The impact of SARS-CoV-2 infection and vaccination on inflammatory arthritis: a cohort study

Abstract

ObjectivesTo investigate the effects of SARS-CoV-2 infection, as well as short- (within 48 hours) and long-term (within 30 days) adverse events (AEs) of SARS-CoV-2 vaccines, including arthritis flares in a large cohort of patients with inflammatory arthritis (IA).MethodsA retrospective cohort study comprising 362 patients: 94 (26%) rheumatoid arthritis, 158 (43.6%) psoriatic arthritis and 110 (30.4%) ankylosing spondylitis; and 165 healthy controls (HC) to ascertain the prevalence and severity of SARS-CoV-2 infection in patients with IA, the rate of AEs associated with SARS-CoV-2 vaccines and disease flares within a month of the vaccination. All patients provided informed consent and data about SARS-CoV-2 infection and/or vaccination status.ResultsOne-hundred-seventeen (32.3%) patients and 39 (23.6%) HC were affected by SARS-CoV-2 infection. Forty (34.2%) patients experienced an IA flare within one month of infection, of whom 3 (7.5%) needed to switch therapy. The prevalence of SARS-CoV-2 infection, disease severity, and hospitalization rate were not significantly different. At least one shot of SARS-CoV-2 vaccine was administered in 331 (91.4%) patients and 147 (89.1%) HC. Within 48 hours, 102 (30.8%) patients developed vaccine-related AEs; 52 (15.7%) patients with >1 vaccine dose experienced an IA flare-up, of whom 12 (23.1%) needed to switch therapy.ConclusionsA significantly higher rate of IA flare was observed among patients who contracted SARS-CoV-2 infection vs. those without infection. Patients with IA experienced flares after SARS-CoV-2 vaccination, though it was not statistically significant.

Effectiveness and Safety of the COVID-19 Vaccine in Patients With Rheumatoid Arthritis in a Real-World Setting

“…The rate of RA flares in our patients was very low, probably because most were in remission or low activity, in agreement with studies that found an association between flares after vaccination and the disease activity [54,60]. Other authors have also found that COVID-19 vaccines were associated with 4.4%-15.7% of RA flares, and although many of them were mild and self-limiting, in other cases they were moderate-severe and required to make changes to the background treatment in 1.5-30% of cases [51,54,[58][59][60][61][62]. We also found that RA flares were inversely related to age, in line with the study of Ma et al [60].…”

Effectiveness and Safety of the COVID-19 Vaccine in Patients with Rheumatoid Arthritis in a Real-World Setting

“…Other authors have reported higher rates of RA flares (4.4–15.7%) that were mainly mild and self-limiting. However, some cases were moderate–severe and required changes in the background treatment (1.5–30%) [ 54 , 57 , 61 , 62 , 63 , 64 , 65 ]. We also found that RA flares were inversely related to age, in line with the study by Ma et al [ 63 ].…”