Baseline factors associated with self-reported disease flares following COVID-19 vaccination among adults with systemic rheumatic disease: results from the COVID-19 global rheumatology alliance vaccine survey
Authors: Rider Lisa G , Parks Christine G , Wilkerson Jesse , Schiffenbauer Adam I , Kwok Richard K , Noroozi Farhadi Payam , Nazir Sarvar , Ritter Rebecca , Sirotich Emily , Kennedy Kevin , Larche Maggie J , Levine Mitchell , Sattui Sebastian E , Liew Jean W , Harrison Carly O , Moni Tarin T , Miller Aubrey K , Putman Michael , Hausmann Jonathan , Simard Julia F , Sparks Jeffrey A , Miller Frederick W ,   the COVID-19 Global Rheumatology Alliance Vaccine Survey Group, Akpabio Akpabio A , Alpizar-Rodriguez Deshire , Berenbaum Francis , Bulina Inita , Conway Richard , Singh Aman Dev , Duff Eimear , Durrant Karen , Gheita Tamer A , Hill Catherine L , Howard Richard , Hoyer Bimba F , Hsieh Evelyn , el Kibbi Lina , Kilian Adam , Kim Alfred H J , Liew David , Lo Chieh , Miller Bruce , Mingolla Serena , Nudel Michal , Palmerlee Candace A , Singh Jasvinder A , Singh Namrata , Ugarte-Gil Manuel F , Wallace John , Young Kristen J , Bhana Suleman , Costello Wendy , Grainger Rebecca , Machado Pedro M , Robinson Philip C , Sufka Paul , Wallace Zachary S , Yazdany Jinoos , Foster Gary , Thabane Lehana , Angevare Saskya , Beesley Richard P , Chock Eugenia , Degirmenci Berk , Felix Christele , Jin Shangyi , Mateus Elsa , Peirce Andrea , Sari Esra , Tseng Robert , Wang Leslie , Zamora Erick Adrian 
Published: April 2022

Abstract

Objective
To examine the frequency of, and risk factors for, disease flare following COVID-19 vaccination in patients with systemic rheumatic disease (SRD).

Methods
An international study was conducted from 2 April to 16 August 2021, using an online survey of 5619 adults with SRD for adverse events following COVID-19 vaccination, including flares of disease requiring a change in treatment. We examined risk factors identified a priori based on published associations with SRD activity and SARS-CoV-2 severity, including demographics, SRD type, comorbidities, vaccine type, cessation of immunosuppressive medications around vaccination and history of reactions to non-COVID-19 vaccines, using multivariable logistic regression.

Results
Flares requiring a change in treatment following COVID-19 vaccination were reported by 4.9% of patients. Compared with rheumatoid arthritis, certain SRD, including systemic lupus erythematosus (OR 1.51, 95% CI 1.03, 2.20), psoriatic arthritis (OR 1.95, 95% CI 1.20, 3.18) and polymyalgia rheumatica (OR 1.94, 95% CI 1.08, 2.48) were associated with higher odds of flare, while idiopathic inflammatory myopathies were associated with lower odds for flare (OR 0.54, 95% CI 0.31–0.96). The Oxford-AstraZeneca vaccine was associated with higher odds of flare relative to the Pfizer-BioNTech vaccine (OR 1.44, 95% CI 1.07, 1.95), as were a prior reaction to a non-COVID-19 vaccine (OR 2.50, 95% CI 1.76, 3.54) and female sex (OR 2.71, 95% CI 1.55, 4.72).

Conclusion
SRD flares requiring changes in treatment following COVID-19 vaccination were uncommon in this large international study. Several potential risk factors, as well as differences by disease type, warrant further examination in prospective cohorts.