Arthritis Research Canada Responding to COVID-19
Since May 5, 2023, the World Health Organization has reclassified COVID-19 from a pandemic to an established and ongoing health issue which no longer constitutes a public health emergency of international concern. However, with cases continuing to occur, and still surging in some parts of the world, the WHO’s director general, Tedros Adhanom Ghebreyesus, also emphasized that the virus still poses a global health threat. The WHO stressed that now is not the time to stop work or dismantle systems, but rather, to address health gaps.
As we enter into the cold and flu season, Arthritis Research Canada recommends that people living with chronic diseases, like arthritis and people who are taking medications that suppress the immune system, ensure that they are up to date on receiving the Health Canada approved vaccines and boosters. Even after vaccination, patients, particularly those who are immunosuppressed, will need to continue to follow all current public health guidelines to protect themselves against COVID-19. People who are immunosuppressed may want to consider wearing a mask when in crowded areas and on airplanes.
This page will continue to serve as a resource as new information, policies, vaccines and more are announced.
COVID-19 Vaccine Information
On December 9, 2020, Health Canada authorized the Pfizer-BioNTech COVID-19 vaccine. Today, five COVID-19 vaccines are approved for use in this country.
What is the latest COVID-19 vaccine information?
Amid an early rise in COVID-19 cases in hospitals, and with the fall and winter flu season ahead, Health Canada has approved Moderna’s updated COVID-19 vaccine targeting the XBB.1.5 Omicron subvariant for everyone over the age of 6 months whose last COVID-19 vaccine was more than 6 months ago.
Approval of similar vaccines from Pfizer-BioNTech and Novavax are anticipated to follow shortly and vaccine roll-out to the provinces are expected in early October.
Clinical studies have shown the vaccine is effective against the currently circulating Omicron subvariants, including XBB.1.5, EG.5 and BA.2.86. Relying on immunity from the original COVID-19 vaccines is not sufficient because of how much the virus has changed over time. This is analogous to getting an annual flu vaccine which targets the circulating strains of flu virus . People can safely get both their flu and COVID vaccines at the same time.
Getting the updated COVID-19 vaccine is particularly important for people with arthritis or auto-immune diseases who are receiving medications that suppress the immune system.
Which COVID-19 vaccines are approved for use in Canada?
What is Paxlovid?
Paxlovid is a pill approved by Health Canada that was shown in a randomized trial by its creator, Pfizer, to reduce the risk of hospitalization or death by 89 per cent compared to placebo in high-risk adults with COVID-19. Treatment must be started within five days of symptoms onset, the earlier the better.
COVID-19 is caused by a virus called a coronavirus. PAXLOVID contains two antiviral medicines copackaged together, nirmatrelvir and ritonavir. Paxlovid stops the virus from multiplying. This can help your body to overcome the virus infection and may help you get better faster.
The medication is intended for people at higher risk of severe illness, such as due to age, underlying health conditions, medications that suppress the immune system, or those who are unvaccinated.
Paxlovid is used in adults to treat mild to moderate coronavirus disease in patients who:
- have a positive result from a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral test and
- who have a high risk of getting severe COVID-19, including hospitalization or death.
PAXLOVID IS NOT approved for any of the following:
- To treat patients who are hospitalized due to severe or critical COVID-19.
- To prevent COVID-19.
- To be used for longer than 5 days in a row.
- For use in children and adolescents less than 18 years of age.
What are the age groups for which each vaccine is indicated?
- Moderna Spikevax COVID-19 vaccine: age 6 months and older, or as a booster dose in individuals age 12 years and older
- Pfizer-BioNTech Comirnaty COVID-19 vaccine: age 6 months and older or as a booster dose in individuals age 5 to 11 years as well as 16 years and older (Pfizer-BioNTech Comirnaty® COVID-19 vaccine)
- AstraZeneca Vaxzevria COVID-19 vaccine: age 18 and older
- Janssen Jcovden (Johnson & Johnson) COVID-19 vaccine: age 18 and older
- Novavax Nuvaxovid COVID-19 vaccine: age 12 years and older, or as a booster dose in individuals age 18 years and older
How do the vaccines work?
All vaccines work by presenting to your immune system proteins (called antigens) that your body recognizes as foreign. This trains your immune system to recognize the SARS-CoV2 virus and mount an immune response (i.e. develop antibodies) that will protect you if you are exposed to the virus at a later date. For SARS-CoV2 it is the spike protein on the virus (what gives the virus its crown appearance). The main differences between the vaccines is what method is used to make the protein and present it to the immune system in a way that allows the body to make antibodies against it.
The Pfizer-BioNTech and Moderna vaccines are messenger RNA vaccines, which contain the genetic coding for the spike protein, stored in a lipid nanoparticle. This is read by your cells’ own protein-making machinery to produce antigens, which then trigger an immune response. There is no risk of getting the disease, because the vaccines don’t include virus particles. There is also no risk of genetic modification of your own DNA because the messenger RNA works downstream from the DNA and does not interact with your genes. The drawback is that the vaccines need to be stored at very cold temperatures. The Pfizer-BioNTech vaccine needs to be kept at extremely cold temperatures (-80 to -60 ◦C), the Moderna vaccine at regular freezer temperatures (-20 ◦C).
The Oxford/Astra-Zeneca and the Johnson & Johnson (Janssen) vaccines are viral vector vaccines, which contain a harmless version of a virus (the vector) to deliver the genetic coding for the spike protein, and instruct the cells to produce large amounts of antigen. There is no risk of getting COVID-19 because the virus used is not SARS-CoV2 but a harmless one. The vaccine can be stored at fridge temperature.
Are COVID-19 vaccines safe for people taking medications that suppress the immune system?
People who take medications that suppress the immune system are told that they should not take any “live vaccines”. These are vaccines that contain the actual virus that causes the disease but in an attenuated form, i.e. a weakened version of the virus that can replicate but doesn’t cause the disease. Examples are yellow fever and measles vaccines. In people with weakened immune systems, there is a small risk that the attenuated virus could cause the disease. This is different from “inactive vaccines” which contain a virus whose genetic material has been destroyed so that it cannot infect cells and replicate (e.g. flu vaccines). None of the vaccines which are currently approved for use, or in the process of obtaining approval, are live vaccines. Therefore, there is no reason to believe that the currently available vaccines would be unsafe for immunocompromised people.
The BC Centre for Disease Control has published a clinical guidance document for persons with autoimmune rheumatic diseases with regards to COVID-19 vaccines. To view that document, click here.
What is the Canadian Rheumatology Association's view on COVID-19 Vaccines for people with arthritis and autoimmune rheumatic disease?
Click here to view the CRA’s position statement on COVID-19 vaccination, which includes recommendations on the use of these vaccines for patients under the care of a rheumatologist.
Looking for a French version? Please click here.
For the Canadian Rheumatology Association’s Recommendation on Covid-19 Vaccination in Persons with Autoimmune Rheumatic Disease, please click here.
Looking for a French version? Please click here.
If you would like to submit a public comment on the CRA’s recommendations, please click here.
Are there any resources available to help me make a decision about the COVID-19 vaccine?
The Canadian Rheumatology Association, under the leadership of Arthritis Research Canada’s Dr. Glen Hazlewood, and with input from the Canadian Arthritis Patient Alliance (CAPA), has developed a Decision Aid for COVID-19 Vaccines in Patients with Autoimmune Rheumatic Diseases. To access it, click here. To access a French version of the Decision Aid, please click here.
What should I do with my arthritis medications when I get vaccinated?
For most medications for arthritis and auto-immune diseases, no changes are needed at the time of vaccination, except the following:
- If you are taking methotrexate or a JAK Inhibitor (e.g. tofacitnib, baricitnib or upadacitnib), skip your medication for one week after each vaccine dose.
- If you are taking abatacept weekly injections, skip the week before and the week after your vaccine dose.
- If you are taking IV cyclophosphamide, take your vaccine at least one week prior to your IV infusion.
- If you are taking rituximab or ocrelizumab, have your first vaccine dose 4 weeks prior to your scheduled infusion and delay your infusion to 2-4 weeks after your second vaccine dose.
- If you are taking prednisone at a dose of 20 mg per day or higher, wait to receive your vaccine until you are at a dose lower than 20 mg per day.
- If you are on any other medications, even if they suppress the immune system, you don’t need to make any changes to your medications when you receive the vaccine.
For more detailed information on the recommendations, see the guidance document from the American College of Rheumatology.
What are side-effects of the vaccines?
Five COVID-19 vaccines are approved for use in Canada. For more information on potential side effects for each vaccine, please click the links below:
COVID-19 Research Videos
Dr. Diane Lacaille - COVID-19 Global Rheumatology Alliance
Dr. Diane Lacaille, Arthritis Research Canada’s Scientific Director, is the Canadian lead on a worldwide alliance to collect information on rheumatology patients with COVID-19. This study can provide important insights on how the COVID-19 infection impacts our patients, and how arthritis medications may add to the risk of infection.
Dr. Mary De Vera - UNIFIED COVID-19 Study
The UNIFIED Study addresses the impact of COVID-19 on medication use and mental health for people with arthritis. This study seeks to better understand the experiences of individuals with rheumatic diseases and immunosuppressive conditions.
Dr. Catherine Backman - Arthritis Research Adapted to Understand Impact of COVID-19
Dr. Catherine Backman, and her team’s study to explore the health benefits of everyday activities for people with inflammatory arthritis, has been adapted in response to COVID-19. A newly added component will assess the effects of self-isolation and staying at home. By better understanding how arthritis and social isolation affect the daily activities that support the health and well-being of people with and without inflammatory arthritis, this research will help improve arthritis self-management studies, rehabilitation programs and public heath recommendations.
Dr. Linda Li - How Arthritis Research on Active Self-Management is Adapting to COVID-19
Dr. Linda Li’s research on active self-management of arthritis has been adapted to address the impact of COVID-19. The OPERAS study tracks the physical health and self-management of people with rheumatoid arthritis and will monitor changes in patients’ health and physical activity during and after COVID-19. This new information will help researchers better understand and improve care for people with rheumatoid arthritis.
To learn more about the OPERAS study, click here.
Dr. Antonio Aviña-Zubieta - Research on COVID-19 and Immunosuppressive Medications
Dr. Antonio Aviña-Zubieta, Senior Research Scientist at Arthritis Research Canada, is conducting research to look at whether drugs used to treat arthritis (e.g., rheumatoid arthritis, lupus, psoriatic arthritis, and ankylosing spondylitis) increase the risk of contracting COVID-19, and if these drugs increase or decrease the risk of severe COVID-19.
Funding for this project is provided by Michael Smith Foundation for Health Research.
To learn more about this research, click here.
Frequently Asked Questions
Are there concerns about taking anti-inflammatory medications?
• In light of observations that patients taking ibuprofen may have more severe respiratory illness when affected by COVID-19, the WHO had recommended to avoid using ibuprofen to treat symptoms of COVID-19 and to use acetaminophen instead to treat fever or headaches. Since then, the WHO has retracted their statement due to lack of good quality evidence. Health Canada has followed the WHO’s advice. Since the issue is not clear, we recommend avoiding the use of non-steroidal anti-inflammatory drugs, also called NSAIDs, if not necessary to control pain. We recommend trying acetaminophen on a regular schedule up to the maximum recommended dose of 3 grams per day to control arthritis pain, and consider using NSAIDs only if there are no other options for pain control.
• Examples of non-steroidal anti-inflammatory medications include ibuprofen (Advil), naproxen (Aleve), diclofenac (Voltaren), indomethacin (Indocid), celecoxib (Celebrex), meloxicam (Mobicox) and Naprosyn. If you are unsure if your medication is an NSAID, contact your pharmacist.
• Please click the links below for further recommendations:
Should patients who are taking prednisone, DMARDs (Disease Modifying AntiRheumatic Drugs) such as hydroxychloroquine (Plaquenil), sulfasalazine, methotrexate and leflunomide (Arava), biologics, or other drugs for their rheumatic diseases stop them?
• It is not recommended for people to stop their DMARD medications if they have no symptoms of COVID-19 as uncontrolled inflammation due to the arthritis can be harmful for the body’s response to the virus.
• Stopping prednisone abruptly is also dangerous to one’s health, as the body’s own production of cortisol is suppressed.
• It is unclear if people should interrupt therapy during episodes of infection (i.e. if symptomatic or positive for COVID-19), as some of the severe manifestations of COVID-19 are due to the body’s immune response to the virus and, therefore, in theory some medications used to treat auto-immune diseases might be helpful. However, good evidence is still lacking. Patients should talk to their rheumatologist or prescribing doctor prior to discontinuing any of their medications. This is a complex decision based on the specific medication used, assessment of risk factors, other chronic diseases, and of the specific situation.
• There is some suggestion that hydroxychloroquine (Plaquenil), chloroquine (not available in North America), and anti-IL-6 drugs tocilizumab (Actemra) and sarilumab (Kevzara) may benefit those hospitalized with severe COVID-19 infection. This is not proven.
Research Participation Opportunities
COVID-19 Global Rheumatology Alliance
Arthritis Research Canada/Arthrite-recherche Canada is collaborating with the COVID-19 Global Rheumatology Alliance on an international initiative collecting information on rheumatology patients with COVID-19 from around the world. By gathering data specific to rheumatology patients, the Alliance will gain important insights on how COVID-19 impacts rheumatology patients, and more specifically, how autoimmune diseases and immunosuppressive medications influence the risk of infection and the outcomes of COVID-19.
A separate initiative by the COVID-19 Global Rheumatology Alliance, is collecting information from adults (and parents of children) with rheumatic diseases to gain a better understanding of how the COVID-19 pandemic is impacting people living with rheumatic diseases. If you would like to participate, please visit https://rheum-covid.org/patient-survey/
UNIFIED COVID-19 Study
This study seeks to better understand the experiences of individuals with rheumatic diseases and immunosuppressive conditions during the COVID-19 pandemic.
Tracking rheumatoid arthritis symptoms during the COVID-19 pandemic
OPERAS (On-demand Program to EmpoweR Active Self-management) is an easy to use web/mobile app designed for people with RA to track their health. This app helps people to “see” how their symptoms and physical activity levels change over time, together with the treatment they use. During the COVID-19 pandemic, this information can be helpful for people with RA to plan all the things that they juggle in their self-care.
Arthritis Wellness Conversation on COVID-19
Arthritis Wellness Conversations - Navigating COVID-19 When You Have Arthritis
Members of our Patient Advisory Board share their personal stories and tips on coping with COVID-19. Joined by our Associate Scientific Director, Diane Lacaille to provide her expert insights.