Patients with rheumatic disease may experience flares after
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Among a group of New York patients with rheumatic diseases who received a SARS-CoV-2 vaccine, nearly one in six experienced disease flares after getting their shots, a new study finds.

A survey of more than 1,100 patients who had received at least one vaccine dose revealed that 14.9% experienced flares. Among the 654 who had received both doses of a Pfizer or Moderna vaccine, 113 (17%) flared, with 26 (23%) flaring only after the first dose, 48 (42.5%) flaring only after the second dose, and 37 (32.7%) flaring after both doses, according to the letter in Annals of the Rheumatic Diseases.

“This information is reassuring and can help inform vaccine decision-making for patients with SRDs [systemic rheumatic diseases],” the researchers, led by Dr. Medha Barbhaiya of the division of rheumatology at the Hospital for Special Surgery in New York, wrote in their report. “Although we did not collect laboratory studies, most SRD flares were described as ‘typical,’ suggesting these symptoms are not vaccine’s adverse effects being misreported as disease flares.”

“However,” the authors noted, “when patients did flare, the majority of flares were reported as moderate to severe, with some lasting more than 3 weeks. Therefore, it will be important to follow these patients prospectively, as well as to perform analyses which incorporate potential confounders to identify predictors of SRD flares post vaccination.”

The authors did not respond to requests for comment. To explore whether the SARS-CoV02 vaccines might trigger flares, Dr. Barbhaiya and colleagues emailed a survey on March 5, 2021 to 3,545 outpatients with systemic rheumatic disease. As of April 12, 2021, 1,483 patients responded, with 1,101 (74.2%) saying they had received at least one dose of a COVID-19 vaccine and reporting whether they had experienced flares. Just 16 (1.5%) had received the Johnson & Johnson vaccine and 3 (0.3%) received the AstraZeneca vaccine. The rest had received either the Pfizer (54.2%) or Moderna (43.9%) vaccines. Among patients receiving either Pfizer or Moderna vaccines, 654 (59.4%) had received both doses.