C-reactive protein rise in rheumatology patients following covid-19 vaccination

Objective The aim was to determine the proportion of patients with inflammatory arthritis who have a flare of their rheumatological disease within 4 weeks of receiving a coronavirus disease 2019 (COVID-19) vaccine, using CRP as a surrogate marker. Methods A retrospective review was conducted of notes for patients with inflammatory arthritis within 30 days of their COVID-19 vaccine. An electronic database (DAWN) was used to identify all patients who were currently on a DMARD or biologic therapy. This was then correlated with vaccine data from the National Immunisation and Vaccination System (NIVS) and CRP within 30 days of their vaccination. Results From the DAWN database, 1620 adults were identified (mean age 61 years, 64% female). Three types of vaccinations were administered: AstraZeneca (AZ), BioNTech-Pfizer or Moderna. Vaccine uptake was 1542 of 1620 (95.2% for the first dose), 1550 of 1620 (95.7% for the second dose) and 1437 of 1620 (88.7% for the third dose). One hundred and ninety-two of 1542 patients (12.5%) had a CRP rise of >10 mg/l within 30 days of their vaccine, which was higher than the baseline flare rate of 8.6% (P = 0.0004). Conclusion Patients with inflammatory arthritis and on DMARDs have a high uptake of COVID-19 vaccine (95%), which is greater than the national average. A CRP rise >10 mg/l within 30 days of vaccination was observed in similar to 1 in 10 patients in our study population after all three doses. There might be a slight increase in disease flare in patients with inflammatory arthritis after COVID-19 vaccinations, and additional research is required to assess this association further. Lay Summary What does this mean for patients? This study aims to assess the proportion of patients with inflammatory arthritis who had a flare of their rheumatological disease after receiving their coronavirus disease 2019 (COVID-19) vaccination. Patient blood tests were reviewed, and a specific inflammation marker was monitored in a blood test and recorded for each patient. A rise in the inflammation marker post-COVID-19 vaccine was seen in similar to 1 in 10 in our patient group. As ongoing booster vaccinations are planned, we recommend that further research is carried out to better inform and counsel inflammatory arthritis patients. Furthermore, this study highlights the need for careful monitoring of inflammatory arthritis patients for disease flares and for swift intervention to prevent loss of disease control.