COVID-19 vaccination should be actively promoted for women with rheumatic and musculoskeletal diseases who are pregnant or planning a pregnancy, say researchers.

The researchers then calculated estimates for vaccine effectiveness, defined as one minus the risk ratio for vaccination relative to no vaccination.

Jansen and team note that “[t]he target-users for these updated EULAR recommendations are healthcare professionals involved in the management and vaccination of [paediatric rheumatology] patients, including paediatricians, paediatric rheumatologists, general practitioners, nurses, pharmacists and primary healthcare professionals involved in the execution of [national immunization programs].”

Research from the COVID-19 Global Rheumatology Alliance has identified a number of factors, including diagnosis and vaccine type, that are associated with flare risk following vaccination among people with rheumatic and musculoskeletal diseases.

COVID-19 vaccination with inactivated virus vaccines is associated with an increased risk for flares among men with gout, and colchicine prophylaxis may help reduce this risk, researchers report.

“Therefore, there is still hesitancy among patients and caregivers, with resultant sub-optimal vaccination rates,” they add.

Among people with rheumatic and musculoskeletal diseases, levels of antibodies against SARS-CoV-2 decrease in the 6-month period following two doses of mRNA vaccines, but remain above the threshold of predicted neutralizing ability in the majority of patients, research suggests.

These findings suggest that “[f]or an optimal response, the interval between rituximab infusion and vaccination should be as long as possible, preferably at least 9 months,” write Jyssum et al in The Lancet Rheumatology .

With COVID-19 vaccination programs underway in many countries, we answer some of the key questions rheumatologists may have, drawing on recommendations from the main professional organizations.

People with rheumatic and musculoskeletal diseases who experience breakthrough SARS-CoV-2 infection after vaccination have lower rates of poor COVID-19 outcomes than their unvaccinated counterparts, researchers report.

The American College of Rheumatology has updated its guidance on COVID-19 vaccination for people with rheumatic diseases to include the timing of the third dose of mRNA vaccines in those taking immunomodulatory drugs.

Raphaèle Seror (Université Paris-Saclay, France) and colleagues found that 88% of 113 participants from the French MAJIK-SFR Registry had detectable antibodies against the SARS-CoV-2 spike protein in March–July 2021, an average of 8.7 weeks after full vaccination.

“There were no findings that warranted concern about the safety of SARS-CoV-2 mRNA vaccination in patients with RMD,” summarize the researchers.

Two people remained negative for anti-spike antibodies following booster vaccination, one of whom was on rituximab therapy and one on mycophenolate.

Preliminary findings from two studies point to low overall rates of breakthrough COVID-19 following vaccination in people with rheumatic and musculoskeletal diseases.

While this study provided estimates of antibody responses following vaccination, Sharma and colleagues caution that the impact on breakthrough SARS-CoV-2 infection “is uncertain,” with “sparse data on T cell responses following SARS-CoV-2 infection in patients with IMIDs,” highlighting the need for more research. medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group 7 September 2021: The coronavirus pandemic is affecting all healthcare professionals across the globe.

The researchers also evaluated cell-mediated immune responses in the US cohort, finding that spike-specific B cells, activated CD4+ T cells, and circulating T follicular helper cells were “induced similarly” in all groups following vaccination.

Findings from a small study suggest that rituximab-treated patients with depleted B cells may be able to mount a T cell-mediated immune response to COVID-19 vaccination, despite having an impaired antibody response.

medwireNews : The Canadian Rheumatology Association (CRA) has developed recommendations on COVID-19 vaccination in patients with autoimmune rheumatic diseases (ARDs).

Get answers to key questions with recommendations from professional organizations