Disease flare and reactogenicity after covid vaccination in RMD patients

Written by | 7 Feb 2022 | 'In Discussion With'

A recent study at Johns Hopkins evaluated responses to SARS-CoV-2 vaccination in patients with rheumatoid and musculoskeletal disease (RMD)1 – a group that was poorly represented in the vaccine trials.  IMI spoke to the lead author, Dr Caoilfhionn Connolly to find out more.

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.


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.

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