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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.
- COVID-19
- arthritis
- rheumatoid
- epidemiology
- vaccination
- outcome assessment
- health care
Data availability statement
No data are available. Data will not be available for others as the data custodians have not given permission.
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Data availability statement
No data are available. Data will not be available for others as the data custodians have not given permission.
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Footnotes
XL and XT are joint first authors.
Handling editor Josef S Smolen
Twitter @CarlosWongHKU
Contributors Study concept and design: XL, ICKW. Data extractions, cleaning and analysis: XT. Data validation and cross-check: PK. Data interpretation: All authors. Drafting of the manuscript: XL, XT, SHHY. Critical revision of the manuscript of significant intellectual contribution: All authors. Study supervision: ICKW. Guarantor: ICKW.
Funding Research Grant from the Food and Health Bureau, the Government of the Hong Kong Special Administrative Region (Ref. No. COVID19F01).
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.
Provenance and peer review Not commissioned; externally peer reviewed.
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