In a patient who is on oral DMARDs and has received 3 COVID boosters, but recently had COVID-19 infection, is bivalent booster still recommended 3 months later?  

It is an open question whether immunity acquired with natural infection in a patient with 3 prior vaccinations can be boosted further with the bivalent vaccine. There is some evidence that may be the case with the primary series. So as it stands and until we get further data, I prefer that patients ...

I would feel more comfortable with giving the additional booster.