Viral infections

COVID-19 Vaccination Recommended for Patients with Rheumatic Disease

Guidance from the American College of Rheumatology advises that patients with rheumatic and musculoskeletal disease receive COVID-19 vaccination. Recommendations on the use of COVID-19 vaccines in patients with rheumatic disease were published online ahead of print in Arthritis & Rheumatology.

“Although there is limited data from large population-based studies, it appears that patients with autoimmune and inflammatory conditions are at a higher risk for developing hospitalized COVID-19 compared to the general population and have worse outcomes associated with infection,” said Jeffrey Curtis, MD, MPH, chair of the American College of Rheumatology COVID-19 Vaccine Clinical Guidance Task Force. “Based on this concern, the benefit of COVID-19 vaccination outweighs any small, possible risks for new autoimmune reactions or disease flare after vaccination.”

Developed by a panel of 9 rheumatologists, 2 infectious disease specialists, and 2 public health experts with current or former employment with the Centers for Disease Control and Prevention, the guidance is intended to provide direction to providers but not to replace clinical judgement and shared decision-making with patients.

The recommendations include guidance for patients with high disease activity and those taking immunosuppressant treatments that may affect response to the vaccine. A lack of evidence specific to COVID-19 vaccination in patients with rheumatologic disease required the task force to look to general principles with other vaccines for a favorable response.

“For example, a rheumatoid arthritis patient with well-controlled disease may benefit from holding a dose of methotrexate immediately following vaccination,” said David Karp, MD,  PhD, president of the American College of Rheumatology. “In the case of drugs with long dosing intervals such as rituximab, there are some circumstances where it may be beneficial to time the vaccine around when the last dose was given to maximize the vaccine’s efficacy. We encourage clinicians to study the charts we’ve provided in the summary for details on how they can time various medications to ensure maximum success.”

Changes to the guidance are likely as more safety and efficacy data about mRNA vaccines become available, as well as data about vaccine response in patients with rheumatic disease.

“This is very much a ‘living document,’ and the task force already has plans to evaluate additional data in the coming weeks,” said Dr Curtis. “We desperately need direct evidence from high quality research. To reach that goal, we would issue a call to action for patients, providers, and researchers to mobilize and support the important research efforts that are underway to study vaccine effectiveness and safety in rheumatology patients.”

—Jolynn Tumolo


Curtis JR, Johnson SR, Anthony DD, et al. American College of Rheumatology guidance for COVID-19 vaccination in patients with rheumatic and musculoskeletal diseases - version 1. Arthritis Rheum. Published ahead of print, March 17, 2021

ACR COVID-19 vaccine guidance recommends vaccination, addresses immunosuppressant drugs & patient concerns [press release]. Atlanta, Georgia: The American College of Rheumatology; February 11, 2021.