Activity of systemic juvenile idiopathic arthritis in children immunized with pneumococcal 13-valent conjugate vaccine: prospective cohort study
Authors:   National Medical Research Center for Children's Health, Moscow, Russian Federation, Vankova D.D. , Alekseeva E.I. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Dvoryakovskaya T.M. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Denisova R.V. ,   National Medical Research Center for Children's Health, Moscow, Russian Federation, Radygina T.V. ,   National Medical Research Center for Children's Health, Moscow, Russian Federation, Zubkova I.V. ,   National Medical Research Center for Children's Health, Moscow, Russian Federation, Brzhozovskaya E.A. ,   National Medical Research Center for Children's Health, Moscow, Russian Federation, Semikina E.L. ,   National Medical Research Center for Children's Health, Moscow, Russian Federation, Tkachenko N.E. ,   National Medical Research Center for Children's Health, Moscow, Russian Federation, Lomakina O.L. ,   National Medical Research Center for Children's Health, Moscow, Russian Federation, Orlova Ya.O. ,   National Medical Research Center for Children's Health, Moscow, Russian Federation, Kurdup M.K. ,   National Medical Research Center for Children's Health, Moscow, Russian Federation, Galkina О.P. ,   National Medical Research Center for Children's Health, Moscow, Russian Federation,   National Medical Research Center for Children's Health, Moscow, Russian Federation
Published: January 2021

Evaluation of the safety profile of vaccines in patients with rheumatic diseases requires an assessment of their impact on disease activity. The effect of antipneumococcal vaccination on the activity of systemic juvenile idiopathic arthritis (sJIA) has not been studied so far. Objective. To evaluate the dynamics of sJIA activity after immunization with pneumococcal 13-valent conjugate vaccine (PCV13) of patients receiving biologicals. Patients and methods. This study included patients with sJIA in remission or active disease receiving biologicals during inpatient treatment and vaccinated with PCV13. To evaluate the effect of immunization on sJIA activity, we measured serum levels of high-sensitivity C-reactive protein (hs-CRP) and calprotectin. In addition to that, we assessed the number of new cases, when concentration of these markers was above the upper limit (UL) 4 weeks after PCV13 administration. Results. In 18 out of 53 patients in remission (34%) and 3 out of 25 patients with active sJIA (12%), hs-CRP levels were undetectable (0.1 mg/L) at both time-points (baseline and after 4 weeks). Among those with detectable hs-CRP levels in at least one time-point 4 weeks after vaccination, patients in remission (n = 35) had no significant changes in hs-CRP (median -0.17 mg/mL; 95% CI -0.84…0.41), whereas patients with active sJIA (n = 22) demonstrated a 3-fold decrease in hs-CRP level (median -0.94 mg/mL (95% CI -3.93…0.05). We observed no significant difference in calprotectin levels in the groups. Concentration of hs-CRP above the UL 4 weeks after vaccination was detected in 2 out of 53 sJIA patients in remission (4%) and none of the patients with active sJIA. Сoncentration of calprotectin above the UL 4 weeks after vaccination was detected in 8 out 53 (15%) and 5 out 25 (20%) sJIA patients in remission and with active disease, respectively. Conclusion. Vaccination against pneumococcal infection in patients with sJIA led to an increase in the level of highly sensitive laboratory markers of sJIA activity in 4–20% of patients. Key words: disease activity, safety, high-sensitivity C-reactive protein, biological drugs, calprotectin, juvenile idiopathic arthritis, pneumococcal 13-valent conjugate vaccine