COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases (Part-8)
Allow me to continue our discussion on the need for Covid vaccines for those with rheumatic and musculoskeletal disease (RMD) and AIIRD or autoimmune and inflammatory rheumatic disease.
Due to the uncertainties in the interpretation of lab testing, the vaccination would have an impact in the clinical decision-making, and the panel.
The Task Force of experts discussed the possibility of recommending additional and more sustained public health measures in AIIRD patients. After deliberation, the panel did not choose to exceed current public health authority guidance given uncertainties about the clinical effectiveness of vaccination in such patients. The appropriateness for continued preventive measures should be discussed with patients as their healthcare providers as seen as appropriate.
The timing considerations consist of the consideration of the treatment.
When using abatacept intravenous, it is best to schedule vaccination so that it occurs one week prior to the next dose of IV abatacept.
For abatacept SQ, it is wise to hold for one to two weeks (as disease activity allows) after each COVID vaccine dose.
The use of non-steroidalanti-inflammatory drugs, assuming that disease is stable, holds for 24 hours prior to vaccination. No restrictions on use post vaccination once symptoms develop.
For the use of Rituximab or other anti-CD20 B-cell depleting agents, it is wise to discuss the optimal timing of dosing and vaccination with the rheumatology provider before proceeding.
Allother conventional and targeted immunomodulatory or immunosuppressive medications should not be used for 2 weeks in relation with disease activity.
The American College of Rheumatology guidance statements are not intended to supersede the judgement of rheumatology care providers nor override the values and perspectives of their patients. Guidance was based on weak and/or indirect evidence and required substantial extrapolation by an expert task force. All statements, therefore, should be considered conditional or provisional.