Both the flare and non-flare groups used medications, such as Benadryl, acetaminophen or NSAIDs, for prevention and treatment of vaccine side effects.
Most systemic rheumatic disease flares were described as moderate to severe and appeared to be typical systemic rheumatic disease flares. Symptoms reported during flares included joint pain, joint swelling, muscle aches and fatigue. Although 27.7% of flares started one day after vaccination, 61.4% began after two to seven days and 10.9% occurred more than seven days post vaccination. Most systemic rheumatic disease flares resolved within seven days of onset, but 26.2% lasted for 8–21 days and 8.9% for more than 21 days.
One thing you can’t tell from this study is whether the patients temporarily discontinued their regular medications prior to vaccination, says Weiwei Chi, MD, an assistant professor of medicine in the division of rheumatology at the Icahn School of Medicine at Mount Sinai, New York.
“We have older studies that say, for example, that methotrexate can affect responses to flu vaccines,” Dr. Chi says. “Some providers recommend holding methotrexate for a few weeks after vaccination to have the best protection.”
Another issue with the study is that they seem to have lumped together several autoimmune diseases, Dr. Chi says. “When you lump everyone together it’s really hard to draw conclusions.”
In the end, this is a risk-benefit calculation, Dr. Chi says. “If you get COVID, it can be devastating and potentially fatal,” she adds. “In a sense, maybe the risk of a flare is worth it, when you’re comparing the long-term consequences of a flare versus a severe case of COVID-19 or long-hauler symptoms.”
“Overall, I think it’s good to have this as a starting point,” Dr. Chi says. “But I wouldn’t take the results to mean that everyone needs to be really careful about vaccinating patients with autoimmune diseases.”
Reference
- Barbhaiya M, Levine JM, Bykerk VP, et al. Systemic rheumatic disease flares after SARS-CoV-2 vaccination among rheumatology outpatients in New York City. Ann Rheum Dis. 2021 Jun 22;annrheumdis-2021-220732. Online ahead of print.
