Research ArticleAccepted Article
Open Access
Canadian Rheumatology Association recommendation for the use of COVID-19 vaccination for patients with autoimmune rheumatic diseases
Glen S. Hazlewood, Jordi Pardo, Cheryl Barnabe, Orit Schieir, Claire E.H. Barber, Sasha Bernatsky, Ines Colmegna, Carol Hitchon, Mark Loeb, Dominik Mertz, Laurie Proulx, Dawn P. Richards, Rosie Scuccimarri, Peter Tugwell, Holger J. Schünemann, Reza D. Mirza, Alan L. Zhou, Roko P.A. Nikolic, Megan Thomas, Helena Chase, Maede Ejaredar and Robby Nieuwlaat
The Journal of Rheumatology May 2021, jrheum.210288; DOI: https://doi.org/10.3899/jrheum.210288
Glen S. Hazlewood
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Jordi Pardo
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Cheryl Barnabe
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Orit Schieir
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Claire E.H. Barber
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Sasha Bernatsky
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Ines Colmegna
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Carol Hitchon
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Mark Loeb
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Dominik Mertz
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Laurie Proulx
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Dawn P. Richards
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Rosie Scuccimarri
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Peter Tugwell
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Holger J. Schünemann
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Reza D. Mirza
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Alan L. Zhou
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Roko P.A. Nikolic
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Megan Thomas
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Helena Chase
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Maede Ejaredar
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Robby Nieuwlaat
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, BC, Canada; Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada; Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Michael G. DeGroote Cochrane Canada and McMaster GRADE Centers, Hamilton, Canada; Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Ottawa, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Correspondence to: Glen S Hazlewood, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada. E-mail: gshazlew@ucalgary.ca
Abstract
Objective To develop guidance on the use of COVID-19 vaccines in patients with autoimmune rheumatic diseases (ARD).
Methods The Canadian Rheumatology Association (CRA) formed a multidisciplinary panel including rheumatologists, researchers, methodologists, vaccine experts and patients. The panel used the GRADE approach. Outcomes were prioritized according to their importance for patients and clinicians. Evidence from the COVID-19 clinical trials was summarized. Indirect evidence for non-COVID-19 vaccines in ARD was also considered. The GRADE Evidence-to-Decision (EtD) framework was used to develop a recommendation for the use of the four COVID vaccines approved in Canada as of March 25, 2021 (BNT162b2, mRNA-1273, ChAdOx1 and Ad26.COV2.S) over four virtual panel meetings.
Results The CRA guideline panel suggests using COVID-19 vaccination in persons with ARD. The panel unanimously agreed that for the majority of patients the potential health benefits of vaccination outweigh the potential harms in people with ARDs. The recommendation was graded as conditional because of low or very low certainty of the evidence about the effects in the population of interest primarily due to indirectness and imprecise effect estimates. The panel felt strongly that persons with autoimmune rheumatic diseases who meet local eligibility should not be required to take additional steps compared to people without autoimmune rheumatic diseases to obtain their vaccination. Guidance on medications, implementation, monitoring of vaccine uptake and research priorities are also provided.
Conclusion This recommendation will be updated over time as new evidence emerges, with the latest recommendation, evidence summaries and EtD available on the CRA website.
In this issue
The Journal of Rheumatology
Vol. 52, Issue 6
1 Jun 2025
Accepted manuscript
Canadian Rheumatology Association recommendation for the use of COVID-19 vaccination for patients with autoimmune rheumatic diseases
Glen S. Hazlewood, Jordi Pardo, Cheryl Barnabe, Orit Schieir, Claire E.H. Barber, Sasha Bernatsky, Ines Colmegna, Carol Hitchon, Mark Loeb, Dominik Mertz, Laurie Proulx, Dawn P. Richards, Rosie Scuccimarri, Peter Tugwell, Holger J. Schünemann, Reza D. Mirza, Alan L. Zhou, Roko P.A. Nikolic, Megan Thomas, Helena Chase, Maede Ejaredar, Robby Nieuwlaat
The Journal of Rheumatology May 2021, jrheum.210288; DOI: 10.3899/jrheum.210288
Accepted manuscript
Canadian Rheumatology Association recommendation for the use of COVID-19 vaccination for patients with autoimmune rheumatic diseases
Glen S. Hazlewood, Jordi Pardo, Cheryl Barnabe, Orit Schieir, Claire E.H. Barber, Sasha Bernatsky, Ines Colmegna, Carol Hitchon, Mark Loeb, Dominik Mertz, Laurie Proulx, Dawn P. Richards, Rosie Scuccimarri, Peter Tugwell, Holger J. Schünemann, Reza D. Mirza, Alan L. Zhou, Roko P.A. Nikolic, Megan Thomas, Helena Chase, Maede Ejaredar, Robby Nieuwlaat
The Journal of Rheumatology May 2021, jrheum.210288; DOI: 10.3899/jrheum.210288
