COVID-19 VACCINE: HESITANCY, ACCEPTANCE and TOLERANCE among PATIENTS with RHEUMATOID ARTHRITIS

ABSTRACT

Background: Patients with rheumatoid arthritis (RA) are considered a high-risk population to develop severe COVID-19 [1] and therefore vaccination is strongly recommended. Previous reports have shown a high hesitancy rate to receive a COVID-19 vaccine among RA. Objectives: This study aimed to evaluate the attitude of patients with RA to vaccination against SARS-CoV-2, explore the factors which may influence it, and assess adverse events of SARS-CoV-2 vaccines. Methods: This is a cross-sectional study including 106 patients with RA diagnosed according to the ACR/EULAR 2010 classification criteria and followed in the Rheumatology Department, over a period of 10 months from March to December 2021.Demographic and disease parameters were collected age, gender, educational status, disease duration, erythrocyte sedimentation rate (ESR), disease activity score (DAS28), and treatments being used. All patients responded to a questionnaire on their perceptions and concerns about the covid-19 vaccine, and the adverse effects for those who got vaccinated. Results: Among the 106 patients, 90 (84,9%) were females and 16 (15,1%) were males. The mean age was 54 ±13 years old [23-77]. Sixty-four percent were from urban areas and 36 % were from rural areas. Thirty-three percent of patients were illiterate. The mean disease duration was 9.54 ±5.76 years [2-22]. The mean DAS28 ESR was 3,88 ±1.34 [1.2-7.58]. All of our patients were taking conventional synthetic DMARDs. Seventeen percent of patients were on biological DMARDs. The majority of the patients (90%) reported that they respected the preventive measures. Twenty-two percent of patients had stopped their treatment because they were afraid of the covid-19. Twenty-eight patients had contracted the SARS-CoV-2. Seventeen percent of the patients reported that they didn't get vaccinated against covid-19. The reasons given by these patients were presumed adverse events (53,3%), presumed inef-fciency (25%), no recommendation from their doctor (46,7%), fear that the vaccine would make RA worse (64,7%). For the vaccinated patients, the vaccines administered were 63,6 % Pfzer BioNTech, 6,8% Oxford/AstraZeneca, 5,7% Moderna, 4,5% Janssen/Johnson & Johnson, 2,3% Sinovac-Coro-naVac and 17% unspecifed. The majority of the patients (72,7 %) received two doses,14,8 % one dose and 12,5% 3 doses. After vaccination, 73,9% of patients reported adverse events, such as pain at the site of injection (88,1%), fatigue (35,8%), headache (14,9%), fever (13,4%) and muscle/joint pains (4,5%). Only 1 patient had experienced rheumatic disease fare. Hesitancy about the COVID-19 vaccination was associated with low intellectual level (p=0.004) and rural origin (p=0.001).RA disease duration, DAS28-ESR, and treatments have no influence on the attitude of patients towards COVID-19 Vaccination (p > 0,05). Conclusion: The acceptance of COVID-19 vaccination by RA patients in our study is quite promising. The majority of patients tolerated their vaccination well, with rare RA fares up. These results should reassure rheumatologists and patients. Education and outreach efforts need to be continued, especially for illiterate people and those who live in rural areas.