BENGALURU: Patients with rheumatoid arthritis (RA) require booster doses on priority, say health professionals. These patients are at higher risk of contracting Covid-19 and any resultant mortality, as this autoimmune disease compromises the immune system in varying degrees of severity, and vaccine response is also poor, they say. The immune system attacks healthy cells in the body by mistake, causing inflammation in the affected parts of the body. In severe cases, it attacks the internal organs.
Dr B G Dharmanand, Consultant Rheumatologist, Vikram Hospitals (a unit of Manipal Hospitals) stated that many RA patients may not mount adequate immune response to vaccination, however, a booster dose could be one of the ways to increase protection along with short-term (one week) stoppage of some of the immunosuppressive medications. “The benefits are weighed against a small risk of arthritis worsening. The best precaution would be to maintain Covid-19 appropriate behaviour,” he said.
A study conducted by the Karnataka Rheumatology Association during the first Covid-19 wave on approximately 9,000 patients with rheumatic diseases in various district hospitals, has shown that the risk of mortality is approximately four times compared to the general population. The study is yet to be published.
Dr Abhishek Patil, Consultant - Rheumatology, Manipal Hospitals, Old Airport Road, who was part of the study said, “We used a number of medications like immunosuppressives on these patients. The immune system is essential to fight off infection, but in RA patients, the immune system is compromised. Our study has shown that RA patients infected with Covid-19 are at a higher risk of mortality.
Even vaccine response is poorer in these patients. Vaccines stimulate the immune system and produces antibodies, and protect against infection. But when immunosuppressant doses are consumed, the vaccine response may be impaired and a booster dose is required for patients on priority basis, when it’s rolled out.
“All patients are sero-positive after vaccination, but antibody titers are found to be significantly lower in about 10-15 per cent in these patients. All immunocompromised patients probably require a booster dose. Despite being vaccinated, precautions like maintaining distance and wearing a mask are required,” said Dr Singhai Shweta, Consultant -Rheumatology, Sakra World Hospital.
It was also pointed out that RA patients need to consult their doctor before taking the vaccine, who could advise them to delay immunosuppressants for two weeks after vaccination. “If the patient is doing well, we can hold back giving drugs for two weeks, but if the patient is in a bad state, we can see if we can hold back drugs after vaccination or not.”