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Caoilfhionn Connolly, MD, on COVID Vaccine Hesitancy in People With Rheumatic and Musculoskeletal Diseases

– Flares were unusual following COVID vaccination, possibly helping to address safety concerns


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According to findings published in , flares from rheumatic and musculoskeletal diseases (RMD) were uncommon following COVID vaccination, with no reports of severe flare. These findings may help clinicians address vaccine hesitancy in people with RMD.

A total of 1,377 patients with RMD who received two-dose COVID-19 vaccinations completed questionnaires detailing local and systemic reactions experienced within seven days of each vaccine dose and one month after the second dose. Ultimately, 11% of respondents reported flares that required treatment. Flares were associated with various factors, including prior COVID-19 infection (IRR 2.09, P=0.02), flares within the six months preceding vaccination (IRR 2.36, P<0.001), and the use of combination immunomodulatory therapy (IRR 1.95, P<0.001). The most frequently reported reactions included injection site pain (first dose 87%, second dose 86%) and fatigue (first dose 60%, second dose 80%).

Caoilfhionn Connolly, MD, MSc, a rheumatologist-researcher with Johns Hopkins University School of Medicine in Maryland, discussed the study and its findings with ̳. The exchange has been edited for length and clarity.

What knowledge gap was this study designed to address?

Connolly: Patients with RMD on immunosuppression were excluded from the original vaccine studies (Pfizer, Moderna, Johnson & Johnson), so the safety of the vaccines in people with RMD was unknown prior to this study.

At the same time, many patients in this population reported vaccine hesitancy because of a lack of safety data. Therefore, we wanted to fill this knowledge gap so that patients could make informed decisions about COVID vaccination.

How would you summarize your key findings?

Connolly: The benefits of COVID-19 vaccination greatly outweigh the risks of adverse effects of the vaccine. Rates of disease flare were low and there were no reports of any flares that required hospitalization. Similar to the general population, local and systemic reactions were common among patients with RMD, but typically did not interfere with daily activity.

How might these findings help affect vaccine hesitancy?

Connolly: These findings should reassure patients who have safety concerns about getting vaccinated. The benefits of COVID-19 vaccination (that is, reducing the risk of severe COVID-19 infection, hospital admission, and/or death) greatly outweigh the risks of adverse effects of the vaccine.

Are there any other clinical take-home messages from this study you would like to highlight?

Connolly: In this study of 1,377 patients with RMD, there were no findings that warranted concern about the safety of the vaccination. Local and systemic reactions (similar to those at rates seen in the general population) should be anticipated, and setting expectations with patients accordingly may help alleviate anxiety.

It has been shown that patients with RMD are more willing to reconsider vaccination if they are provided with more medical education or a physician recommendation. We hope these data can help address vaccine hesitancy in this patient population.

Read the study here.

Connolly did not disclose any relevant financial relationships with industry.

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Primary Source

Arthritis & Rheumatology

Source Reference:

American College of Rheumatology Publications Corner

American College of Rheumatology Publications Corner