Dear patients,

Last week the American College of Rheumatology released new guidelines to help physicians and patients navigate the Covid vaccines and their medications for autoimmune diseases.

Here is a list of recommendations, which may help guide you. If you have any further questions, please reach out to our office.

  1. MEDICATIONS THAT DO NOT REQUIRE ANY CHANGE TO THE MEDICATION OR VACCINE TIMING (no need to stop the medicine, proceed with vaccination)

Hydroxychloroquine (Plaquenil);


Glucocorticoids, prednisone-equivalent dose <20mg/day:

Sulfasalazine (Azulfidine);

Leflunomide (Arava);

Mycophenolate (Cellcept);

Azathioprine (Imuran);

Cyclophosphamide (Cytoxan – oral);

TNFi (Remicade, Inflectra, Renflexis, Avsola, Humira, Enbrel, Cimzia, Simponi, Simponi Aria);

IL-6R (Actemra, Kevzara);

IL-1i (Kineret);

IL-17 I (Cosentyx, Taltz);

IL-12/23i (Stelara);

IL-23i (Tremfya);

Belimumab (Benlysta);

oral calcineurin inhibitors (Cyclosporin, Tacrolimus, Pimecrolimus)

Glucocorticoids, prednisone-equivalent-dose≥ 20mg/day**

  1. Methotrexate

Hold MTX 1 week after each vaccine dose, for those with well-controlled disease; no modifications to vaccination timing

***For patients with very active disease, please contact your doctor for guidance.

  1. Abatacept (Orencia) SC (weekly shots given at home)

Hold SQ abatacept both one week prior to and one week after the first COVID-19 vaccine dose (only); no interruption around the second vaccine dose

  1. Abatacept (Orencia) IV (in-office infusion)

Time vaccine administration so that the first vaccination will occur four weeks after abatacept infusion (i.e., the entire dosing interval), and postpone the subsequent abatacept infusion by one week (i.e., a 5-week gap in total); no medication adjustment for the second vaccine dose

  1. Cyclophosphamide  (Cytoxan) IV infusion

Time Cyclophosphamide administration so that it will occur approximately 1 week after each vaccine dose, when feasible

  1. RITUXIMAB (Rituxan) IV infusion

Assuming that patient’s COVID-19 risk is low or is able to be mitigated by preventive health measures (e.g., self-isolation), schedule vaccination so that the vaccine series is initiated approximately 4 weeks prior to next scheduled rituximab cycle; after vaccination, delay RTX 2-4 weeks after 2nd vaccine dose, if disease activity allows.

Walter L. Chmelewski, MD ,              A.Silvia Ross, MD                  Sherry L. Sinclair, MD





COVID-19/  Coronovirus Update

We always strive to maintain a clean and sanitary environment for our patients and employees.  In light of the current situation, our housekeeping has been exponentially increased.  If you are well and have a scheduled appointment, it is our intent to be available to not only serve your needs but provide a safe and sanitary environment to do so.

If you have an upcoming appointment and can answer yes to the below listed questions, please notify us.  You may send us a message through our secure patient portal or call us at 919-881-8272 (please be advised, we are seeing increased call volume and you may experience longer call back times if you opt to call) .  We will ask that you remain at home and provide you with a new appointment at your convenience.

Are you displaying any common flu-like symptoms (fever, cough, shortness of breath) or any respiratory difficulty?

Have you traveled to an area with widespread or ongoing transmission (Level 3 Travel Health Notice) such as China, Iran, South Korea, Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, Monaco, San Marino, Vatican City, the UK, or Ireland?

Have you had direct contact with a confirmed case of COVID-19?  Any patient presenting to our offices affirming any of the above will be asked to go home and contact their primary care provider. Again, we will work with you to reschedule your appointment to another time with no penalty.

We will also be providing Telehealth appointments.  Please contact us at 919-881-8272 to schedule a Telehealth Appointment. (This will either be a facetime or phone call appointment).

Additionally, out of an abundance of caution, we are limiting any non-essential visitors.  If you are well and coming to our office for an appointment, we kindly ask that you limit the number of persons who accompany you, if at all possible.  We may ask that only you be present in the clinical areas and any other accompanying adults remain in one of our waiting areas.

Thank you

If you would like further information on preventing illness visit the CDC