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Vaccines (including COVID) and Every Rheum Disease

There is lots of information out there to suggest vaccines are safe. The COVID19 pandemic certainly has seen the topic of vaccine safety come to forefront. I am here today to say vaccines are neither safe or not safe. Like any other treatment, they are a medication that is not perfect. But, here is an approach to make sure they are right for you.

EVERY thing we do in life has risks and benefits. When I cross the street, I will benefit by whatever is on the other side. However, I could be hit by a car. I will take every precaution I can so I don't get hit by a car, but it's still possible.

When I take a medication, my intent - my hope - is that it will improve some medical problem I have. But with that potential benefit comes risk. I could experience a side effect from that medication. Is the risk worth the benefit?

And it's not even that simple because we have to explore the other side of the coin too. If I don't cross the street, I lose the benefit of what is on the other side, although I have reduced my risk. If I don't take the medication for my medical condition, I won't experience side effects from it, but potentially the condition will not improve or even get worse.

This is all complicated, and it's that complicated for vaccines too. What is the risk and benefit of having the vaccine? What is the risk and benefit of not having the vaccine? AND, for someone with a rheum condition, how does that change the equation?

There is much data to support that vaccines reduce your risk of COVID19, and even if that benefit is getting smaller with subsequent COVID19 variants (here's looking at you OMICRON), vaccines still reduce your risk of getting BAD COVID, meaning you are very sick, might need to be hospitalized, might need oxygen, or might need to be intubated (a tube down your throat to help you breathe). Vaccines against COVID19 also reduce your risk of death. And these vaccines are quite effective - but not perfect - at doing this. They do not make the risk zero, - you still can get COVID, bad COVID, or die - but reduce the risk substantially. So, the benefit of the vaccine is there, and the risk of not having the vaccine is clear as well.

The benefit of no vaccine is that you will not have a side effect, which remains the big risk of the vaccine. No one wants side effects. Fortunately, the majority of side effects of the COVID vaccine are mild. Now, mild doesn't mean they are nothing, and certainly it can feel significant, but they resolve, usually over a day or two. More significant side effects are possible - example: myocarditis - but very very uncommon (You can get myocarditis from COVID itself, which is much worse). The risk of getting COVID and getting bad COVID is higher than the risk of bad side effects from COVID vaccine, by a lot.

What about for those with rheum conditions though? Is the benefit/risk any different? In terms of benefit, we often say the vaccine may be more important than someone who is healthy, although maybe less effective. Why more important? Theoretically, someone with a rheum condition and on rheum medications does not have an immune system as strong to fight off a serious infection like COVID, so having the protection of the vaccine helps. Why less effective? Because the immune system is not as strong, the body may not respond to the vaccine as well, meaning less antibodies. But any antibodies is likely better than none.

What about risk? There are many folks who worry that the COVID vaccine will make their arthritis or rheum condition worse. Well, there is data to say there is a chance of this happening, but it is a very small chance. What is actually more common is to get the common side effect of the COVID vaccine of aches and pains for a few days post injection. This side effect could feel like your rheum condition flaring, but in fact, it's not. The other possible coincidence is that your rheum condition flares after the injection, but not because of it. It happens that many folks will flare, so it is only natural that when millions and millions of people are also getting the vaccine, that some will have a flare of their arthritis too. That doesn't mean it caused it though.

Here, we fully support vaccines for those with rheumatic conditions. That's probably come through from what we've written here so far. BUT, it's important that you - EVERY person - goes through this equation for themselves. What's the benefit and risk of getting the vaccine? What's the benefit and risk of NOT getting the vaccine? Once you've gone through that exercise, you can make a decision that's right for you.

What do you think?

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