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Letter
Systemic rheumatic disease flares after SARS-CoV-2 vaccination among rheumatology outpatients in New York City
  1. Medha Barbhaiya1,2,
  2. Jonah M. Levine3,
  3. Vivian P. Bykerk1,4,
  4. Deanna Jannat-Khah1,4,
  5. Lisa A. Mandl1,2
  1. 1 Division of Rheumatology, Hospital for Special Surgery, New York, New York, USA
  2. 2 Department of Medicine and Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
  3. 3 Hospital for Special Surgery, New York, New York, USA
  4. 4 Department of Medicine, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Dr Medha Barbhaiya, Division of Rheumatology, Hospital for Special Surgery, New York, NY 10021-4898, USA; barbhaiyam{at}hss.edu

https://doi.org/10.1136/annrheumdis-2021-220732

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    Vaccination against SARS-CoV-2 is crucial for patients with systemic rheumatic diseases (SRDs), who may be at increased risk of severe outcomes post-COVID-19.1 However, as patients with SRDs were not included in the mRNA vaccine trials (ie, Pfizer/BioNTech (BNT162b2) and Moderna (mRNA-1273)), no data exist regarding whether these vaccines might trigger SRD flares. Sparse data suggest that other vaccines may be associated with SRD flares,2 3 possibly from molecular mimicry triggering immune activation or non-specific adjuvant effects. As SRD flares are associated with disease deterioration, increased flares could have serious clinical implications.4

    We report the interim results of a web-based survey evaluating SRD flare incidence post-SARS-CoV-2 vaccine. The survey was e-mailed 5 March 2021 to 3545 outpatients with SRDs seen at a large rheumatology division in New York City. ICD-10 algorithms were used to identify SRDs (online supplemental material). A self-reported disease flare was defined as ‘a sudden worsening of your rheumatology condition or arthritis’ within 2 weeks of the vaccine.

    Supplemental material

    [annrheumdis-2021-220732supp001.pdf]

    As of 12 April 2021, out of 1483 respondents (41.8% response rate), 1101 patients (74.2%) with SRDs reported receiving at least one dose of a SARS-CoV-2 vaccine and provided flare data (mean age: 60.8 years (14.2 years); 80.6% female; …

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors All authors have made substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data; were involved in drafting the work or revising it critically for important intellectual content; provided final approval of the version published; and were in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding MB is currently supported by the Rheumatology Research Foundation Investigator Award and the Barbara Volcker Centre for Women and Rheumatic Diseases at Hospital for Special Surgery. LAM received grant support from Regeneron Pharmaceuticals, and is an associate editor at Annals of Internal Medicine.

    • Disclaimer The funders had no role in study design, data collection, analysis, decision to publish or preparation of the manuscript.

    • Competing interests MB is currently supported by the Rheumatology Research Foundation Investigator Award and the Barbara Volcker Center for Women and Rheumatic Diseases at Hospital for Special Surgery. LAM received grant support from Regeneron Pharmaceuticals, and is an associate editor at Annals of Internal Medicine. The funders had no role in study design, data collection, analysis, decision to publish or preparation of the manuscript.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.