EMPOWER RHEUMATOLOGY LLC.

August 14, 2021

Dear Empower Rheumatology patients and families, as we are creating this post to address the recently released FDA recommendation on Covid Booster vaccine, we are still waiting on the formal recommendation from American College of Rheumatology (ACR) on how FDA recommendation applies to our rheumatology patients and their treatments.  There will be additional update as we receive ACR’s recommendation.

Studies have shown effective management of systemic inflammation and autoimmunity minimizes risk for Covid infection (uncontrolled autoimmune inflammation increases risk of Covid infection by 2 times) and proper use of Covid vaccines further enhances this protection.  Please stay tuned!

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Covid Vaccine Booster 101

1. What are available for Covid vaccine booster?

Currently we have Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines for a third dose.

• Who can benefit from it?

The Center for Disease Control and Prevention’s Advisory Committee recommended that rheumatology patients being actively treated with high-dose corticosteroids, alkylating agents, antimetabolites, tumor-necrosis factor blockers and other biologic agents that are immunosuppressive or immunomodulatory received a third dose of the Pfizer or Moderna mRNA Covid vaccine.

*If you are only on Hydroxychloroquine, low dose prednisone of 5mg or below daily, low dose Sulfasalazine 1000mg daily or below, or minocycline, you may not need to obtain a booster vaccine at this time.

• Is antibody testing necessary before receiving the booster vaccine?

The CDC noted that the effectiveness and accuracy of antibody testing are still being evaluated and currently there is no recommendation for routine antibody testing before receiving the booster dose.

• When should I obtain the booster vaccine?

The additional dose of mRNA COVID-19 vaccine should be administered at least 28 days after completion of the primary mRNA COVID-19 vaccine series, and patients and providers should stick to the same brand for the third dose, if possible. No determination was made on the safety of receiving one of the mRNA vaccines if a patient initially received the Johnson & Johnson shot.

• Do I need to hold my rheumatologic treatment?

*Please refer to our Covid Vaccine 101 posting earlier.

• What else can I do to stay healthy? (this applies to all patients)

*Wearing a mask

*Staying 6 feet apart from those they don’t live with you

*Avoiding crowds and poorly ventilated indoor spaces until advised otherwise by their healthcare provider

*Close contacts of immunocompromised people should be strongly encouraged to be vaccinated against COVID-19

Together We are Stronger

Let us hear from Ashley!

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I grew up in Jefferson City, Missouri, and from a young age, I loved taking care of others. I was fascinated with the medical field and started volunteering at a hospital at the age of 14. I have worked in a medical office or hospital since the age of 16. I graduated with a Bachelor of Science degree in Exercise Science from Truman State University, and then earned a Master of Medical Science degree as a Physician Assistant from Saint Louis University. My first nine years working as a Physician Assistant was in Emergency Medicine. I gained tremendous knowledge and experience, treating all types of patients with acute conditions. After having my first child, I longed to have continuity of care with my patients, and switched to work in Pediatrics. I worked in a Pediatric office the past eight years, where I was able to get to know my patients and their families, and gain a different level of empathy and compassion for patients, while still treating acute and chronic conditions.

I am excited to bring that level of empathy and compassion for patients to Empower Rheumatology. I want to help patients understand their conditions, help them thrive and have the best quality of life they can. I am passionate about medicine, healthy lifestyles, and whole body wellness. I want to build trusting and lasting provider-patient relationships with patients. I am honored and excited to be a part of the Empower Rheumatology team.

My husband and I have two children. We are active in their school, church, sports and other activities, but we make sure to have plenty of family time. We enjoy family trips, going to the lake, camping, biking, having a game or movie night, and making s’mores in the back yard.

I am excited for this new opportunity in Rheumatology and I look forward to getting to know you!

— Ashley Ahring

Updated Feb. 28, 2021

Covid Vaccines 101 for Empower Rheumatology Patients and Families:

1. What are approved?

Pfizer, Moderna and Johnson and Johnson vaccines. They are NOT live virus vaccines.

2. Who can benefit from them?

Aside from lack of studies in children and pregnant women(active plans to recruit this population for Covid vaccine testing), these vaccines are considered providing more benefits and safe to receive in our autoimmune patient population.

3. What are common side effects?

Injection site pain, muscle and joint achiness and flu like symptoms that self-limit and resolve timely in most cases.

4. When should we get the vaccines?

1^st batch of vaccines are prioritized to health care workers and long term care residents and their care takers.  Public vaccination has been rolled out and in accordance to announced phases by each state.

5. Should I hold my rheumatology medication before I obtain the vaccine?

Updated recommendation from American College of Rheumatology(ACR) released in early February 2021 states no modification to either immunomodulatory therapy or vaccination timing if patients are on Hydroxychloroquine, Sulfasalazine, Leflunomide, Mycophenolate(Cellcept), Azathioprine, oral Cyclophosphamide, TNF inhibitor(ie. Humira, Enbrel), IL-6 inhibitor(ie. Actemra, Kevzara), IL-1 inhibitor (ie. Anakinra), IL-17 inhibitor (ie. Cosentyx, Taltz), IL-12/23 inhibitor (ie. Stelara), IL-23 inhibitor (ie. Tremfya), Belimumab (ie. Benlysta), oral Cyclosporin, IVIG or/and prednisone (equivalent to <20mg/day, likely 20mg/day or great is ok as well).

For patients on Methotrexate, Jakinase inhibitor (ie. Xeljanz, Rinvoq, Olumiant), ACR recommends holding treatment 1 week AFTER each vaccine dose for those with Well-Controlled disease.

For patients on SubQ Orencia, ACR recommends to consider holding injection one week prior to and one week after the First covid 19 vaccine dose (only) with no interruption around the second vaccine dose. Similarly those on IV Orencia, consider obtaining the first Covid vaccine 4 weeks after the last Orencia infusion and postpone subsequent infusion 1 week after the first vaccine (total of 5 week gap between infusions).

For patients on Rituximab (Rituxan, Truxima), consider scheduling vaccination so that the vaccine series is initiated approximately 4 weeks prior to next scheduled rituximab cycle; after vaccination, delay rituximab 2-4 weeks after 2nd vaccine dose, IF disease activity allows.

6. I have severe allergy (aka anaphylaxis) to vaccines, can I still be a good candidate for the vaccine?

Early data from UK suggests people with severe (life threatening allergy) may have more pronounced side effects from the vaccines.  We recommend discussing your allergy history and severity with your family medicine providers before making the decision.

7. If I already had Covid 19 infection, should I still get the vaccine? Will it be helpful still?

Early data suggests our body will have the Covid virus antibody for months and then it begins to wean.  Therefore, it is advisable to obtain the vaccines still.

8. After I get my vaccine, do I still need to wear mask and wash hands and keep safe distance from people?

Yes.  We do not know what constitutes the Herd Immunity nor do we know asymptomatic Covid 19 infection amongst the vaccinated people.  It is still important we practice common-sense protection.