The COVID-19 pandemic, caused by SARS-CoV-2 infection, has seen over 162 million confirmed cases and over 3.36 million deaths worldwide recorded up to 15 May 2021, although the true number of cases worldwide is unknown. Closer to home in Malaysia, we have so far recorded seen over 1822 deaths since the COVID pandemic began last year.
For most, being inflicted with COVID would mean a mild-to-moderate flu-like illness characterized by fever, cough, and loss of taste and smell. However for some, this disease takes a severe and aggressive form, requiring hospitalization and ventilatory support, and potentially resulting in death.
When the pandemic arrived in early 2020, the rheumatology fraternity received more attention than many other medical subspecialities. Many were curious if patients with pre-existing autoimmune rheumatic disease or those who were immunocompromised were more or less likely to become infected or fair worse than the general person. At the outset of the pandemic, hydroxychloroquine (plaquenil), a drug commonly used in autoimmune diseases was touted as both a preventive and therapeutic treatment for COVID-19, but subsequent clinical trials have not found any benefit.
Looking at a UK based study of 10,926 COVID-19-related deaths over the first 3 months of the pandemic, it was observed that people with a diagnosis of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) or psoriasis, were (slightly) more likely to die in relation to COVID-19 compared to the general population
However, we must note that rheumatological diseases are very heterogenous and most studies do not take into account current levels of disease activity (severity), specific disease-related comorbidities (such as concomitant hypertension or diabetes) and most importantly the use of glucocorticoids (steroids) and disease modifying anti-rheumatic drugs (DMARDs), all of which are risk factors for serious infection.
The Rheumatology fraternity including myself believe and advocate that patients with RA should be prioritized for COVID-19 prevention and management at all times.
Below are some common questions usually asked by RA patients:
Q: Should RA patients be prioritized for COVID‐19 prevention and management?
A: Yes. Since RA patients were at higher risk of COVID-19 and COVID-19 disease that resulted in hospitalization or death it is generally believed they need early prevention and management strategies to minimize the negative health outcomes associated with COVID-19.
Q: Why do patients with RA have an inherently increased risk of COVID-19 infection?
A: It is hypothesized that both RA itself, particularly when RA is very active, and the medications used to treat RA, immunosuppressive therapies, both contribute to the risk of COVID-19 in RA.
Q: How and why does RA increase the severity of COVID-19 symptoms?
A: It is likely the same factors, namely immune dysregulation related to active RA and RA therapies, that contribute to COVID-19 risk also leads to a more severe COVID-19 disease course.
Q: Why is it important that RA patients get vaccinated?
A: RA patients on immune weakening medications or having cardiovascular disease, a potential complication of RA does make people more prone to severe COVID-19 outcomes. Nevertheless, this should ideally be done when the disease is under control.
Q: Are the vaccines safe and effective for RA patients?
A: Severely immunocompromised patients are generally advised not to receive a live vaccine. The COVID-19 vaccine is NOT a live vaccine. The Malaysian Rheumatology Society and the CDC (Centre for Disease Control) specifically states that people with autoimmune conditions can receive COVID-19 vaccine.
However, patients are advised to consult their rheumatologist to consider shifting the timing of some common RA medications.
Q: What side effects should RA patient pay special attention to?
A: Most common side effects are pain and swelling in the arm where the injection occurred. Others include fever, chills, and headaches. These symptoms are more common after the second shot. This indicates that your body is mounting a vigorous immune response. However, in RA patients, distressing side effects include joint pain and fatigue, two symptoms that can also occur with the disease itself. This tends to be mild to moderate, and they go away within a few days.
In summary, while these vaccines are showing to be highly effective at protecting people against serious illness from COVID-19, there still remains many unanswered questions following vaccinations. Such as is it still possible for a vaccinated person to still spread the virus, even without symptoms. Therefore, it is important to continue to protect yourself and others, including avoiding crowded spaces, physical distancing, hand washing and wearing a mask at all times.
References:
- Risk of COVID‐19 in Rheumatoid Arthritis: A National Veterans Affairs Matched Cohort Study in At‐Risk Individuals , Bryant et all. Arthritis Rheumatology, May 2021
- Covid-19 Clinical Guidance Summary for Adult Patients with Rheumatic Diseases- updated February 2021
