Vaccine and flare characteristics in outpatients with systemic rheumatic diseases, stratified by flare status post-COVID-19 vaccination
| First dose vaccine N=1101 | Second dose vaccine* N=626 | |||
| Flare N=117 (10.4%) | No Flare N=984 (87.5%) | Flare N=85 (13.6%) | No Flare N=541 (86.4%) | |
| Vaccine manufacturer, N% | ||||
| Pfizer | 67 (57.3%) | 530 (53.9%) | 35 (41.2%) | 285 (52.7%) |
| Moderna | 47 (40.2%) | 436 (44.3%) | 50 (58.8%) | 256 (47.3%) |
| Janssen | 3 (2.6%) | 13 (1.3%) | N/A | N/A |
| AstraZeneca | 0 (0%) | 3 (0.3%) | 0 (0%) | 0 (0%) |
| Other† | 0 | 1 (0.1%) | 0 | 0 |
| Missing | 0 | 1 (0.1%) | 0 | 0 |
| Medications taken for prevention of COVID-19 vaccine side effects (prior to vaccine) (N, %)‡ | ||||
| No medications | 104 (88.9%) | 911 (92.6%) | 73 (85.9%) | 502 (92.8%) |
| Benadryl | 7 (6.0%) | 20 (2.0%) | 2 (2.4%) | 13 (2.4%) |
| Corticosteroids | 2 (1.7%) | 7 (0.7%) | 3 (3.5%) | 4 (0.7%) |
| Acetaminophen | 4 (3.4%) | 29 (3.0%) | 7 (8.2%) | 24 (4.4%) |
| NSAIDs/CoX-2 inhibitors | 4 (3.4%) | 22 (2.2%) | 1 (1.2%) | 11 (2.0%) |
| Medications taken for treatment of COVID-19 vaccine side effects (after vaccine) (N, %)‡ | ||||
| No medications | 64 (54.7%) | 748 (76.0%) | 26 (30.6%) | 310 (57.3%) |
| EpiPen | 1 (0.9%) | 0 (0%) | 0 (0%) | 0 (0%) |
| Benadryl | 7 (6.0%) | 10 (1.0%) | 4 (4.7%) | 13 (2.4%) |
| Corticosteroids | 6 (5.1%) | 3 (0.3%) | 4 (4.7%) | 5 (0.9%) |
| Acetaminophen | 29 (24.8%) | 152 (15.5%) | 36 (42.4%) | 166 (30.7%) |
| NSAIDs/CoX-2 inhibitors | 25 (21.4%) | 82 (8.3%) | 31 (36.5%) | 76 (14.1%) |
| Flare severity (N, %) | ||||
| Mild | 50 (42.7%) | 32 (37.7%) | ||
| Moderate | 49 (41.9%) | 44 (51.8%) | ||
| Severe | 18 (15.4%) | 9 (10.6%) | ||
| Flare described as ‘typical’ (N, %) | ||||
| Yes | 83 (70.9%) | 58 (68.2%) | ||
| No | 18 (15.4%) | 16 (18.8%) | ||
| Not sure | 16 (13.7%) | 11 (12.9%) | ||
| Flare symptoms (N, %)‡ | ||||
| Fever | 6 (5.1%) | 9 (10.6%) | ||
| Joint pain | 98 (83.8%) | 74 (87.1%) | ||
| Joint swelling | 56 (47.9%) | 38 (44.7%) | ||
| Skin rash | 14 (12.0%) | 10 (11.8%) | ||
| Fatigue | 62 (53.0%) | 57 (67.1%) | ||
| Muscle aches | 57 (48.7%) | 48 (56.5%) | ||
| Other§ | 16 (13.7%) | 11 (12.9%) | ||
| Number of days after vaccine when flare started (N, %) | ||||
| 1 day | 30 (25.6%) | 26 (30.6%) | ||
| 2–3 days | 39 (33.3%) | 26 (30.6%) | ||
| 4–7 days | 35 (29.9%) | 24 (28.2%) | ||
| >7 days | 13 (11.1%) | 9 (10.6%) | ||
| Length of flare (N, %) | ||||
| 1 day | 7 (6.0%) | 2 (2.4%) | ||
| 2–4 days | 23 (19.7%) | 40 (47.1%) | ||
| 5–7 days | 41 (35.0%) | 16 (18.8%) | ||
| 8–21 days | 28 (23.9%) | 25 (29.4%) | ||
| >21 days | 18 (15.4%) | 0 (0%) | ||
| Missing | 0 | 2 (2.4%) | ||
Flare defined as self-reported ‘sudden worsening of rheumatology condition or arthritis’ within 2 weeks of COVID-19 vaccination.
*654 patients reported receiving 2/2 vaccine doses, but 28 of these patients did not respond to second dose flare questions.
†One participant reported receiving Sinovac vaccine from China.
‡Rows not mutually exclusive.
§Other flare symptoms indicated by patients at first COVID-19 vaccine dose: paresthesias, swelling in face or feet, ‘brain fog’, muscle spasms, psoriasis rash, migraines. Other symptoms at second vaccine dose: paresthesias, swelling in face or feet, and muscle spasms.
CoX-2, cyclooxygenase-2; NSAIDs, nonsteroidal anti-inflammtory drugs.