The study showed that RMD patients who received two doses of SARS-CoV-2 vaccination experienced low rates of systemic and local reactions that were mostly mild. Importantly, the frequency of disease flare after vaccination was also low.¹ “This is very, very reassuring and this information can help providers and patients have very informed discussions about decision-making around vaccination”, says Dr Connolly.

Turning to the wider context for covid-19 vaccination, Dr Connolly says that there have been “a number of papers showing that much higher antibody levels are required to prevent the omicron variant infection but, reassuringly, vaccines appear to be very effective at prevention of severe infection and death. As the SARS-CoV-2 virus evolves I think that medical counter-measures will also have to evolve and this will require a multi-faceted strategy including prevention through the use of vaccination pre-exposure prophylaxis [for] high-risk patients and then early treatment and intervention with antiviral therapies to reduce severity of infection”.

In the UK sotrovimab and molnupiravir are to be available for early treatment of patients at the highest risk of seriously illness from covid-19 such as those receiving immunosuppressive treatment.

“Patients on immunosuppression or who are immunocompromised in some way – they’re the high-risk patients that we really have to work in the medical community to protect. …. I think that these patients are the ideal candidates for early treatment with antiviral therapies because it has been shown to reduce severity of infection and [is] something that we’re implementing here”, says Dr Connolly

“We’re using Paxlovid, when it is available – hopefully supplies will increase over coming weeks and months – and then molnupiravir is also an option, although we’re preferentially using Paxlovid if it’s available, she adds.

Dr Connolly would encourage RMD patients to be vaccinated for SARA-CoV-2. She says, “The risks of not being vaccinated include getting covid-19 infection and the risks associated with that include severe infection, hospitalization and death. ….The risks of vaccination include very mild local and systemic reactions like pain in the arm and fatigue and less than one-in-10 chance of a flare of underlying rheumatic disease. So, I think you know the safety profile of the vaccines is very reassuring and I would urge patients to get vaccinated if they can”.

Reference

Connolly CM et al. Disease Flare and Reactogenicity in Patients With Rheumatic and Musculoskeletal Diseases Following Two-Dose SARS–CoV-2 Messenger RNA Vaccination. Arthritis and Rheumatology 2022;74: 28-32

Dr Caoilfhionn Connolly is a second-year rheumatology fellow at the division of rheumatology at Johns Hopkins in Baltimore, Maryland, US.

Read and watch the full series on our website or on YouTube.

The study under discussion – Disease Flare and Reactogenicity in Patients with Rheumatic and Musculoskeletal Diseases Following Two-Dose SARS–CoV-2 Messenger RNA Vaccination – was part of a larger study designed by Dr Dorry Segev and the ERGOT (Epidemiology Research Group in Organ Transplantation) transplant group at Johns Hopkins evaluating the safety and efficacy of the SARS-CoV-2 vaccines in immunosuppressed patients.  “Unfortunately, patients with rheumatic and musculoskeletal diseases were not well represented in the vaccine trials and, in fact, being on immunosuppression was an exclusion criterion, so very little was known”, explains Dr Connolly. “We looked at rates of local and systemic reactions as well as the impact of the vaccines on patients’ underlying rheumatic disease”, she adds.

The study was started in December 2020, in the middle of the coronavirus pandemic, and patients were invited to enrol online via social media postings from  rheumatology patient advocacy groups or through the Johns Hopkins rheumatology centres. Any patient with a diagnosis of rheumatic or musculoskeletal disease was eligible.

Dr Connolly recalls, “We were we were pretty overwhelmed by the enrolment – patients really wanted to help and … get information for themselves and for other patients in similar situations”.

All the data was patient-reported using a total of three questionnaires. One questionnaire was completed seven days after the first vaccine dose and a second questionnaire was completed one week after the second vaccine dose. A separate flare questionnaire was completed one month after the second vaccination.

“The most frequently-reported local reaction was injection site pain and the most frequently reported systemic reaction was fatigue. These reactions were typically mild and did not interfere with activities of daily living, which was very reassuring and similar to the general population. We found that the rates of overall reactions increased after dose two, but … that’s very similar to the experience in the general population”, said Dr Connolly.

Overall, the frequency of flares was quite low and reported flares were typically mild. No patient required admission to the hospital or use of intravenous therapy for treatment.  “What we did find is that flare of their underlying disease was more common if patients reported prior covid19 infection which may suggest that there is some sort of immunological priming. We also found that patients who had reported flare of their underlying disease in the six months preceding vaccination were more likely to flare after the vaccine and really we think that this is a surrogate, perhaps for patients having poor baseline disease control”, explains Dr Connolly.

Reference

Connolly CM et al. Disease Flare and Reactogenicity in Patients with Rheumatic and Musculoskeletal Diseases Following Two-Dose SARS–CoV-2 Messenger RNA Vaccination. Arthritis and Rheumatology 2022;74: 28-32

Dr Caoilfhionn Connolly is a second-year rheumatology fellow at the division of rheumatology at Johns Hopkins in Baltimore, Maryland, US.

Read and watch the full series on our website or on YouTube.