Updated: COVID-19 Vaccination

EULAR, the European Alliance of Associations for Rheumatology has updated its recommendations for COVID-19 vaccination in people with rheumatic and musculoskeletal diseases (RMDs). COVID-19 is the infection caused by the SARS-CoV-2 virus. The outbreak of this virus was declared a pandemic in 2020 by the World Health Organization. EULAR published its first recommendations on how to manage RMDs during the pandemic in June 2020, and updated them in July 2021. The first recommendations were made before vaccines for COVID-19 were available, and included general public health measures and precautions. Since that time, a lot of new information and data has been collected on COVID-19, and several vaccines have been approved. The recommendations were updated again in November 2021.

A EULAR taskforce was set up to look at the emerging evidence in this fast-moving area. The taskforce included rheumatologists and patients with RMDs, as well as specialists with expertise in infectious disease, epidemiology, and methodology,

Previously there were 13 recommendations. This has now been reduced to 9, and the content updated based on the most current evidence and expert opinion. The group also added two new points to consider around third doses and boosters. The points to consider do not yet have the required level of evidence to support their inclusion as full recommendations, but – in line with healthcare authorities – EULAR supports the use of third doses and boosters in people with RMDs.

The individual recommendations are supported by five overarching principles. The principles emphasise that – in general – people with RMDs do not have a higher risk of getting COVID-19 than people without RMDs, and do not generally have a worse outcome when they do get infected. The treatment of COVID-19 in people with RMDs should be mainly done by expert in infectious disease. But rheumatologists are the experts for their patients’ RMD treatments, and should be involved in any decision to maintain or discontinue them because of COVID-19. Unless it is recommended in an official guideline or is done as part of a clinical trial, immunomodulatory or immunosuppressive drugs should not be used off-label to treat COVID-19. The recommendations cover general measures and prevention of infection, with emphasis on the role of vaccination, as well as guidance on the management of COVID-19 in people with RMDs.

Overall, these updated recommendations provide guidance for rheumatologists, health professionals, and people with RMDs. EULAR hopes the updated recommendations will help support healthcare professionals to make decisions about COVID-19 prevention and vaccination, and to continue to treat people’s underlying RMDs. The recommendations should be used alongside existing country guidance.