4th covid jab: Hi can anyone help my confused brain... - NRAS


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4th covid jab

Gladjake profile image

Hi can anyone help my confused brain regarding this 4th covid vaccine

I was under the impression that it you have RA and are on meds that lower your immune system you are eligible for having it, however when I phoned my GP she said you must be on 20mg or more methotrexate to be eligible.I am on 12.5 methotrexate injections along with hydroxy.I’m assuming this is correct but as my consultant has just retired( waiting for referral to another one) I can’t ask her.any thoughts anyone🤦‍♀️Thanks

27 Replies

That is what my GP and head pharmacist at my local trust said too. I am on 15mgs of MTX but that does not count apparently. It is only the biologic that I take that qualifies me for it.

Gladjake profile image
Gladjake in reply to Wobbies

Thanks Wobbies seems a bit daft as we are all immunosuppressed but obviously down to the strength of the meds

wishbone profile image
wishbone in reply to Gladjake

We all react differently to meds and vaccines too.

Wobbies profile image
Wobbies in reply to Gladjake

Yes I agree especially as there seems to be no shortage of vaccines. Better to jab all the immuno-compromised.

madme1 profile image
madme1 in reply to Wobbies

Can't see why Wobbies, I'm on 15mg same as you and I qualify, as in the letter it says if you would become extremely ill. Not if you are on a biologic, which I am. I'm having my 4th booster on 15th.

Yes your GP is right…if you look on a post from Maureen Gibson I think it was ….she posted a list of eligibility a couple of days ago.

I'm eligible because I'm on 20mg Metoject; the hospital pharmacy which supplies it sent me a text. The good thing is that you know that you're not particularly immunocompromised. 😉

Gladjake profile image
Gladjake in reply to Boxerlady

Hi all thanks for your replies it is good to know that I’m not particularly immunocompomised (one if the lucky ones as I know lots of you are ) xx

Yes your GP is right. See box 1 on page 25 for the criteria for a third primary vaccination (i.e. 4 in total) assets.publishing.service.g...

However, it is worth noting that it relates to the medication you were on at the time of your first and second doses not your current medication.

The hydroxchloroquine doesn’t apply. Whilst it's an immunomodulatory med it doesn't suppress your immune system enough. With methotrexate it's 20mg or above. That said I’ve had 3 primary & a booster & I’m on 17.5mg injections. I am on maintenance dose prednisolone however, though I'm not clear if it's length of time or dose which has made the difference. My GP Surgery has arranged all my appointments. That said I received a letter through the post on Monday inviting me for my 4th (booster) dose, a tad late as I had it on 20th December! It would seem your GP is correct I'm afraid.

Do you have access to a Rheumy nurse? If so you could act dumb & see whether she/he thinks you should have it.

As you’re describing it as maintenance dose, it’ll be the length of the pred, I suspect; relevant dosages as per the BRS are 20mg or greater a day (or 0.5mg per kg) for 4 weeks OR any dose for more than 4 weeks alongside any immunosuppressant DMARD or biologic.

Thanks for explaining Charlie, that answers it perfectly. It will be the latter, as it's 9 years for both pred & MTX together, although I’ve been on MTX longer.

bpeal1 profile image
bpeal1 in reply to nomoreheels

The criteria for a third primary dose for those taking steroids is as follows (copied form the Green Book Chapter 14a)

long term moderate dose corticosteroids (equivalent to ≥10mg prednisolone per day for more than 4 weeks) in the 3 months before vaccination and those on ≥7.5mg prednisolone per day in combination with other immunosuppressants (other than hydroxychloroquine or sulfasalazine)

nomoreheels profile image
nomoreheels in reply to bpeal1

Thank you for explaining, helpful to know.

Hi I’ve had my fourth jab and I’m on 15 mg of methotrexate and 2 and half mg of prednisone hope you get sorted

Hi Gladjake, if I were you I would contact your Rheumatology department and ask their advice on this matter. I was sent a letter from my rheumatologist telling me that I should have a 4th jab. I went to the vac centre with the letter showed it to the nurse on checking in(as instructed by my rheumatology dept) and I was given the 4th jab. My meds by the way are Etanacept injection once per week, sulphasalazine and 5mg of prednisolone.

Hoe this helps.


I was told as I'm on a biologic (rituxamab) I am supposed to get 4th.

AgedCrone profile image
AgedCrone in reply to Juliesb

You need to speak to your rheumy nurse……she will tell you how long after your last infusion you need to wait before you go for your fourth jab!

Juliesb profile image
Juliesb in reply to AgedCrone

Yes, I have. Am having mine on Wednesday in time to have my next infusion when it is needed. So far I've done 7 months as it was my first time having it in July and at the moment I'm OK. So now is probably the best time to have the 4th one. Thanks.

AgedCrone profile image
AgedCrone in reply to Juliesb

I’ve been on Rtx very successfully since 2016 & together with my rheumy decided I would prioritise my infusion over the 4th jab.So far…so good!

Hello Gladjake - I've just read Wobbies reply to your question, and that is how it is for me. I have 10mgs of MTX plus a biologic, and it's the biologic that makes me more vulnerable to covid - hence the 4th vaccine. And I had the 4th just yesterday.

Hello - that us I understand it too there was, I think somereference to this on the NRAS website. It is so confusing.

Hello, My GP gave me my 4th Covid shot a week ago. I am on 10 mg of Hydrocortisone which equals 2.5 mags of Prednisone. I have RA along with PMR. I also receive 800 mg of Actemra via infusion every 4 weeks.

How confusing it all is.

I was on MTX which, following nausea was then replaced by mycophenolate. This, I took for several years but they never did get a diagnosis straight even though it was agreed I had an auto-immune condition.

The rheumatologist, however, suggested last summer that I should not be taking such powerful drugs and so she told me to taper the dose to zero last August. There was no replacement and yet, I received a letter from her last week saying it was important I have a 4th dose

Hello, Gladjake. The rules have changed (yet again!), and now, if you are on Methotrexate at all, you qualify for a 4th jab. I volunteer at our local GP Vax centre, & was shown the table for qualifying yesterday. I had previously asked for a 4th, & been refused, but the RA Nurse at the hospital has told me I qualify, & has written to my GP. I have to just show proof of Mtx treatment. Fingers crossed, I will have mine at the next clinic on Thursday. Good luck with yours!

Gladjake profile image
Gladjake in reply to MistysMum

Hi misty mum thanks for that info I will speak to go about it I am 75 so I think I am eligible now because of age hope you got yours at clinic

Yes, all done very easily. So glad I contacted the RA Nurse - I would definitely still be waiting & wondering otherwise......Good luck with yours.

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