As a rheumatologist, I feel responsible for engaging my patients in a discussion to assess COVID-19 vaccination status and engage in a shared decision-making process to discuss receiving the COVID-19 vaccine. You should know these ten facts if you have rheumatoid arthritis or any other autoimmune and inflammatory rheumatic disease.

1) Autoimmune and inflammatory rheumatic disease patients are at higher risk of hospitalized COVID-19 and worse outcomes than the general population, and based on your risk for COVID-19, you should prioritize your vaccination.

2) Beyond known allergies to vaccine components, there are no known additional contraindications to COVID-19 vaccination.

3) The expected response to COVID-19 vaccination for many patients on systemic immunomodulatory therapies is likely to be blunted in its magnitude and duration compared to the general population.

4)A theoretical risk exists for flare or disease worsening following COVID-19 vaccination. However, the benefit of COVID-19 vaccination outweighs the potential risk for new-onset autoimmunity.

5) Based on the data for the mRNA COVID-19 vaccines available in the U.S., there is no preference for one COVID-19 vaccine over another. Therefore, you should receive either vaccine available to you.

6) For a multi-dose vaccine, you should receive the second dose of the same vaccine, even if there are non-serious adverse events associated with receipt of the first dose, consistent with the timing described in CDC guidelines.

7) Healthcare providers should not routinely order any lab testing (e.g., antibody tests for IgM and IgG to spike or nucleocapsid proteins) to assess immunity to COVID-19 post-vaccination, nor to assess the need for vaccination in a yet-unvaccinated person.

8) Following the COVID-19 vaccination, RMD patients should continue to follow all public health guidelines regarding physical distancing and other preventive measures.

9) Certain rheumatoid arthritis medications will need modifications in timing and interval, so talk to your rheumatologist for more information if your medication needs change in time interval around your vaccine.

10) There is no direct evidence about mRNA COVID-19 vaccine safety and efficacy in rheumatic disease patients. Regardless, there is no reason to expect vaccine harms will trump expected COVID-19 vaccine benefits in these patients.

I adapted these guidelines from the American college of rheumatology. ACR guidance statements are not intended to supersede the judgment of rheumatology care providers nor override their patients' values and perspectives. The guidance was based on weak and indirect evidence and required substantial extrapolation by an expert task force. All statements, therefore, should be considered conditional or provisional.

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