The COVID-19 Vaccine and Arthritis – Your Frequently Asked Questions Answered
Our medical advisor and consultant rheumatologist Dr Wendy Holden has answered your questions about the COVID-19 vaccine for people living with arthritis.
Read more about the vaccination rollout in the The Joint Committee on Vaccination and Immunisation (JCVI) report, published on 13th April 2021.
Q: How do the COVID-19 vaccinations work?
All vaccines work by helping train the body to recognise the virus as dangerous, so that the body’s immune system can kill it and prevent illness. Vaccines work by showing the body a harmless part of the virus, called an ‘antigen’. The body’s immune system recognises the antigen as foreign and starts to make ‘antibodies’ which stick to the antigen and kill it.
In the case of the three COVID vaccinations used in the UK, a part of the spike protein which is on the surface of the virus is used as the antigen.
This is injected into the body. The immune system recognises these as dangerous and makes antibodies to the spike protein.
Once antibodies are made, they circulate round in the blood waiting for the appearance of the real spike protein on COVID-19 ready to bind to it, stop it from getting into cells, and stop it from causing disease. The antibodies act just like an army ready to attack the enemy.
Q: What is a “live” vaccination?
Live vaccinations use a weakened form of the virus that causes disease. It’s important to remember that live vaccinations can’t ever cause the disease, because it doesn’t have the genetic information that the virus needs to multiply and spread through the body.
Q: Can patients develop COVID-19 from the vaccination?
No. None of the vaccinations contain the genetic information that is needed for the virus to multiply, so they can’t cause COVID-19. Vaccinations help the body to get ready in case COVID-19 comes along, by preparing your immune system. It is this immune preparation that can cause people to feel unwell for a day or so after the vaccination, not the virus itself.
Q: Does the vaccination have any side effects?
Many people have no side effects at all.
Millions in the UK have now been vaccinated, and many more worldwide with no serious side effects reported. A very small number of people may have a serious allergy to one of the additives in the vaccination, so they should avoid this particular vaccination. If you have any serious allergies, ask your GP if you are OK to have the vaccination.
Common side effects (more than 1 in 10 people) include:
- Arm soreness
- Muscle aches
- Joint pains
These are usually very mild and settle in a day or so. Paracetamol can help.
Q: Which vaccinations are best for people with arthritis?
There are three vaccinations currently authorised by the Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK.
The Oxford-AstraZeneca vaccine is based on part of a common cold virus found in chimpanzees, and has been genetically changed so that it cannot cause disease in humans. This common cold virus is very good at infecting cells, so the scientists have used this ability to smuggle in a piece of genetic information containing the harmless COVID-19 spike protein. This trigger the body to produce antibodies against COVID-19. This vaccine can be stored in a normal fridge, so is easier to give in primary care.
The Pfizer/BioNTech vaccine and the Moderna, mRNA-based vaccine both contain the genetic code of the spike protein, called mRNA, which the body then recognises as dangerous. The body makes antibodies against the spike protein, which stay in the blood ready to attack the spike protein if a real COVID-19 virus comes along.
The Joint Committee of Vaccination and Immunisation (JCVI) have advised that all of these vaccines are safe, and all give a good level of protection for people with arthritis. No one vaccine is considered better than another.
Q: Are the vaccinations safe?
Some people worried that COVID-19 vaccines were developed very quickly and worried about safety.
The good news is that Scientists know a lot about other coronaviruses already, and this type of technology has been used for many years to make vaccines against other types of virus such as influenza and other types of coronavirus, for example Middle Eastern Respiratory Syndrome (MERS). The vaccine has been shown to be extremely safe.
Before the vaccines were approved in the UK, the safety evidence was reviewed by the MHRA – the Medicines and Healthcare Products Regulatory Agency who make sure that medicines are safe. Similar regulatory agencies work in the EU and USA to make sure that vaccinations are safe.
Other than a tiny number of people who have had a severe allergic reaction to another vaccine or one of the additives, everyone else definitely should have a vaccine. It is far safer for most people to get the vaccine than risking a severe COVID-19 infection. This includes all people with arthritis receiving disease-modifying drugs such as methotrexate, biologic drugs or corticosteroids and anyone classified as clinically vulnerable.
Q: Why are some people reluctant to have the vaccination?
A lot of frightening information has been going around social media about the vaccination which has made some people worried.
The vaccination does not contain gelatine or pork. It is not made from embryos or embryo cells – it is entirely made in a laboratory. The vaccination cannot turn anyone into a monkey, and it does not contain monkey cells – the Oxford vaccination uses an altered part of a cold virus, not chimpanzee cells. The vaccination doesn’t contain alcohol.
Q: What about the new variants? Will the vaccinations work against these?
All viruses mutate frequently, which means that they change their shape or structure. That’s why a different flu vaccination is needed every year against the mutated structure of the flu virus.
Luckily, scientists already know exactly what the COVID-19 virus looks like, and can predict which mutations will happen and what the mutations will do.
All the current vaccinations work well against the original and the Alpha (Kent) variant of COVID-19.
The Beta (South African) variant is a little more worrying because it has a different spike protein structure, which might mean that it can hide from the body’s immune system. Small trials have shown that the Oxford AstraZeneca vaccination may be less effective against mild and moderate COVID-19 infections, however may still protect against severe disease. More research is needed.
The good news is that scientists can keep ahead of any mutations by quickly developing new vaccinations which are much quicker to produce than the original. Yearly boosters may be needed, however this isn’t known yet.
Q: What can I expect when I go for my vaccination?
First of all, remember that the vaccination is always free and the invitation will come from the NHS. You will never be asked to pay, so if you get a strange phone call or knock on the door with an offer to have a vaccination for money, this is a scam and phone the police immediately.
Often the vaccination happens in a large room with tables, screens, a waiting area and a recovery area for afterwards, with a one-way-system to make sure everything is safe.
An administration person will note that you have arrived at the centre. You will be asked to sit at a desk with the person doing the vaccination, who will be wearing a mask/visor.
You will be asked some questions about your general health, for example if you have had a temperature, are allergic to vaccinations, are taking any medicines or whether you have had a recent COVID-19 infection (vaccination should be postponed for 4 weeks after the infection).
You don’t need to remove any clothes, just to be able to expose one upper arm, usually your non-dominant arm. There will be screens or curtains for modesty.
If all is well, you will be given a small injection in your upper arm. They will also give you information about common side effects, and asked to wait for 15 minutes to make sure that you have not had a reaction. After that, you can go home.
Everyone I’ve spoken to who has had a vaccination has been impressed by how organised the whole system is!
Q: Once I have had the vaccination, can I go and see my family and friends?
Not yet – it will take 2-3 weeks for your body to make enough antibodies for you to be protected.
Scientists still don’t know how effective the vaccination is at stopping you from spreading the virus, so others may still be able to catch the virus from you, even if you can’t get ill from it.
We all still need to be very careful for some time, even after 2 vaccinations.
Q: I am on methotrexate – will the vaccination be effective in protecting me from COVID-19?
There are a number of research projects currently investigating immune response in patients on immunosuppressive medicines.
In a recent small study of people living in New York City or Erlangen, Germany, people with inflammatory arthritis who were taking either methotrexate alone or another immunomodulator such as an anti TNF inhibitor were compared to healthy participants given the Pfizer-BioNTech vaccination.
More than 90% of healthy individuals and patients on non-methotrexate treatments or biologic treatments produced adequate levels of Covid 19 antibodies.
Only 62% of 45 participants taking methotrexate produced adequate levels of antibodies.
Similar small studies have also shown reduced antibody responses with the Moderna vaccination and in patients taking regular steroids (corticosteroids) and B cell inhibitors such as rituximab.
What does this mean?
Studies so far have all been very small, and scientists do not yet know what level of antibodies is considered “effective” so no firm conclusions can be made. It may mean that some people taking methotrexate may be less effective at responding to the COVID-19 vaccination. We know that this is already the case with some other vaccinations such as influenza. Scientists do not yet know if booster vaccinations will be needed for some people or if temporarily stopping methotrexate will help boost the immune response.
More research is currently being done and for now advice continues to be that getting the COVID-19 vaccination is safe and still recommended but people taking immunosuppressive treatments should continue to be cautious and protect themselves from unnecessary COVID-19 exposure and to continue be careful with hand hygiene and social distancing.
On 23rd August 2021, the Lancet published findings of the OCTAVE-Trial, research looking at patients on immunosuppressive medicines to see if the COVID-19 vaccinations are effective. Read the research paper here.
Q: My immune system is already weakened by my arthritis and my arthritis medicines. Why should I have the vaccination?
We know that people who have active arthritis or who have a weakened immune system due to medicines are more at risk of serious complications from COVID-19 infections. This is completely preventable by taking the vaccine. The vaccination will not weaken your immune system more.
Q: Why is the UK giving the two vaccinations 8-12 weeks apart, rather than 3 weeks apart as they do in the US and Europe?
Scientists know that the first dose of the vaccination gives protection from catching COVID-19 for about 12 weeks, so it is safe to give the second dose at 12 weeks rather than 3 weeks. There is some evidence that the Oxford vaccination is even more effective in the long run if given this way. Giving the vaccination 8-12 weeks apart means that many more vulnerable people will be protected from severe disease, which will prevent the most deaths.
Q: I’ve had COVID-19. Do I still need to have the vaccination?
Having COVID-19 probably offers some protection from getting another COVID infection for a while, but no one knows how long that protection lasts or how much protection individuals will have. For this reason, it is important to get the vaccination and be protected as much as possible.
In studies of healthcare workers and others who have had COVID-19, 6 months after infection, about 88% still had antibodies in their blood to COVID-19, however no-one knows how much protection these really offer.
Q: Should I get a booster vaccination?
NHS England are just setting out plans for who should have a Covid-19 booster vaccination and this programme will be in 2 stages.
The first stage from 6th September 2021 will include booster vaccinations for those who are immunocompromised and clinically extremely vulnerable. This will include people taking medicines for inflammatory arthritis such as methotrexate, biologics and corticosteroids, and the group will also include people over 70 and those living in care homes as well as NHS frontline staff.
Stage 2 will be adults over 50, at risk people aged 16-49 and household contacts of immunocompromised individuals.
Annual influenza and Covid-19 vaccinations will be given at the same time.
No advice has been given yet about the choice of vaccination but evidence is still being collected about whether a different type of vaccine given as a booster will be more effective and the choice of vaccine is likely to be a balance between effectiveness and potential adverse effects in certain groups.
Q: Is it safe to have different vaccinations?
All three vaccines available in the UK are safe and effective and at the moment no one knows if offering different vaccinations will boost the immune response or be better for some people. Research is still ongoing.
Q: Are people with immune conditions more at risk of death during the pandemic?
An observational study of death records in the UK has shown that in March and April 2020, people with rare autoimmune rheumatic conditions were slightly more likely to die during this period than the average person. It is not known whether this risk was due to Covid-19, due to alterations in the health services or treatments due to Cavid-19 or due to other factors. More research is being done on this question.
Q: Is it safe to have a steroid injection or to start methotrexate before the vaccination?
Experts suggest that delaying a non-urgent steroid injection or starting methotrexate or another disease modifying drug for 2 weeks after the vaccination may help the vaccination be more effective.
If you need urgent steroid or other treatment because your arthritis is severe, then don’t delay your treatment. Having active arthritis is also bad for the immune system, and will make you more vulnerable to COVID-19.
Experts also suggest that rituximab has been shown to reduce the effectiveness of some vaccinations. It may be worth postponing rituximab for 2-4 weeks after the vaccination, or switching to an alternative medicine if possible. If you have a life-threatening condition, however, then rituximab shouldn’t be postponed, and your healthcare professional can give you more guidelines for your situation.
Q: Should I delay my methotrexate or other arthritis drugs for a few days around the time of the vaccination?
Scientists do not know the answer to this question yet, so there has been no guidance. However, many arthritis drugs work for a long time – weeks or months – so common sense suggests that it is not logical to stop them for a few days before a vaccination, as the medicine will still be in your system.
Q: Should I delay planned surgery because of the vaccination?
Current advice is to delay surgery for a week after the vaccination. This is because both the vaccination and surgery can cause a temperature, and this may lead to unnecessary tests or checks after your surgery.
Q: What should I do if I haven’t had my vaccination letter?
If you still haven’t received an invitation, you can call 119 or visit the NHS website to book your vaccination.
Q: Do I have to go to a vaccination centre, as it’s a long way from home and I don’t have transport?
Firstly – some taxi services are offering free transport to vaccination centres – check with your surgery or healthcare professional if anything is available.
If you can’t get to a centre or prefer to go to your GP surgery, you can choose to do this instead – GP surgeries should know who has and who hasn’t had the vaccination, and will invite you later on once they have the vaccine themselves.
Q: I’d like to know how the vaccines interact with medication, especially DMARDs that already interact with T cells.
All the vaccines stimulate the production of B and T cells that are specific for the COVID-19 virus. Some arthritis drugs can affect T-cells that are relevant to rheumatoid arthritis, but these are different T-cells to the COVID-19 specific ones. In other words, the COVID-19 vaccination should not affect how well your arthritis medicines work.
The reverse situation, however, is that some arthritis drugs (especially rituximab) can affect how well the body responds to a vaccination, so for most people it is recommended that rituximab infusions are delayed if possible until after the vaccination. Similarly, new DMARDs for arthritis may have the start delayed for a couple of weeks after vaccination. Your healthcare professional can advise you further based on your own situation.
Q: Following my first Pfizer vaccination, my Rheumatoid Arthritis has been in full remission. Methotrexate and steroids have never done this. It feels like I have gone back ten years in time!
This is great to hear! It is known that after many types of viral infection, some people can develop a form of arthritis called reactive arthritis, and some vaccinations (for example Hepatitis B) can also do this. COVID-19 has been associated with reactive arthritis on rare occasions, but there are no reports so far of arthritis going into remission after the vaccination. As ever, more evidence is coming in all the time!
Q: I have just been diagnosed with long COVID-19, giving me shortness of breath without any problems in my lungs. I understand COVID-19 affects muscles, so would that have a detrimental effect on the joints?
Yes, long COVID-19 is likely to be a problem for many people – up to 1 in 10 may have symptoms like fatigue that last more than few months.
Inactivity will weaken muscles and contribute to joint pain, but with severe fatigue, pacing your activities is vital. Pushing yourself too hard before your body is ready will make you feel worse, but it is important to try to keep moving at the same time.
If you suffer after exercise then do less, even if it’s only walking a few steps. Do this every day and build up very slowly. Don’t push yourself too hard – fatigue will improve in time, but be kind to yourself. Our website has some great chair-based exercises to keep the muscles around your joints active without having to leave your home.
Q: Would one brand of vaccine be better than another for somebody with an autoimmune condition?
It’s important to remember that the reported effectiveness of different brands may not reflect what actually happens in real life. The trials of different vaccines were done in different countries and with different proportions of women, older people, and people from different ethnic backgrounds, so the results can’t be directly compared. Both the Pfizer and Oxford vaccination are very effective and no one brand is ‘better’ for anyone with a particular condition, provided that you are not allergic to any of the components.