Among adults with rheumatic diseases including spondyloarthritis, who received COVID-19 vaccines, the side effects reported by patients were typical of those reported by the general population, according to the results of the international COVID-19 Global Rheumatology Alliance (C19-GRA) Vaccine Survey.
Among 2,860 survey respondents, the most common side effects reported after vaccination were fatigue (33.4%), headache (27.7%), widespread muscle or joint pains (22.8%), and fever or chills (19.9%). Only 4.6% of those who took part in the survey reported a post-vaccine rheumatic disease flare that required medication changes.1
The findings may be welcome news for those with rheumatic diseases, who were largely excluded from the vaccines’ initial clinical trials. Many with spondyloarthritis (SpA) have had specific questions about how the vaccines might interact with their disease, or the medications used to treat it, which were not addressed in general safety reports released to the public. The lack of data about the effects of the vaccines on those with rheumatic diseases have led many to remain uncertain about getting vaccinated.
“People have been concerned: Will they have worse side effects? Will their disease flare?” said Jean Liew, MD, a co-author of the study, published in RMD Open (Rheumatic & Musculoskeletal Diseases). “It’s reassuring that the common side effects we know most people get were the same in this population. The frequency, or how common the side effects were after the vaccine, also looks very comparable to what’s seen in the general population. There wasn’t a difference if you have SpA.”
Rheumatoid arthritis was the most common rheumatic disease reported among survey participants (1,209, 42.3%), followed by inflammatory myositis (487, 17.0%), Sjögren’s syndrome (438, 15.3%), systemic lupus erythematosus (391, 13.7%), spondyloarthritis excluding psoriatic arthritis (256, 9.0%), and psoriatic arthritis (206, 7.2%). (In other words, 16.2% of the study population had a form of SpA.) The use of NSAIDs (nonsteroidal anti-inflammatory drugs) was reported by 740 participants (25.9%), and TNF inhibitors were the most commonly used biologic medication, taken by 493 participants (17.2% of the total).1
The types of vaccines participants received were Pfizer-BioNTech (53.2%), Oxford/AstraZeneca (22.6%), Moderna (21.3%), Janssen/Johnson & Johnson (1.7%) and others (1.2%).
Rheumatic disease flares, lasting at least two days after getting a vaccine, were reported by 382 (13.4%) of participants, with 132 (4.6%) requiring a new or increased dose of medication to treat the flare. The frequency of side effects and disease flares were similar across vaccine types.
It wasn’t clear if all reported flares were due to increased rheumatic disease activity, or if they were instead common vaccine side effects that mimicked a flare.
“In that 13.4%, it’s hard to tell if it’s a flare of underlying disease, or part of the vaccine side effects,” said Liew. “Vaccine reactions can also cause joint pain, so it’s hard to know exactly what was happening in all of those individuals. But less than 5% had a flare that required them to change their medication in some way.”
It’s unclear how much the demographics of the survey population influenced the outcomes, she added. Survey respondents were largely female (86.7%), white (86.3%), and with a mean age of 55.3 – so selection bias might have been a factor. “There’s a possibility that if the population was more in line with SpA, with more males in the population, we may have seen different results. But I don’t know in what direction the number might have changed,” she said.
The COVID-19 Global Rheumatology Alliance Vaccine Survey is the largest international survey of vaccine outcomes among people with systemic rheumatic diseases. Almost all participants who discussed vaccination with a healthcare provider were recommended to get a vaccine.1, 2
While the survey results showed rheumatic flares to be infrequent after vaccination, individual concerns should still be discussed with your doctor, Liew said.
“If you do get a SpA flare after the vaccine, that’s something we can treat. The ACR’s guidance to get vaccinated is universal, from a rheumatology standpoint. Research has demonstrated that neither SpA medications, nor SpA itself, are reasons to avoid getting a COVID-19 vaccine.”
- Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey | RMD Open (bmj.com)
- ACR Releases Updated COVID-19 Vaccine Clinical Guidance Including Timing 3rd Doses with Immunomodulatory Drugs (rheumatology.org)
Spondylitis Association of America