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Frequently asked questions about Coronavirus (COVID-19)

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Am I at risk?

Medication

It is vitally important to keep your RA as well controlled as possible. If you come off your medication(s) you have a very high likelihood of going into RA Flare. Due to the massive impact of this virus on the health service you would more than likely be unable to get to see your GP or rheumatology team for any sort of speedy intervention. You may be advised to pause your medications if you are showing symptoms of COVID-19 but you should seek proper medical advice from speaking to 111 and ideally your rheumatology team.

Shielding and clinically extremely vulnerable

Vaccines and COVID-19 treatment

Watch our Facebook Live from 21 December on COVID-19 Vaccine and Rheumatoid Arthritis (RA) here.

NRAS do our very best to bring you the most up to date and evidenced-based reliable information and guidance.
Here is what we know so far about COVID-19 vaccination for people with inflammatory arthritis.

There will be further updates over the coming weeks and months as new information becomes available and things are moving so rapidly in this space– please check back here frequently.

People with RA or JIA often have very different symptoms as well as different treatment pathways and potentially living with other conditions. It is therefore impossible for us to give any advice on a case-by-case basis, your own rheumatology team who know you and your full medical history should be consulted if the following frequently asked questions don’t answer your query fully.

Generally, yes.

People with auto-immune conditions who were considered to have well controlled disease for at least 6 weeks before were included in the clinical trials. There was no significant difference in their response to the vaccine. So, at this time there is no reason why someone with stable disease should not be offered the vaccine. However further analysis of data is ongoing. At present, there is no specific evidence from trials of this vaccine in groups of people with RA or JIA. It is therefore not currently known whether the vaccine may trigger a general flare in some cases.

Vaccines can be produced in one of 3 ways.

1) They take a bit of the virus and inject it into the body. There is no chance it can cause the virus as it’s only one small part (usually proteins which go to make up the virus) which the body can then recognise at a later date.

2) They take a virus, attenuate it (weaken it) to make it safe and then inject it into a person. Such as BCG (vaccine against TB). This type is risky for immunosuppressed people as it does not always respond the same way for them.

The third way of developing a vaccine, which is what they have done with the Oxford vaccine is as follows;

3) They take another/different ‘live’ virus, one completely harmless to humans which in the case of the Oxford vaccine is a harmless weakened adenovirus that usually causes the common cold in chimpanzees. This adenovirus has been genetically changed so that it is impossible for it to grow/replicate in humans. The protein of the virus they want to provide immunity against i.e. COVID-19 is then tagged onto this adenovirus.  Which means that the original replication-deficient virus is like a delivery van that takes the protein marker to where it needs to be within the body, to do what it needs to do.

This also makes it safer to give to children, the elderly and anyone with a pre-existing condition such as diabetes. Chimpanzee adenoviral vectors are a very well-studied vaccine type, having been used safely in thousands of subjects.

Yes – as to date we don’t know yet how long immunity will last after contracting coronavirus.

There should be at least 14 days between having the flu jab and getting the COVID vaccine. It is still really important to get your flu jab so if you are being offered the flu vaccine now then we would strongly recommend you attend for vaccination as it may be sometime (weeks or months) before you’re invited to get the COVID19 vaccine.

The COVID-19 vaccination will reduce the chance of you getting severe COVID-19 disease and therefore it is generally recommended that people with inflammatory arthritis should have the vaccine. It may take a week or two after the second dose for your body to build up protection. No vaccine is 100% effective – some people may still get COVID-19 after having a vaccination, but this should be less severe.

The NHS will offer a COVID-19 vaccination to all people who are in the ‘clinically extremely vulnerable’ group and those with underlying health conditions putting them at higher risk of serious disease and mortality. Whether you are offered the vaccine may depend on the severity of your condition.

At the present time, there is no definitive answer, however being on any medications which dampen down the immune system, will not change the safety of the vaccine as they have been shown to be safe. It may alter how well the vaccine works but the response rate is still well above what you need to be protected. What we do know is that the COVID-19 vaccines are low risk and being vaccinated is the best way to protect yourself and others against coronavirus. If you are taking medication such as methotrexate, or biologic drugs (which include biosimilars), your immune system is still able to fight off infections, just not quite as well as other people and so your risk of complications from coronavirus itself could be increased. It is therefore likely that you will be on the priority list for any COVID-19 vaccine. But because your immune system is able to able to respond to infections, you are still able to have vaccines that are ‘live’ vaccines, no matter what medicine you take for your rheumatoid arthritis. There is data available from studies of vaccination for other indications in people living with rheumatoid arthritis who take biologics and concomitant methotrexate which show that such individuals can still make a good immune response to the administered vaccine. However, methotrexate may reduce the response. In the case of vaccination for seasonal influenza, it has been shown that temporary discontinuation of methotrexate for 2 weeks after vaccination improves the protective response to seasonal influenza vaccination without increasing rheumatoid arthritis disease activity. Therefore, your rheumatology team may suggest that you miss one or two doses of methotrexate around the time of your COVID-19 vaccination. The dosage of methotrexate also varies considerably from person to person so we cannot give a blanket response and it is always best to speak with your own rheumatology nurse or consultant who knows your specific treatment regime.

General Information about the COVID19 vaccine

The COVID-19 Pfizer/BioNTech vaccine is given as an injection into your upper arm. It is given as two separate doses, at least 21 days apart.

After you have had the first dose you need to plan to attend your second appointment. You will be given a record card with your next appointment written on it for an appointment in 21 or 28 days.

It is important to have both doses of the vaccine to give you the best protection.

Keep your record card safe and make sure you keep your next appointment to get your second dose.

Additional COVID-19 vaccines are being trialled and their method of administration may vary. We will update this information and guidance as new vaccines are approved for use by the NHS.

Women who are pregnant or breastfeeding
The vaccines are not currently recommended during pregnancy. If you are pregnant or breastfeeding, you should not have the COVID-19 vaccine. If you think you may be pregnant or are planning a pregnancy within three months of the first dose you should wait until your pregnancy is completed before you are vaccinated. You should have the vaccine as soon as possible afterwards if eligible. You should avoid becoming pregnant until at least two months after the second dose of the vaccine.

At present there is no evidence suggesting that the COVID-19 vaccine is unsafe if you are pregnant or breastfeeding. This is cautionary advice until more evidence is available confirming you can be offered the vaccine.

A person with a confirmed anaphylactic reaction to any components of the vaccine
If you have a known anaphylactic (severe allergic i.e. if you regularly carry an epipen) reaction to any of the components of the vaccine, you will be advised not to have the vaccination. The Pfizer/BioNTech vaccine does not contain any animal products or egg.

We do not yet know whether the COVID-19 vaccine will stop you passing on the virus. So, it is important to follow the guidance in your local area to protect those around you.

Like all medicines, vaccines can cause side-effects. Most of these are mild and short-term, and not everyone gets them.

Very common side-effects include:

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  • having a painful, heavy feeling and tenderness in the arm where you had your injection. This tends to be worst around 1-2 days after the vaccine.
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  • feeling tired.
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  • headache.
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  • general aches, or mild flu-like symptoms.

It is not possible to contract COVID-19 infection from having the vaccination.

Although feeling feverish is not uncommon for 2 to 3 days, a high temperature is unusual and may indicate you have COVID-19 or another infection. You can rest and if you would normally be able to safely take painkillers, such as a normal dose of paracetamol (follow the advice in the packaging), then you can do so to help you feel better.

Symptoms following vaccination normally last less than a week. If your symptoms seem to get worse or if you are concerned, call NHS 111. Even if you do have symptoms after the first dose, you will most likely be recommended to have the second dose. Although you may get some protection from the first dose, having the second dose will give you the best protection against the virus. However, this advice may depend on the severity of your side-effects and you should discuss this with your consultant if unsure.

If you do seek advice from a doctor or nurse, make sure you tell them about your vaccination (show them the vaccination card if possible) so that they can assess you properly.

Guidelines – England, Scotland, Northern Ireland and Wales

England

Scotland

Wales

Northern Ireland

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