ABSTRACT
Background: Rheumatologists recommend vaccination in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) patients, but there are few studies on the occurrence of adverse events (AEs), particularly worsening disease related activity and unrelated immune reactions in these groups. Objectives: To evaluate the uptake of COVID vaccination in RA and axSpA patients, compare the frequency of AEs, and identify risk factors associated with vaccine AEs in two prospective cohorts comprised of these patients. Methods: The IMPACT study is a monthly survey of two prospective cohorts of established RA and axSpA patients in northern Alberta, Canada from November 2020-2021 who answered at least one or more Redcap surveys through de-iden-tifed email link surveying demographics, disease characteristics, COVID symptoms, treatment of RA and axSpA, health care utilization, vaccination status, vaccine AEs and use of cannabis. Univariate analyses evaluated independent variables associated with the dependent variables of (1) any AE, (2) any severe AE, (3) any arthritis fare, and (4) any severe arthritis fare, followed by multi-variate analyses of these four dependant variables using all clinically relevant variables from the univariate analysis. Results: 773/2167 patients (RA 574, axSpA 197) responded to at least one survey. 32/663 (5%) were single vaccinated, 631 (95%) double vaccinated and 230 (54%) triple vaccinated with 80% receiving Pfzer, 24% Moderna, 28% Astra-Zeneca and 30% 'other'. 456 (69%) reported at least one AE (Figure 1) with 21 (3%) patients seeing a physician for their AE. Increased age was associated with all AEs. RA patients had lower reported AEs versus axSpA patients for all AE defnitions except for severe arthritis fares. Generally, males reported worse AEs (Table 1). 'Any arthritis fare' was lower in patients reporting cannabis use. Conclusion: RA and axSpA patients showed high uptake of COVID vaccination with largely minor AEs. Older age and male gender were associated with more general and arthritis specifc AEs. The association of any AE and/or arthritis-spe-cifc AEs in SpA versus RA patients is a novel fnding which may correlate with the male predominance of SpA. The association of cannabis with fewer arthritis AEs may refect the nociceptive properties of cannabis.
ABSTRACT
Background: Throughout the pandemic, there has been ongoing concern that people with autoimmune diseases such as rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) will have more severe COVID-19 disease due to immune dysfunction associated with autoimmune diseases and their treatment. Objectives: We aimed to compare the severity of COVID-19 in patients with RA versus axSpA and characterize the predictors of COVID-19 severity during the pre-Omicron pandemic phases. Methods: The IMPACT (IMPact of infammatory Arthritis on COVID Outcomes STudy) study is a monthly survey of two established northern Alberta, Canada prospective cohorts of RA and axSpA patients from November 2020-2021 who answered Redcap surveys through de-identifed email link surveying patient demographics, disease characteristics, COVID-19 symptoms, treatment of RA and axSpA, health care utilization, vaccination status and vaccine adverse events. Descriptive and univariate analyses (dependent variable = severe COVID-19) were performed followed by multivariate analyses of all signifcant and clinically relevant independent variables from the univariate analysis. Infection severity was defned as any patient with COVID-19 symptoms who visited a doctor, ER or required hospital admission. Results: 773 of 2167 (36%) patients (RA n=574, axSpA n=197) registered in both cohorts answered at least one baseline survey, 28 (4%) reporting positive COVID-19 tests (24 positive once). Of 442 reporting COVID-19 symptoms during the survey, 11 (3%) were admitted for a mean of 4 days, 2 requiring ICU or blood clot treatment and 1 requiring advanced therapy. 116 (26%) visited a physician for Covid symptoms. Univariate analysis showed that the use of steroids, NSAIDs and increased disease activity were associated with having less severe infection but these associations were not signifcant in the multivariate analysis (Table 1). There were no signifcant impacts of RA vs axSpA, age, gender, treatment, disease activity, or smoking. Conclusion: Possible disease related risk factors for increased COVID-19 severity in RA and axSpA patients preceding the onset of the Omicron variant including use of steroids or DMARDs were not associated with severe infection. These fndings are consistent with other international studies whereby other non-rheumatic disease comorbidities played a greater role in infection severity.