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COVID-19 and Rheumatoid Arthritis: What You Should Know

Rheumatoid arthritis (RA) is an autoimmune disease that involves inflammation in the joints and other parts of the body. It involves changes in your immune system. Certain treatments for RA may also affect how your immune system works.

If you have RA, it’s important to take steps to reduce your risk of infections — including with the virus that causes COVID-19. People with RA appear to have an increased risk of developing severe COVID-19.

Read on to learn how COVID-19 may affect you — and how you can lower your risk of infection.

How does COVID-19 affect the body?
COVID-19 is a disease caused by an infection with the SARS-CoV-2 virus. It can result in a wide variety of symptoms, ranging from mild to severe. Potential symptoms include:

shortness of breath
fatigue or weakness
body or muscle aches
sore throat
loss of smell or taste
nasal congestion or runny nose
nausea, vomiting, or diarrhea

Some people develop more severe symptoms, such as:

difficulty breathing
chest pressure or pain
difficulty waking up or staying awake
pale, gray, or blue-tinted skin, lips, or nails

If you contract SARS-CoV-2, it may take up to 2 weeks to develop symptoms of COVID-19, although symptoms can develop after 2 to 3 days with the Delta variant. Some people who contract the virus never develop noticeable symptoms. It’s possible to pass the virus onto others even if you don’t have symptoms.

If you develop severe symptoms of COVID-19, call 911 or your local emergency number.

How does COVID-19 affect people with RA?

Research evidence suggests that people with RA are more likely than average to develop severe COVID-19.

In a 2021 study of people with COVID-19Trusted Source, researchers compared 9,730 people with RA and 656,979 people without RA. People with RA were at increased risk of:

  • severe COVID-19
  • hospitalization for COVID-19
  • complications such as stroke, blood clots in deep veins, and a type of tissue damage known as sepsis
  • death associated with COVID-19

This may be partly due to the fact that RA is more common in older adults, who are at increased risk of severe COVID-19. Many people with RA also have obesity and health conditions such as high blood pressure and heart disease, which raise risk of severe COVID-19. A few of the medications used to treat RA, such as rituximab and prednisone, pose additional risks.

When the authors of this study controlled for sex, race, body mass index, and coexisting health conditions, they found that the risk of severe and fatal COVID-19 was similar in people with and without RA. However, people with RA still had a higher risk of certain complications, including blood clots in deep veins and sepsis.

Is the COVID-19 vaccine recommended for people with RA?

If you have RA, the American College of Rheumatology (ACR) recommends that you receive a COVID-19 vaccination. They also encourage members of your household and other close contacts to get vaccinated to help lower your risk of infection.

The risk of severe side effects from COVID-19 vaccines is very low. According to the ACR, COVID-19 vaccines appear to be equally safe for people with and without autoimmune inflammatory rheumatic disease such as RA.

In theory, it’s possible that people with RA may experience a flare of symptoms after receiving a COVID-19 vaccine. However, the ACR reports that the expected benefits of COVID-19 vaccination far outweigh the potential risks.

If you have not yet been vaccinated against COVID-19, the ACR recommends multiple doses of the Pfizer-BioNTech or Moderna mRNA vaccine rather than a single dose of the Johnson & Johnson vaccine. However, the Johnson & Johnson vaccine also provides some protection.

COVID-19 vaccination may be somewhat less effective than average if you’re taking a disease-modifying antirheumatic drug (DMARD) or other medication that suppresses your immune system. The effects of COVID-19 vaccination may also wear off more quickly if you’re receiving those treatments. Even so, the ACR still recommends that you get vaccinated. You can discuss the timing of the vaccination with your rheumatologist.

If you’re taking any immune-suppressing medications other than hydroxychloroquine, the ACR recommends that you receive an additional booster shot of a COVID-19 vaccine. Ask your doctor how long you should wait to get this extra dose after you receive your first two doses of the Pfizer-BioNTech or Moderna vaccine or a single dose of the Johnson & Johnson vaccine.

Ask your doctor if you should adjust the timing of your RA medications when you’re preparing to get a COVID-19 vaccine. They may advise you to temporarily pause or delay certain RA treatments after getting a vaccine dose. This might help make the vaccine more effective.

How can COVID-19 be diagnosed and treated?

If you come into close contact with someone who has COVID-19 or you develop symptoms of COVID-19, follow your local public health authority’s instructions for getting tested. COVID-19 vaccination reduces your risk of developing the disease, but it’s still possible to contract the virus after getting the vaccine.

If you develop COVID-19, it’s important to self-isolate to avoid passing the virus to other people. Stay home and maintain physical distance from others, even if you don’t have symptoms. Wearing a face mask also lowers transmission of the virus to other people.

If you develop a mild case of COVID-19, you can likely recover at home. Your doctor can share suggestions for managing symptoms that you develop. For example, they may recommend over-the-counter medications and rest to treat fever, cough, and fatigue.

If you’re at high risk of severe symptoms or complications from COVID-19, your doctor may prescribe REGEN-COV. This monoclonal antibody therapy and others may help prevent or treat symptomatic infection.

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