Risk of Exacerbation of Rheumatic Disease after COVID-19 Vaccination

Abstract

Objectives: To investigate the risk of flare-ups after COVID-19 vaccination in patients with rheumatic disease. Methods: A total of 1,617 patients with rheumatic diseases were identified from three rheumatology clinics. Patients were interviewed for demographic data, disease activity, and vaccination status. Disease flare-up was determined clinically by independent rheumatologists. Change of serum markers and medications were retrieved from medical records. The risk of exacerbation of rheumatic disease, change in serum markers, and escalation of rheumatic medications between vaccinated and nonvaccinated patients were determined using Cox, linear, and logistic regression models, respectively. Possible confounding factors were also taken into consideration. Results: Among 562 (34.76%) patients who received COVID-19 vaccination, rheumatic disease (HR = 2.10, [Formula: see text] 0.001), inflammatory arthritis (HR = 2.71, [Formula: see text] 0.001), rheumatoid arthritis (RA) (HR = 2.03, [Formula: see text] = 0.002), spondyloarthritis (SpA) (HR = 4.78, [Formula: see text] 0.001), autoimmune disease (HR = 1.77, [Formula: see text] = 0.01), and systemic lupus erythematosus (SLE) (HR = 1.99, [Formula: see text] = 0.02) were associated with postvaccination clinical flare-up. Adult Still’s disease (B = 12.76, [Formula: see text] = 0.03) was associated with increased serum C-reactive protein (CRP). No association was found between vaccination and escalation of rheumatic medication. Subgroup analyses showed that only the mRNA vaccine was associated with flare-ups. Conclusion: COVID-19 vaccination was associated with minor disease flare-up but not escalation of rheumatic medications. In the absence of absolute contraindications, COVID-19 vaccination is recommended in patients with rheumatic disease.KEY MESSAGES1. Vaccination is effective in the prevention of morbidity due to COVID-19 in patients with autoimmune diseases.2. The mRNA vaccine was associated with mild rheumatic disease flare-up.3. Inactivated virus vaccine is preferable to mRNA vaccine in patients with active autoimmune disease.