Reassurance on flare risk with COVID-19 vaccination
medwireNews: Disease flares are uncommon in people with rheumatic and musculoskeletal diseases (RMDs) following receipt of messenger (m)RNA vaccines against SARS-CoV-2, researchers report.
In their survey-based study, Julie Paik (Johns Hopkins University School of Medicine, Baltimore, Maryland, USA) and colleagues found that among 1377 people with RMDs who received both doses of the Pfizer–BioNTech (BNT162b2) or Moderna (mRNA-1273) vaccine in December 2020–April 2021, 11% reported disease flares requiring treatment following vaccination. Most flares (60%) occurred after the second dose.
The most common RMD in the study population was inflammatory arthritis (47%), followed by systemic lupus erythematosus (20%) and overlap connective tissue disease (20%). Half of the participants were on combination therapy, while conventional DMARDs and biologics were used by 26% and 22%, respectively.
In an analysis of predictors of flare risk following vaccination, the study authors showed that people with prior SARS-CoV-2 infection had a significantly higher flare risk than those without, at an adjusted incidence rate ratio (IRR) of 2.09, which they say “may suggest immunological priming.”
Having a flare in the 6 months prior to the first vaccine dose (IRR=2.36) and use of combination therapy (IRR=1.95) were also significantly associated with an increased flare risk.
“[T]hese factors may be a surrogate for more refractory disease at baseline and thus the relationship with vaccination is unclear,” writes the team in Arthritis & Rheumatology.
Paik and colleagues also evaluated local and systemic reactogenicity following SARS-CoV-2 vaccination, finding that 87% and 86% of respondents experienced injection site pain after dose 1 and dose 2, respectively, and a corresponding 60% and 80% experienced fatigue.
They note that reports of reactions preventing daily activities following vaccination were uncommon; fatigue (19%) and myalgia (11%) were the most frequently reported such reactions, and one participant was admitted to hospital for management of diarrhea following the second dose.
“There were no findings that warranted concern about the safety of SARS-CoV-2 mRNA vaccination in patients with RMD,” summarize the researchers.
They conclude: “These early, reassuring results may ameliorate concern among patients and inform critical discussions regarding vaccine hesitancy or refusal.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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