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. 2022 Apr;81(4):564-568.
doi: 10.1136/annrheumdis-2021-221571. Epub 2021 Oct 22.

Two-dose COVID-19 vaccination and possible arthritis flare among patients with rheumatoid arthritis in Hong Kong

Xue Li  1   2   3 , Xinning Tong  1 , Winnie Wan Yin Yeung  1 , Peng Kuan  2 , Samson Hin Hei Yum  4 , Celine Sze Ling Chui  3   5   6 , Francisco Tsz Tsun Lai  2   3 , Eric Yuk Fai Wan  2   3   7 , Carlos King Ho Wong  2   3   7 , Esther Wai Yin Chan  2   3   8 , Chak Sing Lau  1 , Ian Chi Kei Wong  9   3   10   11
Affiliations

Two-dose COVID-19 vaccination and possible arthritis flare among patients with rheumatoid arthritis in Hong Kong

Xue Li et al. Ann Rheum Dis. 2022 Apr.

Abstract

Objectives: To investigate the relationship between COVID-19 full vaccination (two completed doses) and possible arthritis flare.

Methods: Patients with rheumatoid arthritis (RA) were identified from population-based electronic medical records with vaccination linkage and categorised into BNT162b2 (mRNA vaccine), CoronaVac (inactive virus vaccine) and non-vaccinated groups. The risk of possible arthritis flare after vaccination was compared using a propensity-weighted cohort study design. We defined possible arthritis flare as hospitalisation and outpatient consultation related to RA or reactive arthritis, based on diagnosis records during the episode. Weekly prescriptions of rheumatic drugs since the launch of COVID-19 vaccination programme were compared to complement the findings from a diagnosis-based analysis.

Results: Among 5493 patients with RA (BNT162b2: 653; CoronaVac: 671; non-vaccinated: 4169), propensity-scored weighted Poisson regression showed no significant association between arthritis flare and COVID-19 vaccination ((BNT162b2: adjusted incidence rate ratio 0.86, 95% Confidence Interval 0.73 to 1.01); CoronaVac: 0.87 (0.74 to 1.02)). The distribution of weekly rheumatic drug prescriptions showed no significant differences among the three groups since the launch of the mass vaccination programme (all p values >0.1 from Kruskal-Wallis test).

Conclusions: Current evidence does not support that full vaccination of mRNA or inactivated virus COVID-19 vaccines is associated with possible arthritis flare.

Keywords: COVID-19; arthritis; epidemiology; health care; outcome assessment; rheumatoid; vaccination.

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Conflict of interest statement

Competing interests: XL received research grants from Research Fund Secretariat of the Food and Health Bureau (HMRF, HKSAR), Research Grants Council Early Career Scheme RGC/ECS, HKSAR, Janssen and Pfizer; internal funding from the University of Hong Kong; consultancy fee from Merck Sharp & Dohme, unrelated to this work. CSLC has received grants from the Food and Health Bureau of the Hong Kong Government, Hong Kong Research Grant Council, Hong Kong Innovation and Technology Commission, Pfizer, IQVIA and Amgen; personal fee from Primevigilance Ltd.; outside the submitted work. FTTL has been supported by the RGC Postdoctoral Fellowship under the Hong Kong Research Grants Council, outside the submitted work. EYFW has received research grants from the Food and Health Bureau of the Government of the Hong Kong SAR, and the Hong Kong Research Grant Council, outside the submitted work. CKHW reports the receipt of General Research Fund, Research Grant Council, Government of Hong Kong SAR; EuroQol Research Foundation, all outside the submitted work. EWYC reports honorarium from Hospital Authority, supports from the Health and Medical Research Fund (HMRF), grants from Research Grants Council (RGC, Hong Kong), grants from National Natural Science Fund of China, grants from Wellcome Trust, grants from Bayer, grants from Bristol-Myers Squibb, grants from Pfizer, grants from Janssen, grants from Amgen, grants from Takeda, grants from Narcotics Division of the Security Bureau of HKSAR, grants from Innovation and Technology Commission of the Government of the HKSAR, all outside the submitted work. ICKW reports research funding outside the submitted work from Amgen, Bristol-Myers Squibb, Pfizer, Janssen, Bayer, GSK Novartis, the Hong Kong RGC, and the Hong Kong Health and Medical Research Fund, National Institute for Health Research in England, European Commission, National Health and Medical Research Council in Australia, and also received speaker fees from Janssen and Medice in the previous 3 years. He is also independent non-executive director of Jacobson Medical in Hong Kong.

Figures

Figure 1
Figure 1
Weekly arthritis-related prescriptions among vaccine recipients and non-vaccinated individuals, between 1 February and 31 July 2021. BTDMARDs, biological or target synthetic disease-modifying antirheumatic drugs; CSDMARDs, conventional synthetic disease-modifying antirheumatic drugs; NSAID, non-steroidal anti-inflammatory drug. Kruskal-Wallis test showed all p values >0.1 for each week comparison, indicating the distribution of arthritis-related prescriptions showed no differences among BNT162b2 recipients, CoronaVac recipients and non-vaccinated individuals.
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