Flare and change in disease activity among patients with stable rheumatoid arthritis following coronavirus disease 2019 vaccination: a prospective Chinese cohort study

Abstract

Background: Vaccination has been shown effective in controlling the global coronavirus disease 2019 (COVID-19) pandemic and reducing severe cases. This study was to assess the flare and change in disease activity after COVID-19 vaccination in patients with stable rheumatoid arthritis (RA). Methods: A prospective cohort of RA patients in remission or with low disease activity was divided into a vaccination group and a non-vaccination group based on their COVID-19 vaccination status. Each of them was examined every 3 to 6 months. In the vaccination group, disease activity was compared before and after vaccination. The rates of flare defined as disease activity scores based on 28-joint count (DAS28) >3.2 with DDAS28 ≥0.6 were compared between vaccination and non-vaccination groups. Results: A total of 202 eligible RA patients were enrolled. Of these, 98 patients received no vaccine shot (non-vaccination group), and 104 patients received two doses of vaccine (vaccination group). The median time interval from pre-vaccination visit to the first immunization and from the second dose of vaccine to post-vaccination visit was 67 days and 83 days, respectively. The disease activity scores at pre-vaccination and post-vaccination visits in the vaccination group patients were similar. At enrollment, gender, RA disease course, seropositivity, and disease activity were comparable across the two groups. Flare was observed in five (4.8%) of the vaccination group patients and nine (9.2%) of the non-vaccination group patients at post-vaccination assessment (P = 0.221). In terms of safety, 29 (27.9%) patients experienced adverse events (AEs) after vaccination. No serious AEs occurred. Conclusions: COVID-19 vaccinations had no significant effect on disease activity or risk of flare in RA patients in remission or with low disease activity. Patients with stable RA should be encouraged to receive the COVID-19 vaccination.

Immune features revealed by single‐cell RNA and single‐cell TCR/BCR sequencing in patients with rheumatoid arthritis receiving COVID‐19 booster vaccination

“…RA is a systemic disease characterized primarily by autoimmune dysregulation. Although our prior investigations have indicated that the administration of COVID‐19 vaccines did not appear to trigger the disease flare in stable RA patients, 7,8 the effects of vaccine on the complicated immune system are still uncertain, and there are continuous reports of vaccine‐induced new‐onset or flare of RA. scRNA‐seq technique is powerful to allow researchers to study an individual cell and its gene expression patterns, which can provide a comprehensive picture of the immune response to the vaccines.…”

“…6 A couple of previous studies found that RA flare requiring treatment adjustment following COVID-19 vaccination was uncommon. 7,8 Nevertheless, it has been recognized that vaccines themselves as well as adjuvants may potentially provoke autoimmunity by molecular mimicry, and subsequently trigger flare of pre-existing autoimmune diseases. 9 In theory, booster shots may lead to a more pronounced immune response.…”

“…Therefore, vaccination has been recommended for RA patients in all guidelines worldwide 6 . A couple of previous studies found that RA flare requiring treatment adjustment following COVID‐19 vaccination was uncommon 7,8 . Nevertheless, it has been recognized that vaccines themselves as well as adjuvants may potentially provoke autoimmunity by molecular mimicry, and subsequently trigger flare of pre‐existing autoimmune diseases 9 .…”