Should people with autoimmune diseases get the COVID-19 vaccine?

COVID-19 vaccination may briefly influence medication timing in patients with rheumatic disease, but the benefits vastly outweigh any risks, says the CU School of Medicine’s rheumatology chief.
July 8, 2021
man with autoimmune disease getting a COVID-19 vaccine
Source: Getty Images.

Serious cases of COVID-19 often stem from the immune system going haywire. It’s fair to wonder, then, whether those with autoimmune diseases – that is, diseases such as rheumatoid arthritis and lupus that involve the immune system attacking the body itself – should worry about getting the COVID-19 vaccines.

Unless one has a vanishingly rare allergy to vaccine adjuvants, those with rheumatic and other autoimmune diseases should have no qualms about COVID-19 vaccination, says Dr. V. Michael Holers, head of the Division of Rheumatology at the University of Colorado School of Medicine. Holers bases this on his team’s clinical experience as well as the recommendations an American College of Rheumatology task force that on March 4 released updated its best practices for COVID-19 vaccination among those with rheumatic diseases.

UCHealth Today spoke with him about the impacts to rheumatology patients of COVID-19 and the vaccines aimed at immunizing against it. The bottom line – and the data backing this up – is that if you have a rheumatic disease, it’s vastly preferable to get a COVID-19 vaccine than it is to become infected with the actual coronavirus.

Dr. V. Michael Holers, who leads the CU School of Medicine’s Division of Rheumatology, is a member of the American College of Rheumatology (ACR) leadership. The ACR recently published recommendations for the approach to COVID-19 vaccination among those with rheumatic and related autoimmune diseases. Photo by Todd Neff for UCHealth.
Dr. V. Michael Holers, who leads the University of Colorado School of Medicine’s Division of Rheumatology, is a member of the American College of Rheumatology (ACR) leadership. The ACR recently published recommendations for the approach to COVID-19 vaccination among those with rheumatic and related autoimmune diseases. Photo by Todd Neff for UCHealth.

Are people with autoimmune diseases at any additional risk when it comes to COVID-19?

Dr. V. Michael Holers: Initially, we thought that they were not at greater risk if they got COVID-19. However, the thinking on that is evolving. More recent data out of Europe and elsewhere shows that there’s a modestly increased risk for severe disease. You’re apparently not at a substantially higher risk of getting COVID itself, but if you do get it, there’s an increased risk of severe disease.

The impact of COVID-19 on those with autoimmune diseases is being actively and intensely studied right now. The rarity of these diseases makes that hard to do. You need to be able to put together data from multiple hospitals or multiple health care systems and then try to address all of the comorbidities that are associated with increased risk – age, obesity, and so on. Trying to disentangle it all is difficult at times, but with large data sets, you can do it. That’s how this slightly increased risk of severe disease has been identified.

Do any particular autoimmune diseases seem to heighten the risk of more serious COVID-19 cases?

Dr. V. Michael Holers: If you look at the guidance in terms of conditions that increase the risk of severe COVID-19, autoimmune and rheumatic diseases are not on the list, and there’s nothing glaring in the data.

Why is it important for those with autoimmune diseases to get vaccinated, including the COVID-19 vaccines?

Dr. V. Michael Holers: It’s important for everyone to get vaccinated. I think the specific issue regarding patients with autoimmune diseases is not whether they should get vaccinated, but how to get vaccinated relative to their medications. We work hard to give usual vaccines at time points when the vaccine can be most effective. That may involve holding off for a week or two on a drug that a patient is taking for an autoimmune condition – often we can do that without risking an adverse event or a disease flare – or vaccinating right before the next dose of the therapeutic so the immunosuppressive aspect of the therapeutic is minimal. For some drugs, we don’t do anything in particular; for others, we time the vaccine so the therapeutics are not interfering with the body’s ability to respond to the vaccine.

Do the COVID-19 vaccines present risks to those with autoimmune diseases?

Dr. V. Michael Holers: We should distinguish COVID-19 infection from COVID-19 vaccination. The COVID-19 infection is a very complex immune process where there is increasing evidence of the development of certain types of autoimmune problems, especially related to clotting and interference with the normal cytokine milieu. The infection involves multiple viral proteins and a lipid membrane. SARS-CoV-2, the formal name of the coronavirus, has a lot of ways it can alter the immune response and result in an autoimmune-like syndrome. How long that syndrome lasts, whether it’s fixed or varies over time, and whether we’ll see a burst of autoimmune-type diseases going forward has yet to be understood. Certainly, a lot of work is being done looking at this question along with long-COVID syndrome and asking whether this complication is related to long-term viral infection or an autoimmune response.

The vaccine, on the other hand, is much simpler. It codes only a part of a single protein on the virus. It does have adjuvants that stimulate the immune response. There is no evidence that the vaccine will cause an autoimmune-like syndrome in the same way the disease does. So the vaccine is a far better option than the actual COVID-19 infection.

I hear from nonmedical friends some of the old wives’ tales going around: “The vaccine will change your own DNA,” and “The vaccine will infect your brain and cause memory problems” – totally wrong. These ideas have no basis in scientific fact.

Is the idea that COVID-19 vaccination triggers autoimmune diseases such as rheumatoid arthritis or lupus similarly incorrect?

Dr. V. Michael Holers: Autoimmune diseases typically develop over many years – many decades, probably. They’re a result of a combination of genes, environmental exposures, and, probably, bad luck acting to dysregulate the immune system. It takes five, ten, fifteen, sometimes twenty years to develop autoimmune diseases.

With exposure to something in the short-term such as a vaccine based on mRNA or DNA, a vaccine’s mRNA is actually gone within two or three days. It’s completely degraded, and you have a really short-term exposure to mRNA. Even the DNA in other vaccines is only in the cell for a short period of time. It gets destroyed because the body knows it doesn’t belong there. So as far as the mechanisms of a vaccine and those of autoimmune disease, we’re talking about entirely different immune processes that are engaged.

Anything else you’d like to add regarding autoimmune diseases and COVID-19 vaccines?

Dr. V. Michael Holers: I think the important point is that people should get vaccinated when their particular group becomes eligible. There’s a personal benefit and a societal benefit, and we need to suppress this pandemic.

About the author

Todd Neff has written hundreds of stories for University of Colorado Hospital and UCHealth. He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado, where he was a Ted Scripps Fellowship recipient in Environmental Journalism. He is author of “A Beard Cut Short,” a biography of a remarkable professor; “The Laser That’s Changing the World,” a history of lidar; and “From Jars to the Stars,” a history of Ball Aerospace.