stay up to date with the Ministry of Health information about it.
The following advice is from Arthritis New Zealand Medical Advisor Assoc. Prof. Andrew Harrison.
The Delta variant of COVID-19 in New Zealand is more easily transmitted than previous variants. New Zealand is currently at Alert Level 4 and mask-wearing when in contact with people outside your bubble is now mandatory. Schools, events and sports are all cancelled and people are urged to Stay Home.
Stay up to date with Alert Level changes on the Covid-19 website.
We encourage people to follow advice from their doctor or specialist about when and how to book your vaccine and to find out information specific to you.
Patients taking methotrexate are minimally, if at all, at increased risk of infection, including flu and COVID-19. There is a small increased risk of infection for patients taking some biologic therapies.
Please note that
- the Delta variant is more contagious than other variations of COVID-19, and
- any infection risk for arthritis patients is linked more to arthritis itself than to the disease-modifying drugs used for arthritis
- If you have a flare of arthritis you may require steroids, which increases the risk of infection more than any other drug used in arthritis.
It is therefore important that you keep taking your arthritis treatment, including biological therapies.
Patients on biologics who become feverish should seek advice from their GP and/or rheumatologist, and stop taking the biologic until the fever has resolved. This is the standard advice for patients on biologics who develop any infection.
COVID-19 Vaccination & Inflammatory Arthritis
COVID-19 Vaccination in Patients with Inflammatory Arthritis and Related Autoimmune Diseases
13 March 2020 (vaccination information edited 19 August 2021)
Arthritis New Zealand-New Zealand Rheumatology Association position statement
Studies published to date have not shown that the use of oral disease-modifying anti-rheumatic drugs (DMARDs) and biological therapies for arthritis increase the risk of infection, hospitalization or mortality caused by the SARS-CoV-2 novel coronavirus.
The use of prednisone greater than 10 mg per day was, however, associated with an increased risk of hospitalisation due to COVID-19 infection.
Previous studies have shown that patients with poorly controlled inflammatory disease are at increased risk of infection.
It is therefore recommended that people with inflammatory arthritis continue to take DMARDs and biological therapies during the current pandemic, and try to minimize the use of corticosteroids such as prednisone.
Patients with inflammatory arthritis, including those taking oral DMARDs and biological therapies, have been receiving the COVID-19 vaccine.
To book your vaccine, visit the Book My Vaccine website.
The American College of Rheumatology (ACR) has released a COVID-19 vaccine clinical guidance, which recommends (among other things) that patients with auto-immune and inflammatory rheumatic disease should be given priority in the “vaccine queue”. It says that inflammatory arthritis is not a contraindication, i.e. not a reason to avoid vaccination. It says that the response to the vaccine may be somewhat less in this group and that there is a theoretical risk that disease may flare to some extent after vaccination. Any of the approved COVID-19 vaccines would be appropriate, and in the case of multi-dose vaccines, the follow-up dose(s) should be given. Household contacts should also be vaccinated.
The ACR recommends that methotrexate should be withheld for one week after each vaccine dose, for those with well-controlled disease. For patients on rituximab, it is recommended that the vaccine series is initiated approximately 4 weeks prior to the next scheduled rituximab cycle. These recommendations have been made to increase the effectiveness of the vaccine rather than due to concerns about safety.
It is important to note that none of the COVID-19 vaccines is 100% effective and that vaccination is not a substitute for public health measures currently in place, such as hand-washing, distancing, wearing a face-covering and isolation and testing when you have COVID-19 symptoms.
COVID-19 & Children with Arthritis
Children 12 to 15 years old are now 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.
March 2020: The COVID-19 advice sheet for Paediatric Rheumatology Patients at Starship Children’s Hospital was published in March 2020 and has not been updated, however, most of the advice is still relevant. Contact your specialist or Healthline if you have any questions.
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