Severe flares of rheumatic, musculoskeletal disease rare after COVID-19 vaccination

Reuters Health - 06/09/2021 - In patients with rheumatic and musculoskeletal diseases, vaccination against COVID-19 does not seem to increase the risk of severe flares, according to new findings.

"For patients, we believe that these findings should allay any fears of potential severe flares of their underlying autoimmune disease post vaccination," Dr. Julie Paik of Johns Hopkins University School of Medicine in Baltimore, Maryland, told Reuters Health by email.

At the onset of the pandemic, there were concerns that patients with rheumatic diseases who were on immunosuppressive medicine might be at higher risk of poor COVID-19-related outcomes, explained Dr. Joann Zell, assistant professor of rheumatology at the University of Colorado School of Medicine, in Denver, in an email to Reuters Health.

While real-world data suggested this wasn't the case, some researchers also worried vaccination could pose a risk to patients with autoimmunity disorders by "activating" their immune system, said Dr. Zell, who wasn't involved in the new study.

To test this hypothesis, a team of researchers led by Dr. Paik evaluated disease flare and reactogenicity in 1,377 patients with rheumatic and musculoskeletal diseases who had received two doses of a COVID-19 mRNA vaccine.

Using questionnaires, patients reported local and systemic reactions that occurred within a seven-day period from each vaccine dose. Patients also answered questions regarding flares of their disease that occurred one month following the second dose.

The median age of the patients was 47 years, the majority were women (92%) and only 10% were non-white. Common diagnoses in the overall population were inflammatory arthritis (47%), systemic lupus erythematosus (20%), and overlap connective tissue disease (20%).

While 11% of patients reported a flare that required treatment after COVID-19 vaccination, none of the patients reported severe flares. The majority of flares occurred after the second dose (60%), the researchers report in Arthritis and Rheumatology.

Flares were significantly associated with prior SARS-CoV-2 infection (incidence rate ratio, 2.09; P=0.02), flare in the six months prior to vaccination (IRR, 2.36; P<0.001) and use of combination immunomodulatory treatment (IRR, 1.95; P<0.001).

Despite these findings, there are lingering questions regarding the implications of vaccination against COVID-19 in this population, Dr. Paik said.

"We still do not know the details of the long-term immunity afforded by vaccination in our patient population, and this requires further study," she noted.

SOURCE: https://bit.ly/3t3i9jF Arthritis and Rheumatology, online August 4, 2021.

By Brandon May



Posted on 6 September 202113 September 2021