Navigating the COVID-19 Pandemic With Rheumatoid Arthritis

The COVID-19 pandemic has disrupted almost everyone’s lives, including people with rheumatoid arthritis (RA). Due to a variety of factors, some individuals may now be facing particular difficulties managing their disease.

By finding ways to work with your medical provider, following practical self-care tips, and getting the COVID-19 vaccine, you can help take control of your life and your symptoms.

Continuing Medical Care

For various reasons, some people have stopped getting regular medical care during the pandemic. For some, it might be simple fear about exposure to COVID if they come into the office for a medical check-up.

Fortunately, this risk is probably very low if precautions are taken. Healthcare providers' offices have taken the risks of disease spread very seriously and have made many changes to reduce this risk. These include mandatory mask-wearing, disinfection measures, social distancing, and other mitigation factors.

In the early days of the pandemic, some medical offices were closed except for urgent appointments. However, many now have more opportunities for patients to be seen in person.

Another option is a telemedicine appointment. Many more medical practices are now offering these than in the past. You may be able to connect with your medical provider over Zoom, FaceTime, Skype, or some other platform.

Although not every medical issue can be addressed remotely, many people are pleasantly surprised with the convenience and effectiveness of a telehealth appointment. Even if you haven’t made a telehealth appointment before, most people find them relatively easy to set up.

At the beginning of the pandemic, legislative changes made it easier for many medical practices to start offering telehealth. But we don’t know if those changes are permanent.

It isn’t clear how many medical offices will continue to offer telehealth appointments in the future. Some people may choose to have most of their appointments via telehealth, if available, even after the pandemic is resolved.

Medical practices currently differ as to their telehealth versus in-person appointment availability. Call your medical provider to see what your options are.

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Cost Issues

Maybe you’ve lost your job and health insurance and you aren’t sure how you will pay for treatment.

Ideally, you could find other health insurance options. You may qualify for Medicaid if your income is low enough. People over 65 should be able to get Medicare. Or you may be able to get a reduced cost plan through the Affordable Care Act.

If you pay for your medical care out of pocket, you should still make every effort not to neglect your health. You may be able to work out a doable payment with your healthcare provider’s office. Let your practitioner know your situation. Although it may not be ideal, you might be able to switch to a less expensive therapy.

Do your best to continue to treat your disease. If possible, do not stop taking your therapies as prescribed. While you may be able to manage to go without treatment for a while, this can permanently damage your joints over the long term.

People with untreated disease may also be more likely to develop complications outside the joints, like potentially serious heart, lung, or kidney issues. By keeping in close communication with your healthcare provider, you can treat these early on if they do happen.

Focusing on Self-Care

In addition to getting regular medical care, do what you can to take care of yourself. This can be particularly challenging in a stressful time.

However, that very stress makes it even more important to prioritize self-care. Stress can worsen symptoms of rheumatoid arthritis. By taking measures to reduce your stress, you may actually help reduce your disease symptoms.

Try to take time for leisure activities, enjoyable hobbies, and safe social connection. Some people find support in spiritual communities or meditation and mindfulness activities. Budget time for whatever activities you find fulfilling and relaxing.

People with rheumatoid arthritis have an increased risk of cardiovascular disease. Because of this, it’s important to do things that help lower your risk of heart disease. For example, this is a great time to quit smoking if you still need to do so. A balanced, heart-healthy diet will also help give you energy and resilience over the long term.

Exercise is also key for heart health. It is great at helping regulate one’s moods, which may be even more important during this time. You don’t have to do much to see a lot of benefits—even walking 20 minutes a day may help.

You can try more gentle exercises like walking, swimming, or tai chi, but many people with rheumatoid arthritis find they do very well with more intense forms of exercise. Don’t overdo it, but see what you can handle. Experiment to find out what you like and what you are willing to do regularly.

Exercise will also help you get good sleep at night, something that is also critical for people with rheumatoid arthritis. Avoid caffeine late in the day, and try to limit your screen time in the evening to help promote relaxation.

Oral care is also important for people with rheumatoid arthritis, as there is some evidence that gum disease may worsen symptoms from RA. Floss and brush regularly, and schedule your dental exams when you are able.

Getting a COVID-19 Vaccine

The Food and Drug Administration (FDA) has approved or granted emergency use authorization (EUA) to four COVID-19 vaccines in the United States:

• Pfizer-BioNTech: An mRNA vaccine approved for people 6 months and older
• Moderna: An mRNA vaccine approved for people 6 months and older
• Johnson & Johnson's Janssen (Janssen): A viral vector vaccine approved for people 18 years and older
• Novavax: A protein-based vaccine approved for people 12 years and older
  

The FDA also granted EUAs for updated bivalent boosters of the Moderna and Pfizer COVID-19 vaccines. The CDC recommends everyone age 6 months and older get one updated bivalent booster shot if they're eligible. The type of booster shot you can get depends on your age, health status, and what vaccine you first received. 

The American College of Rheumatology (ACR) recommends everyone with rheumatoid arthritis receive a COVID-19 vaccine unless they have a known allergy to a component of the vaccine.

People who are immunocompromised, such as those with RA, are at higher risk for severe COVID-19. Therefore, the CDC currently recommends that people who are moderately or severely immunocompromised receive extra primary doses and boosters. Specifically, the American College of Rheumatology (ACR) and the CDC recommends people with RA get the following:

• At least three doses of an mRNA vaccine (Pfizer-BioNTech or Moderna)
• One booster dose

RA and Risk of Serious COVID-19 Symptoms

Research suggests that people with rheumatoid arthritis are at a higher risk for developing serious symptoms from COVID-19. Specifically, those with rheumatoid arthritis and other rheumatological conditions seem to have an increased risk of needing hospitalization for COVID-19.

People with rheumatoid arthritis may also be more likely to get infected if exposed to someone infected with the virus. That’s because many people with rheumatoid arthritis take immunosuppressive therapies, ones that diminish the immune response in some way.

For example, if you are taking a biologic therapy like Enbrel (etanercept), you might be more likely to get infected if you’ve spent time with someone who has the virus. So if you have rheumatoid arthritis, you should get vaccinated as soon as you are able.

Does It Matter Which Vaccine I Get?

Based on the current data, you should get the same type of vaccine for your second shot as you did for your first shot.

For example, if your first vaccine dose was made by Moderna, your second one also should be Moderna. They should have this information at your vaccination site, but you should also keep a record for yourself.

Due to possible side effects from the Janssen vaccine, the CDC recommends that people get one of the mRNA vaccines (Moderna or Pfizer) or the Novavax vaccine instead.

Could the Vaccine Accidentally Transmit COVID-19?

People taking some therapies for rheumatoid arthritis shouldn’t get certain types of vaccines, specifically those based on live viruses. For example, you shouldn’t get the live-virus version of the shingles vaccine if you are taking certain biologic therapies, including TNF inhibitors like Humira (adalimumab).

The current vaccines available in the United States use neither live nor inactivated viruses. So there is no chance that you can actually get COVID-19 from taking these vaccines, even if your immune system is immunocompromised. (You might get a few symptoms right after vaccination, like a slight fever, but these are to be expected.)

Could the Vaccine Trigger a Disease Flare?

Some people are also concerned they might experience a disease flare after getting vaccinated. These vaccines are new, and they haven’t been well studied specifically in people with rheumatoid arthritis. So we can’t completely rule out the possibility that getting vaccinated might trigger a disease flare.

However, based on their knowledge of COVID-19 of other vaccines, experts at the ACR think the chance of this is very low. If you do get a flare after vaccination, it is likely to be mild and of short duration. The benefits of vaccination heavily outweigh this theoretical risk.

Experts will continue to study how specific groups of people, like people with rheumatoid arthritis, respond to getting vaccinated.

Modifying Treatment Before or After Vaccination

You might need to modify your rheumatoid arthritis treatment before or after vaccination. It’s a good idea to check with your healthcare provider.

From our experience with other vaccines, we think some therapies may make it less likely that you’ll develop a strong immune response to the vaccine if they are still in your system.

Following the ACR’s recommendations will help ensure your body develops good immune memory after getting the vaccine. That’ll help better protect you from getting sick if you are exposed to COVID-19 in the future. (However, check with your healthcare provider before making any changes.)

If your disease is under control, you may need to stop taking certain treatments for 1 to 2 weeks after each vaccine dose. This may apply if you are taking any of the following:

• Trexall (methotrexate)
• Xeljanz (tofacitinib)
• Olumiant (baricitinib)
• JAK inhibitors such as Rinvoq (upadacitinib)

You are also likely to need to alter your therapy schedule if you are taking Orencia (abatacept) or Rituxan (rituximab). For these, you may need to alter your therapy schedule both before and after vaccination.

If you are taking other therapies, your healthcare provider will likely advise you to take them as you would normally.

You probably won’t need to alter your medications if you take older rheumatoid arthritis therapies such as Plaquenil (hydroxychloroquine) and others. People taking 20 milligrams (mg) per day or less of glucocorticoids can also continue to take their medications normally.

Can I Relax All Precautions After Vaccination?

Unfortunately, no. You won’t be fully protected until a week or two after your second shot. Even then, you might be one of the small percentage of people for whom the vaccine was not effective.

For this reason, you should continue to practice recommended public health measures. Make sure the rest of the people in your household get vaccinated when that is possible.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.