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Common vaccinations among adults do not increase the risk of developing rheumatoid arthritis: results from the Swedish EIRA study
  1. Camilla Bengtsson1,
  2. Meliha C Kapetanovic2,
  3. Henrik Källberg1,
  4. Berit Sverdrup1,
  5. Birgitta Nordmark3,
  6. Lars Klareskog3,
  7. Lars Alfredsson1,
  8. EIRA Study Group
  1. 1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  2. 2Institute for Clinical Sciences, Department of Rheumatology, Lund University, Lund, Sweden
  3. 3Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
  1. Correspondence to Camilla Bengtsson, Institute of Environmental Medicine, Karolinska Institutet, Box 210, S-171 77 Stockholm, Sweden; camilla.bengtsson{at}


Objective To investigate the association between vaccinations in adults and the risk of developing rheumatoid arthritis (RA).

Methods Data from the Swedish population-based Epidemiological Investigation of RA case-control study encompassing 1998 incident cases of RA aged 18–70 years and 2252 randomly selected controls matched for age, sex and residency were analysed. Those vaccinated within 5 years before disease onset were compared with those not vaccinated by calculating OR with 95% CI.

Results Vaccinations neither increased the risk of RA overall (OR 1.0, 95% CI 0.9 to 1.1) nor the risk of two major subgroups of RA (antibodies to citrullinated peptide-positive (ACPA-positive) and ACPA-negative disease). Furthermore, vaccinations did not increase the risk of RA in smokers or carriers of HLA-DRB1 shared epitope alleles, two groups with established risk factors for RA.

Conclusions In this case-control study of incident cases of newly diagnosed RA, no increased risk of RA following immunisation was observed for vaccinations overall or for any specific vaccination. This indicates that immunological provocation of adults with commonly used vaccines in their present form carries no risk of RA. These findings should be implemented among public healthcare providers in order to encourage vaccinations according to recommended national vaccination schedules.

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  • Funding The study was supported by grants from the Swedish Medical Research Council; from the Swedish Council for Working Life and Social Research; from King Gustaf V's 80-year foundation; from the Swedish Rheumatism Foundation; from Stockholm County Council and from the insurance company AFA.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of Regionala etikprövningsnämnden (EPN), Stockholm, Sweden.

  • Provenance and peer review Not commissioned; externally peer reviewed.