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Q:

Emma from Canada asks: I received my 2 doses of the Moderna vaccine and with the first experienced a 1 week rheumatoid arthritis flare but it was manageable. After the 2nd dose, my RA took a turn for the worst & I have been in the worst flare of my life since (4 months now).  Should I still get the booster?

The best advice for anyone in this situation is to speak with your rheumatologist.  Regardless of the vaccine, a flare lasting more than a few weeks deserves a conversation with your rheumatologist to determine the best course of action going forward to get it under better control.  That said, while there is some evidence that the COVID vaccine may induce flares in a small minority of cases, most times the flare is either a side effect of the vaccine but perceived as a flare (likely what is described after the first shot) or a coincidence of association, rather than causation.  As so many people are getting COVID vaccine, it will happen that some will flare afterwards, but it is likely that many of those flares would have happened anyways.  As a general principle, 3rd (and now 4th) shots for COVID vaccine are encouraged for those with rheumatic diseases.

Q:

Hayley from Calgary asks: I have recently gotten sick and need to know if I should continue my methotrexate injections or hold them while I am sick ?

As a general rule, it’s ok to continue traditional DMARDs (examples: methotrexate, plaquenil, sulfasalazine, leflunomide) when sick, particularly anything mild without a fever or needing antibiotics.  For those on biologics, we generally recommend that they are held, particularly if you have a fever or require antibiotics, until you are feeling better.  However, during the COVID19 pandemic, we are often a little more cautious and it would be reasonable to hold any DMARD – traditional or biologic – until you are feeling better.  In most cases for methotrexate, this would mean missing one dose, which wouldn’t impact arthritis control for most individuals.

Q:

Savannah from Calgary asks: Do rheumatologist treat fibromyalgia and multiple sclerosis?

Rheumatologists generally treat autoimmune diseases related to inflammation.  These include rheumatoid arthritis, lupus, ankylosing spondylitis, gout and many more.  Neurologists typically diagnose and manage multiple sclerosis, which is also an autoimmune disease but of the nervous system.  Rheumatologists will see patients for fibromylagia, but many it is not a diagnosis exclusively managed by rheumatologists.  Many physicians, including family doctors, can diagnose fibromyalgia.  Please see our fibromyalgia information page for the self-management options available.

Q:

Michael from St. Albert asks: I am having terrible stomach and gut issues with the initial medication I started from AS. Do I have to continue as I’d rather suffer with AS.

The simple answer is you should not continue a medication if it’s giving you side effects that are not acceptable to you.  You should discuss your concerns with your rheumatologist who may have ways to settle the problem, or may suggest another medication instead.  If you cannot get hold of your rheumatologist’s office and you are suffering, in many cases it is ok to stop your medication while you are waiting for advice from your rheumatologist.  We have information on most medications on our website which can help you to make sure it is safe to just stop.

Q:

Ashley from Edmonton asks: Should I hold methotrexate before having a COVID19 shot or flu shot?

From a safety perspective, it is very safe to continue methotrexate while getting either of these vaccines.  There is some data to suggest that holding your methotrexate for 1-2 weeks AFTER the flu shot, and maybe the COVID shot, will make these vaccines work better.  Check with your rheumatologist if this is right for you, as there is a need to balance vaccine efficacy with disease control, and this balance may be different for every individual.

Q:

Raewyn from Canada asks: How does the COVID vaccine impact those with Takayasu disease or other large vessel vasculitis?

When it comes to most of the rheumatic conditions, there have been no indicators to date that the vaccines are unsafe or do harm to your underlying disease.  This would include all forms of vasculitis.  That is not to say that vaccines do not have risks, but they would be rare, and are not specific to a rheumatic disease.  The benefits of vaccine far outweigh their risks.  This is particularly the case for those with rheumatic disease, as a COVID infection could be much worse with worse outcomes if you have an active vasculitis.  Where things get more complicated is the medications used to treat our conditions, which may decrease the benefit of the vaccine.  This is why a 3rd shot of the COVID vaccine has been advocated for successfully for those on most rheumatologic treatments.

Q:

Alex from Calgary asks: If someone had $100K to invest in the most ambitious treatment for arthritis, where would you suggest they put it?  If someone had a free 5 years of time to commit to research on a current approach in therapy, what direction would you suggest?

It’s an interesting question.  It is an amazing time in arthritis research.  The number of new treatment options that have become available over the last 10 years is enormous.  This will only continue.  Where we struggle is not necessarily with the treatments themselves, but how to best deploy them.  Our model of care needs to be modernized.  Standard of care should include not just a rheumatologist/physician, but an entire arthritis care team.  Each person should be followed in a systematic data driven way to inform best treatment choices and then learn from that for future patients.  This can inform us how to personalize the use of our treatment options, leading to better outcomes with safer treatment being offered not just for arthritis, but for a person as a whole.  Arthritis centres, like those in Edmonton and Calgary, are at the forefront of this work but much support is needed to make it a true reality.

Q:

Allie from Canada asks: I have lupus and low platelets (thrombocytopenia).  I understand COVID vaccines can make low platelets worse.  Can I get a COVID vaccine?

Low platelets can be a manifestation of systemic lupus.  It is still safe for those with lupus to receive a COVID-19 vaccine. There is a concern of the virus vector vaccines (Astra Zeneca and Johnson & Johnson products) inducing low platelets and a syndrome called vaccine induced thrombotic thrombocytopenia (VITT).  The risk of developing VITT is very rare.  There is no data to suggest having low platelets in lupus would increase the risk of developing VITT.  Perhaps more importantly, the mRNA vaccines (Pfizer and Moderna products) do not have the same risk associated with them.  For most Canadians, the mRNA vaccines are the ones that are available to them.  In Alberta, those with lupus fall under Phase 2B, meaning they would only be offered an mRNA vaccine at this time.  For information on COVID19 vaccines and rheumatology medications, click here.

Q:

Erin from Jasper asks: My dentist diagnosed me with rheumatoid arthritis based on findings in my TMJ joint.  What should I do now?

Rheumatoid arthritis is a systemic disease and whether or not it impacts one joint or many, it should be ideally managed by a rheumatologist.  Rheumatoid arthritis is a condition that can be placed into remission with the right treatment.  If not already, you should speak to your family physician or dentist about a referral to a rheumatologist to ensure there are no other joints involved and treatment options are discussed.  In Alberta, all rheumatologists require a referral.

Q:

Elena from Calgary asks: Is it possible to connect with a Rheumatologist virtually? Or do appointments need to be in person?

The COVID-19 pandemic has changed how rheumatology visits happen.  While some patients are still being seen in person, many are being seen virtually – either through phone or video (Zoom) appointments.  Check with your rheumatologist’s office to see what they are doing, and if a virtual visit is appropriate for you.  For more information on virtual visits and how to best prepared, check out our webpage and video.



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