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.