Department of Rheumatology and Immunology, Singapore General Hospital, Academia, Level 4, 20 College Road, Singapore, 169856, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Adv Rheumatol. 2023 Aug 1;63(1):38. doi: 10.1186/s42358-023-00316-0.
To determine prevalence and factors associated with flares post Coronavirus disease 2019 (COVID-19) mRNA vaccination in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthritis (SpA).
A retrospective multi-centre study was conducted (January 2021 to February 2022). Data were collected during index visit, defined as first post-vaccine visit in which the patient had a physician-defined flare, or if at least 3 months had elapsed since first vaccine dose, whichever came first. Factors associated with flares were identified using mixed effects Cox regression and expressed as hazard ratio (HR) and 95% confidence interval (CI).
Total of 2377 patients were included (1563 RA, 415 PsA and 399 SpA). Among patients with RA, PsA and SpA, 21.3%, 24.1% and 21.8% experienced a flare respectively. Of those who experienced a flare, only 10.2%, 11.0% and 14.9% were severe in patients with RA, PsA and SpA respectively. Patients with low or moderate/high disease were more likely to flare compared to those in remission in patients with RA only (HR: 1.68, 95% CI 1.22-2.31; HR: 2.28, 95% CI 1.50-3.48, respectively). Receiving the Moderna vaccine was associated with a higher HR of flare compared to the Pfizer vaccine in patients with PsA only (HR: 2.21, 95% CI 1.20-4.08). Patients who had two vaccine doses were found to be less likely to flare (HR: 0.08, 95% CI 0.06-0.10). HRs of flares were not significantly different among RA, PsA and SpA.
About one-fifth of patients experienced a disease flare post COVID-19 mRNA vaccination, but most flares were non-severe. Patients with active disease prior to vaccination should be monitored closely for disease flares, especially in patients with RA.
确定新冠肺炎（COVID-19）mRNA 疫苗接种后，类风湿关节炎（RA）、银屑病关节炎（PsA）和脊柱关节炎（SpA）患者发生疾病 flares 的患病率和相关因素。
进行了一项回顾性多中心研究（2021 年 1 月至 2022 年 2 月）。在指数就诊时收集数据，定义为患者出现医生定义的 flares 的首次疫苗接种后就诊，或者首次疫苗接种后至少 3 个月，以先发生者为准。使用混合效应 Cox 回归确定与 flares 相关的因素，并表示为风险比（HR）和 95%置信区间（CI）。
共纳入 2377 例患者（1563 例 RA、415 例 PsA 和 399 例 SpA）。在 RA、PsA 和 SpA 患者中，分别有 21.3%、24.1%和 21.8%发生 flares。在发生 flares 的患者中，只有 10.2%、11.0%和 14.9%在 RA、PsA 和 SpA 患者中为严重 flares。与缓解期患者相比，仅 RA 患者中低或中/高疾病活动度患者更有可能发生 flares（HR：1.68，95%CI 1.22-2.31；HR：2.28，95%CI 1.50-3.48）。与 Pfizer 疫苗相比，仅 PsA 患者接受 Moderna 疫苗与更高的 flares HR 相关（HR：2.21，95%CI 1.20-4.08）。接受两剂疫苗的患者发生 flares 的可能性较低（HR：0.08，95%CI 0.06-0.10）。RA、PsA 和 SpA 患者的 flares HR 无显著差异。
约五分之一的患者在 COVID-19 mRNA 疫苗接种后发生疾病 flares，但大多数 flares 为非严重 flares。接种疫苗前处于疾病活动期的患者应密切监测疾病 flares，尤其是在 RA 患者中。
