Increased risk for flares in patients with autoimmune rheumatic disease after receiving COVID-19 vaccination

According to a recent study published in Rheumatology, more than 10% of patients with autoimmune rheumatic disease experience flares following COVID-19 vaccination. 

Dr. Jagtap and colleagues conducted the COVAD 1 and COVAD 2 surveys to investigate disease flare patterns in immunized autoimmune rheumatic disease patients. COVAD 1 and COVAD 2 were multinational, cross-sectional, patient-reported electronic surveys conducted in 2021 and 2022, respectively. The surveys included 36 questions related to COVID-19 and the patients’ individual autoimmune rheumatic disease states. Demographics, disease type, disease duration, clinical symptoms, and current medications were among the topics covered. The surveys received 3,453 responses from individuals with autoimmune rheumatic diseases, and the researchers found that 11.3% of patient-reported flares occurred. The frequency of flares suggested by prescribed immunosuppression was 14.8%, while the frequency of flares suggested by novel markers was 9.5%. Meanwhile, the frequency of flares based on declining patient-reported outcome measures such as PROMIS scores between surveys was 26.7%. The two most frequently reported symptoms were weariness and arthritis, accounting for 61.6%. Additionally, self-reported flares were associated with more comorbidities, mental health disorders, and autoimmune multimorbidity (P =.013, P < 0.001, and P < 0.002, respectively).

A retrospective cohort study conducted in 2022 examined 2339 patients with autoimmune inflammatory rheumatic diseases to evaluate disease flares within 3 months of receiving the first dose of an anti-SARS-CoV-2 mRNA vaccine. The study revealed a moderately high rate of disease flares following vaccination. The most common autoimmune inflammatory rheumatic diseases diagnosed were rheumatoid arthritis (45%), psoriatic arthritis (12.6%), and systemic lupus erythematosus (12.3%). About 8% of patients were treated with biologics or targeted disease-modifying drugs, while 91% of the patients had minimal disease activity or were in remission. Patients who were older and had active disease at baseline were more likely to experience flares than those with inflammatory arthritis. Interestingly, patients in the oldest age group had a lower risk of flare (hazard ratio [HR] 0.80, p = 0.05). On the other hand, patients with baseline active disease and those with inflammatory arthritis had a higher likelihood of experiencing flares than those with connective tissue disease, vasculitis, and other diseases [HR 1.72, p < 0.001 and 1.82, p < 0.001, respectively].

Following COVID vaccination, flares affect almost one in ten people with AIRDs; those with autoimmune disease multimorbidity, mental health disorders and those receiving the Moderna vaccine are particularly vulnerable. Future research should focus on investigating flare profiles and developing targeted vaccine approaches for this population.


  1. Jagtap K, Naveen R, Day J, Sen P, Vaidya B, Nune A, Nikiphorou E, Tan AL, Agarwal V, Saha S, Shinjo SK. Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period—a cross-sequential study based on COVAD surveys. Rheumatology. 2023 Mar 24:kead144.
  2. Ma M, Santosa A, Kong KO, Xu C, Xiang JT, Teng GG, Mak A, Tay SH, Ng VW, Koh JZ, Fong W. POS0200 Post-mRNA Vaccine Flares in Autoimmune Inflammatory Rheumatic Diseases: Interim results from the coronavirus national vaccine registry for immune diseases Singapore (CONVIN-SING).
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