Advances in Rheumatology (Aug 2023)

Prevalence and factors associated with flares following COVID-19 mRNA vaccination in patients with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis: a national cohort study

  • Warren Fong,
  • Ting Hui Woon,
  • Li-Ching Chew,
  • Andrea Low,
  • Annie Law,
  • Yih Jia Poh,
  • Siaw Ing Yeo,
  • Ying Ying Leung,
  • Margaret Ma,
  • Amelia Santosa,
  • Kok Ooi Kong,
  • Chuanhui Xu,
  • Gim Gee Teng,
  • Anselm Mak,
  • Sen Hee Tay,
  • Tyng Yu Chuah,
  • Nur Emillia Roslan,
  • Stanley Angkodjojo,
  • Kee Fong Phang,
  • Melonie Sriranganathan,
  • Teck Choon Tan,
  • Peter Cheung,
  • Manjari Lahiri

DOI
https://doi.org/10.1186/s42358-023-00316-0
Journal volume & issue
Vol. 63, no. 1
pp. 1 – 9

Abstract

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Abstract Objective To determine prevalence and factors associated with flares post Coronavirus disease 2019 (COVID-19) mRNA vaccination in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthritis (SpA). Methods A retrospective multi-centre study was conducted (January 2021 to February 2022). Data were collected during index visit, defined as first post-vaccine visit in which the patient had a physician-defined flare, or if at least 3 months had elapsed since first vaccine dose, whichever came first. Factors associated with flares were identified using mixed effects Cox regression and expressed as hazard ratio (HR) and 95% confidence interval (CI). Results Total of 2377 patients were included (1563 RA, 415 PsA and 399 SpA). Among patients with RA, PsA and SpA, 21.3%, 24.1% and 21.8% experienced a flare respectively. Of those who experienced a flare, only 10.2%, 11.0% and 14.9% were severe in patients with RA, PsA and SpA respectively. Patients with low or moderate/high disease were more likely to flare compared to those in remission in patients with RA only (HR: 1.68, 95% CI 1.22–2.31; HR: 2.28, 95% CI 1.50–3.48, respectively). Receiving the Moderna vaccine was associated with a higher HR of flare compared to the Pfizer vaccine in patients with PsA only (HR: 2.21, 95% CI 1.20–4.08). Patients who had two vaccine doses were found to be less likely to flare (HR: 0.08, 95% CI 0.06–0.10). HRs of flares were not significantly different among RA, PsA and SpA. Conclusion About one-fifth of patients experienced a disease flare post COVID-19 mRNA vaccination, but most flares were non-severe. Patients with active disease prior to vaccination should be monitored closely for disease flares, especially in patients with RA.

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