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- Title
Prevalence and factors associated with flares following COVID-19 mRNA vaccination in patients with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis: a national cohort study.
- Authors
Fong, Warren; Woon, Ting Hui; Chew, Li-Ching; Low, Andrea; Law, Annie; Poh, Yih Jia; Yeo, Siaw Ing; Leung, Ying Ying; Ma, Margaret; Santosa, Amelia; Kong, Kok Ooi; Xu, Chuanhui; Teng, Gim Gee; Mak, Anselm; Tay, Sen Hee; Chuah, Tyng Yu; Roslan, Nur Emillia; Angkodjojo, Stanley; Phang, Kee Fong; Sriranganathan, Melonie
- 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.
- Publication
Advances in Rheumatology, 2023, Vol 63, Issue 1, p1
- ISSN
2523-3106
- Publication type
Article
- DOI
10.1186/s42358-023-00316-0