ACR Updates COVID-19 Vaccine Guidance for Managing Patients With Rheumatic and Musculoskeletal Diseases

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Nurse at pharmacy clinic giving flu shot to a female patient. Syringe, needle on counter. Adhesive bandage.
The American College of Rheumatology updated COVID-19 vaccine clinical guidance to include recommendations regarding medication timing considerations during the management of patients with rheumatic and musculoskeletal diseases.

In February 2021, the American College of Rheumatology (ACR) COVID-19 Vaccine Clinical Guidance Task Force released a summary of consensus-based recommendations for the management of patients with rheumatic and musculoskeletal diseases (RMDs) with regard to COVID-19 vaccination.

Recently, the guidance was updated to include new recommendations regarding mycophenolate, methotrexate, acetaminophen, and nonsteroidal anti-inflammatory drug (NSAID) timing considerations for patients with RMDs. The updated report was published on the ACR website and is intended to be published in Arthritis & Rheumatology.

Updates to the ACR COVID-19 Vaccine Guidance

  • The task force recommended holding acetaminophen and NSAIDs for 24 hours before vaccination against COVID-19 in patients with stable disease. However, they noted that no restrictions were needed on acetaminophen and NSAID use after COVID-19 vaccination.
  • In patients with stable disease, providers may hold mycophenolate for 1 week after each COVID-19 vaccine dose.
  • In the modified guidance, the task force suggested holding methotrexate for 1 week following each of the 2 mRNA vaccine doses and for 2 weeks following the single-dose COVID-19 vaccine.
  • Citations were updated regarding the attenuation of COVID-19 vaccine response in patients receiving mycophenolate, methotrexate, Janus kinase inhibitors, and other immunomodulatory therapies.


ACR COVID-19 Vaccine Clinical Guidance Task Force. COVID-19 vaccine clinical guidance summary for patients with rheumatic and musculoskeletal diseases. American College of Rheumatology. Published February 8, 2021. Updated April 28, 2021. Accessed May 3, 2021.

This article originally appeared on Rheumatology Advisor