RMD Flares Uncommon After 2-Dose COVID-19 Vaccination

Among patients with rheumatic and musculoskeletal diseases (RMDs), disease flares after 2-dose messenger RNA (mRNA) vaccination were uncommon, and postvaccination reactions did not usually interfere with daily activity. Researchers from Johns Hopkins University published the findings in Arthritis & Rheumatology.

“We previously reported that local and systemic reactions following dose 1 were typically mild, but there is a paucity of data on reactions or flares following dose 2,” researchers wrote. “Thus, we sought to evaluate disease flare and reactogenicity in RMD patients following two-dose SARS–CoV-2 mRNA vaccination.”

The study included a total 1377 patients with RMDs who received two-dose SARS-CoV-2 mRNA vaccination between December 16, 2020, and April 15, 2021. Participants responded to questions about any local and systemic reactions within 7 days of each dose and about disease flares 1 month after the second dose.

Some 11% of patients reported disease flares requiring treatment after vaccination, the majority of which occurred following the second dose. No participants reported serious flares requiring intravenous therapy or hospital admission, the study found.

Flares were linked with prior SARS–CoV-2 infection (researchers reported a 2.09 incidence rate ratio), flares in the 6 months before vaccination (2.36 incidence rate ratio), and combination immunomodulatory therapy (1.95 incidence rate ratio).

Postvaccine reactions were common but did not typically interfere with daily activity, according to the study. The most frequent reactions were injection site pain (reported by 87% of patients after dose 1, and 86% after dose 2) and fatigue (60% after dose 1, and 80% after dose 2). Systemic reactions in particular increased after dose 2; in addition to fatigue, patients reported headache (65%), myalgia (58%), and chills (42%).

“There were no findings that warranted concern about the safety of SARS–CoV-2 mRNA vaccination in patients with RMD,” researchers concluded. “These early data can continue to address vaccine hesitancy in this patient population.”

—Jolynn Tumolo

Reference

Connolly CM, Ruddy JA, Boyarsky BJ, et al. Disease flare and reactogenicity in patients with rheumatic and musculoskeletal diseases following two-dose SARS-CoV-2 messenger RNA vaccination. Arthritis Rheumatol. 2022;74(1):28-32.