Psoriatic Arthritis and COVID: Vaccine Considerations

Psoriatic arthritis (PsA) is an autoimmune condition that causes inflammation and swelling of the joints and other parts of the body. PsA treatments can weaken the immune system, putting those with the condition at higher risk of contracting COVID-19 and becoming seriously ill.

Vaccination has proven to be the most effective way to protect against severe illness from COVID-19. Individuals with PsA are no exception. However, due to the impact this condition has on the immune system, special considerations are necessary to enhance the protective benefits of the COVID-19 vaccine.

This article discusses the safety and effectiveness of the COVID-19 vaccine for individuals with PsA. It also outlines vaccine options and the benefits and risks of each.

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Is It Safe to Get the COVID-19 Vaccine If You Have Psoriatic Arthritis?

If you’ve been diagnosed with psoriatic arthritis, you may be wondering whether the COVID-19 vaccine is right for you.

People who have been diagnosed with autoimmune conditions like psoriatic arthritis or who are taking immunosuppressive medications, like those prescribed for PsA, can have a weakened immune system. These individuals are at a higher risk for severe illness and death from COVID-19.

CDC Recommendations

The Centers for Disease Control and Prevention (CDC) recommends that immunosuppressed people and people with weakened immune systems be fully vaccinated against COVID-19 to protect themselves against severe illness.

Is the Vaccine Less Effective for Those With Psoriatic Arthritis?

Vaccines work by safely introducing a pathogen into the body that triggers an immune response. This signals the immune system to start building antibodies against that pathogen to prepare for future (and less safe) exposures.

People with a weakened immune system have a reduced immune response and may not be able to build up the same number of antibodies as someone with a healthy immune system.

For this reason, it’s possible that the vaccine is less effective for those with psoriatic arthritis. Its effectiveness is further impacted by the medications sometimes prescribed for this condition and how they affect the immune system. That is not to say that the vaccine is ineffective against COVID-19; it is simply less effective in some cases.

Although the vaccine may not be as effective for people with PsA, it still provides an essential layer of protection against severe illness and death.

Ultimately, the benefits of being vaccinated far outweigh the risks of being unvaccinated and contracting the virus causing COVID-19.

Vaccination Options

There are currently three COVID-19 vaccination options approved by the US Food Drug Administration (FDA): Pfizer, Moderna, and Johnson & Johnson (J&J).

The Pfizer vaccine is the only vaccine that has been approved for children age 5 and above. People age 18 and above are eligible for any of the three approved vaccines.

The CDC recommendations outlined below are specifically for individuals who are moderately or severely immunocompromised, meaning they have a weakened immune system.

Currently, mRNA (messenger RNA) vaccines are the preferred vaccine type. These include either the Pfizer or Moderna vaccine.

Pfizer

The Pfizer vaccination series involves a two-dose series and a booster shot. In some cases, a third dose given after the first two doses and before the booster shot is recommended.

The second dose should be administered at least 21 days after the initial dose. In immunocompromised people, a third dose is recommended at least 28 days after the second dose. A booster is recommended at least three months following the second or third dose.

A second booster shot is now recommended in some cases, including in people age 50 or older, people who are immunocompromised, or people who received two doses of the J&J vaccine.

Moderna

Similar to the Pfizer vaccination series, the Moderna vaccine involves two doses, followed by a booster shot.

The second dose should be administered at least 28 days after the initial dose. In immunocompromised people, a third dose is recommended at least 28 days after the second dose. A booster shot is also recommended for people who received the Moderna vaccine.

A second booster shot is recommended for people age 50 or older, people who are immunocompromised, or those who received two doses of the J&J vaccine.

Johnson & Johnson/Janssen

The J&J vaccine series is a two-dose series that includes a J&J shot followed by a second dose of either the Moderna or Pfizer vaccine at least 28 days after the first dose. A booster with either Moderna or Pfizer is recommended at least two months after the second dose.

Due to possible side effects, the FDA recommends that people seek one of the mRNA vaccines (Moderna or Pfizer) over a J&J vaccine series, where possible.

What This Means for People With PsA

For immunocompromised people with PsA, being fully vaccinated means having received four total doses of the Pfizer or Moderna vaccine or three total doses of a combination of J&J and either Pfizer or Moderna.

Vaccination Benefits

Being fully vaccinated can help improve the body’s immune response, especially in people with PsA who may have a weakened immune system.

The COVID-19 vaccine has potentially life-saving benefits. According to the World Health Organization (WHO), getting vaccinated protects against serious illness, hospitalization, and death, and could even reduce your risk of transmitting the virus to other people.

Vaccination Risks

The COVID-19 vaccines have proven to be safe and effective. However, all vaccines have potential side effects, which are typically mild.

Some possible side effects of the COVID-19 vaccines include:

There is a risk of an allergic reaction, but these cases are very rare.

A 2021 study reported people experiencing psoriasis flare-ups (a related condition to PsA) after receiving the vaccine. However, more evidence is needed to determine the cause of these flare-ups.

Of note, a report from the same publication also noted PsA flare-ups resulting from COVID-19 infections.

Benefits vs. Risks

Based on the current research and recommendations, the benefits of receiving the vaccine far outweigh the risk of potential flare-ups.

Should I Get the COVID-19 Vaccination Booster If I Have Psoriatic Arthritis?

The National Psoriasis Foundation COVID-19 Task Force has aligned with current CDC guidance and recommends that individuals with psoriatic arthritis receive a booster dose of a COVID-19 vaccine.

The vaccine schedule outlined in a previous section indicates that people who have a weakened immune system should receive a total of four doses of either available mRNA vaccines (Pfizer or Moderna) or a combination of one dose of the J&J vaccine with two follow-up doses of the Pfizer or Moderna vaccines.

A 2022 study that looked at the impact of booster doses on people who have a weakened immune system found that the immune response in people who had received a second dose of the vaccine was 41% and increased to 67% after a third dose. The study also found that people who had little to no immune response to the initial two-dose series saw a 44% increase in antibodies after receiving a booster dose.

Summary

Being fully vaccinated against COVID-19 is the best way for people with psoriatic arthritis to protect themselves against the virus. Although the vaccines may be slightly less effective for those taking immunosuppressive medications that treat PsA, the immune-boosting benefits make a big difference in the severity of COVID-19.

There is a possible risk of PsA flare-ups as a result of the vaccine, but the same risk exists from infection with COVID-19. It’s encouraged to talk to a healthcare provider about any concerns.

A Word From Verywell

If you have an autoimmune condition like psoriatic arthritis, you are likely wondering how COVID-19 and the vaccine may affect you. Research has shown the effectiveness of the COVID-19 vaccines, even in immunocompromised people. Talk to your healthcare provider if you have any questions or concerns about the COVID-19 vaccine and other ways you can protect yourself against the virus.

Frequently Asked Questions

  • Can the COVID-19 vaccine cause a psoriatic arthritis flare up?

    There have been reports of the COVID-19 vaccine causing psoriatic flare-ups, but, similarly, contracting the virus itself can lead to flare-ups as well. Vaccination is the best way to protect yourself against COVID-19.

  • Is the COVID-19 vaccine safe for people with psoriatic arthritis?

    The COVID-19 vaccine is safe and recommended for people with psoriatic arthritis. It helps to boost the immune response in people who may have a weakened immune system.

  • Is the COVID-19 booster safe for people with psoriatic arthritis?

    Yes, it’s both safe and recommended for people with psoriatic arthritis to receive a booster dose.

  • Does the AstraZeneca antibody drug AZD7442 (Evusheld) protect against COVID-19?

    Research has shown that a single dose of AZD7442 can provide protection against COVID-19. It also reduces the risk of death or serious illness from the virus if contracted (when taken after symptom onset).

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