Third covid shot or booster

[tntlamb]

Does methotrexate influence COVID-19 infection? Case series and mechanistic...

Heres an article summing up some of the research: Coronavirus and Rheumatoid Arthritis: What You Need To Know About COVID-19

https://www.rheumatologynetwork.com/view/targeted-biologics-did-not-affect-humoral-immunity-to-first-dose-of-covid-19-vaccinehttps://www.arthritis.org/health-wellness/about-arthritis/related-conditions/other-diseases/covid-19-faqs-medication-treatment-and-vaccines

Methotrexate, rheumatoid arthritis and infection risk—what is the evidence?

Although there is currently no evidence to prove that patients with autoimmune disorders or on immunosuppressive drugs are at a greater risk of contracting the COVID infection, there remains a theoretical risk of increased complications in such patients if they acquire the infection [3]. However, data from the COVID-19 Global Rheumatology Alliance Global Registry which gives live time information regarding rheumatic diseases and COVID-19 showed that as of on 17 August, 2020, the commonest rheumatic disease in which COVID-19 was documented was RA (694 patients out of 1783) [4]. Based on a few other studies, rheumatoid arthritis seems to be the most common rheumatic disease in which COVID-19 infection has been documented [3, 5]. In a Chinese case series of 5 patients with rheumatic diseases who developed COVID-19, four of them had RA and one had systemic sclerosis. In another case series from New York, in which 86 patients with immune-mediated inflammatory diseases who contracted COVID-19 were studied, a high percentage of the admitted patients had RA [6].
"Managing rheumatoid arthritis during COVID-19 | SpringerLink

As I said in the post “In short we are not considered truly immunosuppressed but should act like we are.” If you are well controlled in your disease your OVERACTIVE immune system is tamped down. PsA as any of the rheumatoid disesase is not on the list of immunosuppresed conditions. (Kidney asthma, transplant etc.)our problem isn’t a depressed immune system but rather one that is soooooo active that the body can prevent antibody production. That doesn’t mean you should not be careful. For everyone of us that reports more infections colds flus etc the are among us many who report less because we through treatment have normalized our immune system. There is a risk of overdoing suppresion through treatment, but a far greater risk if we don’t treat. The need for vaccination and boosters is paramont. which is what the question was.

[Bern]

I’m in Ohio. My rheumatologist told me to take the shots. My Cosyntex stopped working good a few months later. Shots were March. In August or September I tried another biological that did not work at all. So between stopping that and restarting Cosyntex at half the dose I took the booster. I feel great now! I refuse to sit home. And the dr. Urged me to get out and live. No side effects with booster and some tiredness and sore arm from first two. I have 4 out of the 5 types of psa.

[Poo_therapy]

@tntlamb

As I said in the post “In short we are not considered truly immunosuppressed but should act like we are.” If you are well controlled in your disease your OVERACTIVE immune system is tamped down.

That’s exactly the advice of my rheumy UK initially when Covid started. However since then they’ve decided varying meds affecting varying things permits us to get not just to get a booster but a 3rd Covid vaccine now and a 4th six months after that. That approach is fine by me.

@tntlamb

For everyone of us that reports more infections colds flus etc the are among us many who report less because we through treatment have normalized our immune system.

And this is certainly true in my case, far less issues of the normal everyday colds etc. I certainly don’t think daily that I’m seriously immunosuppressed at all, I consider myself with a much more normally fuctioning immune system thanks to PsA meds.

However I remain terrified of catching Covid not because I have PsA but because of my age, weight, life long asthma etc etc. So I’m quite delighted than due to PsA I have access to 4 covid vaccines.

There remains the question that because of our PsA meds how many of us are growing antibodies to Covid from the vaccine. The present research seems chaotic on that but certainly points to many of us not making antibodies. Hence an even greater relief on being able to access these extra Covid vaccines.

[Jen75]

Yes, I sometimes think it depends on perspective. I’ve been 6 months without a biologic now, and I can tell you what a malfunctioning immune system looks like! This week I saw my haematologist, dermatologist and gynaecologist, all for linked issues, and next week is the cardiologist.

I definitely would not trust my immune system to protect me from COVID, the acute flares I’m having I’d be surprised if it didn’t launch straight into ARDS (which after all is caused by the over-reaction of our immune system to COVID) within the first 24 hours. I’ll be relieved to get onto Remicade finally next week, and be getting that 3rd shot to time with our opening up (and once the cardiologist clears it).

Though yes, I do act like I am immunocompromised and do all the right things, my experience has been it is dependent on the infection. Bacterial infection in a burst cyst in my skin - very slow healing and lots of antibiotics probably due to Humira.

Dengue infection (2nd, which is almost always worse than the first, and can be very dangerous, because the immune system can overreact and create a cytokines storm), Humira was probably protective - it was subjectively a mild infection.

Salmonella- jumped on that with antibiotics and it cleared quickly without a missed dose, so seems like the Humira had little effect.

Influenza? Dunno, got it pretty bad but not hospitalised so I’m guessing just average.

Whew, that was a hard year!

Anyhoo, that is my long-winded way of saying that whilst I behave as though I am immune compromised, because occasionally it can have that effect, I try not to worry too much about it, because my experience is that like others, most of the time the biologics are protective for me.

[Amos]

This is a very helpful thread! One thing that I take away from it is how unique each of us is in how we process the meds, infections, disease and recovery. It would be easy if one shoe fit everyone. We find general similarities that guide us but always on the alert for each body to respond in a unique way. With all of the biologics, Dmards and vaccinations, I wonder why the dosage isn’t applied with more precision. A 110 pound woman might need a different dose than a 250 pound man but I haven’t seen that kind of tailoring of meds. Perhaps a small bodied person over reacted to the covid vaccine because they just didn’t need as much? Or the way that a 250 pound man processes 25 mg of MTX with less side effects and less good effects just doesn’t seem to part of the equation. Giving everything in one size fits all just seems sloppy and maybe even reckless. With the rheumy’s permission, I am currently looking for a “sweet spot” in which I can benefit from MTX without the side effects. At 15mg or more, I break out in swollen acne like sores on my face and I have less pain. But at 10mg, it all clears up but I lose noticeable pain control.

[tntlamb]

That’s one of the main reasons I use inject-able MTX much Easier to hit that sweet spot. It’s also why I am excited for @Jen75 going on Remicaid. Its based strictly on weight and they don’t take your word for it. I get weighed every time. Then the infusion center compound the dose for that day. It takes a while (not that I mind now that some of the resrictions are loosened I get food and coffee delivered to my “chair” again. (I’m even hoping to lead some sing alongs again soon. The Pink Lady and her Keyboard is coming back this month) I have had the best luck with this old drug not to mention over 3 year on it now - A record!

[dazqz]

@tntlamb

“In short we are not considered truly immunosuppressed but should act like we are.”

If you click through the links in the first article I mentioned, we’re included in the list of immunocompromised conditions. See the CDC slides here where they include TNF blockers and other biologics.

This one that you linked to says:

It is well recognized that the long-term morbidity and mortality for patients with RA is significantly increased. An important part of this increased risk is due to a higher rate of infection in patients with RA when compared with a healthy control population. In a retrospective case–control study of 609 patients diagnosed with RA from 1955 to 1994, examining objectively confirmed infections (positive microbiological results and/or imaging), the risk of infection was significantly elevated in RA patients (19.64/100 person-years compared with 12.87/100 person-years in healthy controls). This increased risk was seen for all types of infection, but particularly osteomyelitis and septic arthritis. Infections requiring hospital admission were also significantly increased in the RA cohort compared with controls. In a 25-year prospective follow-up study of 209 RA patients, there was a significantly decreased median life expectancy when compared with the general population with the major cause of death infection-related.

The other article you linked to also talks about general immunosuppression:

If you have rheumatoid arthritis (RA), you’re more likely to get certain infections. That means you may have a higher chance of getting COVID-19. If you do get sick, your symptoms could be more serious than someone who doesn’t have RA. Some medicines you take might also make infections more likely.

It also says:

On the flip side, researchers are looking into the benefits of some RA drugs for COVID-19, the infection caused by the new coronavirus. But more research is needed to know if and how they could prevent or treat COVID-19.

but that doesn’t mean that we aren’t immunocompromised. As far as I can tell, it just means that there are certain arthritis drugs that can counter symptoms of bad COVID in some patients with an out of control immune response to the virus.

The immune system isn’t as simple as a number between 1 and 10, so I don’t think it’s accurate to say “I have an overactive immune system (10) and if I take this medication, it will bring me back to normal (5).” If it were that simple, it seems like any immune suppressant would work for everyone, and we would be equally susceptible to every kind of pathogen.

My main point is that I think care should be taken about telling people that they aren’t immunosuppressed when the doctors and medication labels say otherwise. Some people don’t have any problems, but it doesn’t mean that the risks aren’t there.

[tntlamb]

The arthritis studies were in utnreated patients. The topic here is vaccines. treated arthritis patients are not in the high risk high mortality Covid groups when vaccinated and in fact if you read all of the studies may in fact be at lower risk.

I am very familiar with package “risk labels” are added with a .5% report in phase 2 studies. If much higher than that with exception of very minor effects the med will not be approved or go to stage 3.

In your list the only medication that applies may be some of the TNF blockers (not all particularly the monclonals) Humira and several of the Monoclonal biosimilars are in stage 1 trials for treatment of the most serious effects of Covid cytokine storm.

You may or may not be immunosuppressed which is why you should act like you are. The main point is that as a cohort our disease population when immunized is no greater at risk from the Covid than the general population.

There simply is no need for hysteria over this. Follow your doctors advise get the shots., and take precautions and we can worry about joint replacements, loss of mobility, and the gifts this disease gives us.

Be careful of words like some, may, could.

[Jen75]

@tntlamb thankyou I’m so excited too! Ironically the weight usually works in my favour with most meds, cause I’m fairly small but seem to need a big persons dose note to self; check threshold weights and manipulate with clothes if required

But I’m super-optimistic too - when the Stelara dose (by weight) was not enough for me they doubled it with compassionate doses - so I’m hoping that will be an option too. I am also going on the new two-weekly subcut version after the first two loading doses, apparently it performs slightly better in that the trough concentration stays more stable. I’m already starting to feel a lot less short of breath from the steroids (or coincidental recovery), so I am planning for all the stuff I’m going to do when Remicade works (cross all your fingers for me, virtually, not physically). Roll on Monday!

[Poo_therapy]

Best of luck on Monday. If anyone needs to catch a big break it’s you @Jen75. Everything crossable (and these days it’s quite a lot too thankfully) are now crossed.