Adults with lupus, rheumatoid arthritis and other autoimmune rheumatic conditions who got a booster or the 2023-2024 updated COVID-19 shot were far less likely to end up in the hospital when they caught COVID than people who never got vaccinated, according to a study of 60,980 US patients published September 9 in Arthritis & Rheumatology, a journal of the American College of Rheumatology.
The practical version: if you have one of these conditions and the last COVID shot you got was the original two-dose series years ago, this is a reason to bring the updated shot up with your rheumatologist this fall. It is not a reason to change any of your other medications, and it does not tell you which shot or what timing fits your situation. That part still belongs with the doctor who manages your immune suppression.
Key takeaways
- Compared with no vaccination, the updated 2023-2024 shot was tied to about 69% lower odds of COVID hospitalization, and a booster to about 71% lower odds.
- Stopping after the original series left a 5.6 percentage point gap in hospitalization risk versus getting a booster or updated shot, which works out to roughly 18 people needing the newer shot to keep one person out of the hospital.
- Only 10% of the patients studied had received an updated shot at all.
What the study found
The team, led by researchers at the University of Alabama at Birmingham, pulled records from the National Clinical Cohort Collaborative on adults with autoimmune rheumatic conditions who caught COVID-19 between December 2020 and August 2024. The median age was 62, and 76% were female.
Hospitalization risk dropped step by step with each level of vaccination. Compared with people who got no doses, the original series was linked to about 41% lower odds of COVID hospitalization (adjusted odds ratio 0.59), very likely somewhere between 37% and 44% lower. A booster was linked to about 71% lower odds (0.29), very likely between 69% and 73% lower. The updated 2023-2024 shot was linked to about 69% lower odds (0.31), very likely between 66% and 72% lower.
Those are relative numbers, and relative numbers always sound bigger than they are. The absolute figure is the useful one: among patients who had only the original series compared with those who got a booster or updated shot, the absolute risk reduction was 5.6%.
Dr. Kumar’s take
That 5.6% is the number worth carrying around. Flip it over and you get a number needed to treat of about 18: roughly 18 people with lupus, rheumatoid arthritis or vasculitis would need the newer shot to keep one of them out of the hospital. For a vaccine, that is a strong return. Plenty of widely used preventive drugs sit in the hundreds.
The honest weakness is that this is observational, not a randomized trial. People who show up for a fourth or fifth COVID shot tend to be people who show up for everything else too: they refill prescriptions, they keep appointments, they have transportation and insurance. That pattern is called healthy-vaccinee bias, and it inflates every estimate of this kind. The researchers adjusted for demographics, clinical risk, social vulnerability and medications, which helps, but adjustment cannot fully remove a difference in how carefully people manage their own health.
Even with that discount applied, the size and direction here are hard to argue with. People on drugs that suppress the immune system mount a weaker antibody response and lose it faster, which is exactly the group for whom a more recent, better-matched dose should matter most.
The uptake figure is the real story buried in this paper. Only 6,336 of 60,980 patients, about 10%, had received an updated shot. That is a medically vulnerable population, and nine in ten of them were running on older immunity. Access for immunosuppressed patients has gotten more confusing, not less, and many people in this group now have to ask for the shot rather than be offered it.
Vaccines keep turning up second-order benefits in older adults, from the high-dose flu shot and Alzheimer’s risk to the shingles vaccine and dementia. This one is simpler. It is the direct effect, in the people who need it most.
What it means for you
If you have an autoimmune rheumatic condition and you are still on the original series, raise the updated shot at your next rheumatology visit rather than waiting to be asked. Bring your current medication list, since some immune-suppressing drugs affect the timing of a dose.
If you are not in this group, this study does not say anything about you. It looked only at people with autoimmune rheumatic conditions, and a benefit found in a high-risk group does not transfer to a low-risk one. And if you already got a booster or an updated dose, there is nothing here to act on.