Can rheumatism patients get the new crown vaccine? Do I need to adjust the medication before and after vaccination?

Medical guidance: Huang Jianlin, director and chief physician of the Department of Rheumatology and Immunology , the Sixth Affiliated Hospital of Sun Yat-sen University

The new crown vaccination nationwide is now in full swing, and many units or communities are organizing employees or the masses to vaccinate.

Can patients with rheumatism be vaccinated? Is there anything to pay attention to? Huang Jianlin, director and chief physician of the Rheumatology Department of the Sixth Affiliated Hospital of Sun Yat-Sen University, has recently received many consultations from patients.

What are the precautions for vaccination?

In general, the following points should be noted for the new crown vaccination:

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Do I need to adjust the original rheumatism medication before and after vaccination?

Whether it is necessary to adjust the rheumatism medication time or the new crown vaccination time, different drugs have different suggestions.

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There is no consensus on whether glucocorticoids (prednisone equivalent ≥20mg/day) need to be adjusted .

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Abatacept (subcutaneous injection): 1 week before and 1 week after the first dose of new crown vaccination, subcutaneous injection of abatacept should be avoided.

Abatacept (intravenous injection): The planned vaccination time is 4 weeks after the first dose of vaccination is infused with abatacept (the entire interval between medications), and the next infusion of abatacept is delayed by 1 week (total interval of 5 weeks) ; The second dose of vaccination does not need to adjust the medication.

Cyclophosphamide (intravenous injection): Cyclophosphamide can be infused 1 week after each dose of vaccination.

Rituximab: If the patient has a low risk of new coronary pneumonia or through preventive measures (such as self-isolation can reduce the risk), the planned vaccination time is 4 weeks before the next rituximab use; if the disease activity allows, the first The administration of rituximab is delayed 2-4 weeks after the second dose of vaccination.
(Note: This drug has no indication for the treatment of rheumatism in mainland China, but this drug is recommended by domestic and foreign guidelines when treating refractory rheumatism, so some patients are also using this drug.
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As a rheumatism patient, when should I get the vaccine?

Experts believe that it is best to vaccinate when the disease is stable; if feasible, vaccinate before the planned immunosuppressive treatment.
The vaccine is most effective when the level of immunosuppression is low.
Due to the risk of recurrence of rheumatic diseases, it is not recommended to reduce the dose of therapeutic drugs for vaccination.

The question is coming again.
A patient asked, what is a stable condition? Stable disease has different standards for different diseases, and it is generally judged by disease evaluation.
To put it simply, if after effective treatment, the symptoms of rheumatism are not obvious, there is no fever, the joint swelling and pain is not obvious, the dosage of the glucocorticoid prednisone is about 10 mg, and the medication is relatively stable for a few months, then the condition is mostly Is stable.
I am really not at ease, so I can consult the treating doctor in private to confirm whether my condition is stable.

There are 1.
4 billion people in our country, and more than 70% of the population needs to be vaccinated to reach the immune barrier, so our country needs more than 1 billion people to be vaccinated with the new crown vaccine to achieve this level of immune barrier.

Now, some people may still be on the sidelines, undecided whether to get a vaccine or not.
Part of the reason may be due to the fact that our country’s epidemic prevention and control has done well.
We believe that the current risk in mainland China is low and there is no need for vaccines.

In fact, if foreign vaccination reaches a certain level (about 70% of the population), their country will have an immune barrier.
If our country's immunization does not reach the level of the immune barrier, our country may become an immune depression.
Once the country is opened in the future, the results of our previous epidemic prevention and control will no longer exist.
Therefore, everyone who can be vaccinated must be vaccinated.

Director Huang Jianlin said that he had been vaccinated and felt a little tired the next day, but it did not affect work.