SARS-CoV-2 vaccines and autoimmune rheumatic diseases: timely information on the COVID-19 landscape
Autoimmune inflammatory diseases are a heterogeneous group of over eighty inflammatory disorders with an immune response to self-tissues. As with other viral infections, COVID-19 can cause an AIID attack. As a general rule, patients with rheumatic diseases are more susceptible to infections, mainly due to altered immune function, comorbidities, and immunosuppressive treatment. Fortunately, initial data from retrospective analyzes of patients with autoimmune inflammatory diseases and coronavirus infection indicate that rheumatic disease alone is not associated with a worse prognosis for COVID-19. However, we must not forget that there are other aggravating factors. Patients with autoimmune diseases are more likely to suffer from cardiovascular disease, diabetes, COPD, obesity, chronic kidney disease - well-known risk factors for worsening coronavirus infection. That is why this is an extremely vulnerable population and must be protected against infection at all costs.
Ideally, vaccines should be given when the autoimmune disease is in remission or low activity and before planned immunosuppressant treatment. However, this is not always possible if you do not meet these conditions, but you must choose whether to get vaccinated or not - the European League against Rheumatism (EULAR) recommends that you vaccinate. Data from other well-studied non-living vaccines show that, however, most drugs used to treat rheumatic patients do not prevent the body from developing effective immunity after vaccination, and its effectiveness is satisfactory, achieving adequate seroconversion after vaccination. Exceptions are treatments with drugs that deplete B lymphocytes and high doses of glucocorticoids, which can affect the immune response to vaccines, making them less effective.
It is too early to say which vaccine is most appropriate for patients with rheumatic diseases, as we do not have enough data from real practice comparing the effectiveness and safety of different types of vaccines. However, vaccination with any of the vaccines is better than no vaccination and potential COVID-19 disease.
Judging by indirect data from our experience with other non-live vaccines, worsening or recurrence of autoimmune disease after administration of a non-live vaccine is extremely unlikely. On the contrary: leading organizations in the field of rheumatology recommend the administration of influenza vaccine and pneumococcal vaccine in patients with autoimmune rheumatic diseases.
In any case, in case of any concerns, hesitations, and side effects around the vaccine, patients should consult a rheumatologist.
References:
1. Velikova, T., Georgiev, T. SARS-CoV-2 vaccines and autoimmune diseases amidst the COVID-19 crisis. Rheumatol Int. 2021;41:509–518. https://doi.org/10.1007/s00296-021-04792-9
2. Furer V, Rondaan C, Heijstek MW, Agmon-Levin N, van Assen S, Bijl M, Breedveld FC, D'Amelio R, Dougados M, Kapetanovic MC, van Laar JM, de Thurah A, Landewé RB, Molto A, Müller-Ladner U, Schreiber K, Smolar L, Walker J, Warnatz K, Wulffraat NM, Elkayam O. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020 Jan;79(1):39-52. https://doi.org/10.1136/annrheumdis-2019-215882