Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period-a cross-sequential study based on COVAD surveys.
Journal: Rheumatology (Oxford, England)
Volume: 62
Issue: 12
Year of Publication: 2023
Affiliated Institutions:
Seth Gordhandas Sunderdas Medical College and King Edwards Memorial Hospital, Mumbai, Maharashtra, India.
Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
Maulana Azad Medical College, New Delhi, Delhi, India.
National Center for Rheumatic Diseases (NCRD), Ratopul, Kathmandu, Nepal.
Southport and Ormskirk Hospital NHS Trust, Southport, UK.
Centre for Rheumatic Diseases, King's College London, London, UK.
NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK.
Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India.
Mymensingh Medical College, Mymensingh, Bangladesh.
Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.
Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India.
Medical Faculty, Sofia University 'St. Kliment Ohridski', Sofia, Bulgaria.
Department of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Szczecin,Poland.
Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Department of Internal Medicine, General Hospital, National Medical Center, 'La Raza', Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Università degli studi di Pavia, Pavia, Lombardy, Italy.
Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
Medizinische Klinik -Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
Bon Secours Rheumatology Center and Division of Pediatric Rheumatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA.
Bristol Medical School Translational Health Sciences, University of Bristol, Bristol, UK.
Department of Rheumatology, Division of Medicine, Rayne Institute, University College London, London, UK.
Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati, India.
Rheumatology, Medical Care & Research, Centro Medico Pensiones Hospital, Instituto Mexicano del Seguro Social Delegación Yucatán, Yucatán, Mexcio.
Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.
Departamento de Inmunología y Reumatología, Hospital General de Occidente and Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
Rheumatology, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Mexico.
Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla/University of Nigeria, Enugu Campus, Enugu, Nigeria.
Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Medicine, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand.
Department of Rheumatology, Clinic of Rheumatology, University Hospital 'St. Ivan Rilski', Medical University, Sofia, Bulgaria.
Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan.
School of Medicine, Universidade Potiguar (UnP), Natal, Brazil.
Rheumatology Unit, Internal Medicine Department, Specialized Medical Center, Riyadh, Saudi Arabia.
Department of Internal Medicine, Section of Rheumatology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Department of Rheumatology, Enam Medical College & Hospital, Dhaka, Bangladesh.
Rheumatology Unit, Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana.
Reference Center for Osteoporosis, Rheumatology and Dermatology, Pontifica Universidad Javeriana Cali, Colombia.
Department of Medicine, Hospital Universidad del Norte, Barranquilla, Atlantico, Colombia.
Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan.
Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.
Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Departamento de Reumatología Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Mexico City, Mexico.
Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Abstract summary
Flares of autoimmune rheumatic diseases (AIRDs) following COVID-19 vaccination are a particular concern in vaccine-hesitant individuals. Therefore, we investigated the incidence, predictors and patterns of flares following vaccination in individuals living with AIRDs, using global COVID-19 Vaccination in Autoimmune Diseases (COVAD) surveys.The COVAD surveys were used to extract data on flare demographics, comorbidities, COVID-19 history, and vaccination details for patients with AIRDs. Flares following vaccination were identified as patient-reported (a), increased immunosuppression (b), clinical exacerbations (c) and worsening of PROMIS scores (d). We studied flare characteristics and used regression models to differentiate flares among various AIRDs.Of 15 165 total responses, the incidence of flares in 3453 patients with AIRDs was 11.3%, 14.8%, 9.5% and 26.7% by definitions a-d, respectively. There was moderate agreement between patient-reported and immunosuppression-defined flares (K = 0.403, P = 0.022). Arthritis (61.6%) and fatigue (58.8%) were the most commonly reported symptoms. Self-reported flares were associated with higher comorbidities (P = 0.013), mental health disorders (MHDs) (P < 0.001) and autoimmune disease multimorbidity (AIDm) (P < 0.001).In regression analysis, the presence of AIDm [odds ratio (OR) = 1.4; 95% CI: 1.1, 1.7; P = 0.003), or a MHD (OR = 1.7; 95% CI: 1.1, 2.6; P = 0.007), or being a Moderna vaccine recipient (OR = 1.5; 95% CI: 1.09, 2.2; P = 0.014) were predictors of flares. Use of MMF (OR = 0.5; 95% CI: 0.3, 0.8; P = 0.009) and glucocorticoids (OR = 0.6; 95% CI: 0.5, 0.8; P = 0.003) were protective.A higher frequency of patients with AIRDs reported overall active disease post-vaccination compared with before vaccination (OR = 1.3; 95% CI: 1.1, 1.5; P < 0.001).Flares occur in nearly 1 in 10 individuals with AIRDs after COVID vaccination; people with comorbidities (especially AIDm), MHDs and those receiving the Moderna vaccine are particularly vulnerable. Future avenues include exploring flare profiles and optimizing vaccine strategies for this group.
Authors & Co-authors:
Jagtap Kshitij K
Naveen R R
Day Jessica J
Sen Parikshit P
Vaidya Binit B
Nune Arvind A
Nikiphorou Elena E
Tan Ai Lyn AL
Agarwal Vishwesh V
Saha Sreoshy S
Shinjo Samuel Katsuyuki SK
Ziade Nelly N
Joshi Mrudula M
Velikova Tsvetelina T
Milchert Marcin M
Parodis Ioannis I
Edgar Gracia-Ramos Abraham A
Cavagna Lorenzo L
Kuwana Masataka M
Knitza Johannes J
Makol Ashima A
Patel Aarat A
Pauling John D JD
Wincup Chris C
Barman Bhupen B
Zamora Tehozol Erick Adrian EA
Rojas Serrano Jorge J
García-De La Torre Ignacio I
Colunga-Pedraza Iris J IJ
Merayo-Chalico Javier J
Chibuzo Okwara Celestine OC
Katchamart Wanruchada W
Goo Phonpen Akawatcharangura PA
Shumnalieva Russka R
Chen Yi-Ming YM
Hoff Leonardo Santos LS
El Kibbi Lina L
Halabi Hussein H
Sazliyana Shaharir Syahrul S
Hasan A T M Tanveer ATMT
Dey Dzifa D
Gutiérrez Carlos Enrique Toro CET
Caballero-Uribe Carlo Vinicio CV
Lilleker James B JB
Salim Babur B
Gheita Tamer T
Chatterjee Tulika T
Saavedra Miguel A MA
Distler Oliver O
Chinoy Hector H
Agarwal Vikas V
Aggarwal Rohit R
Gupta Latika L
Study Outcome
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