Evidence map›Paper›PMID 37528453›Full record

ArticleAdvances in rheumatology (London, England)2023

Prevalence and factors associated with flares following COVID-19 mRNA vaccination in patients with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis: a national cohort study.

Warren Fong, Ting Hui Woon, Li-Ching Chew, Andrea Low, Annie Law, Yih Jia Poh, Siaw Ing Yeo, Ying Ying Leung, Margaret Ma, Amelia Santosa and 13 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Advances in rheumatology (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Review
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  5. Review
  6. Review
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  8. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Warren Fong *Department of Rheumatology and Immunology, Singapore General Hospital, Academia, Level 4, 20 College Road, Singapore, 169856, Singapore. gmsfwsw@nus.edu.sg.ORCID 0000-0003-1891-1892
Ting Hui Woon *Department of Rheumatology and Immunology, Singapore General Hospital, Academia, Level 4, 20 College Road, Singapore, 169856, Singapore.
Li-Ching ChewDepartment of Rheumatology and Immunology, Singapore General Hospital, Academia, Level 4, 20 College Road, Singapore, 169856, Singapore.
Andrea LowDepartment of Rheumatology and Immunology, Singapore General Hospital, Academia, Level 4, 20 College Road, Singapore, 169856, Singapore.
Annie LawDepartment of Rheumatology and Immunology, Singapore General Hospital, Academia, Level 4, 20 College Road, Singapore, 169856, Singapore.
Yih Jia PohDepartment of Rheumatology and Immunology, Singapore General Hospital, Academia, Level 4, 20 College Road, Singapore, 169856, Singapore.
Siaw Ing YeoDepartment of Rheumatology and Immunology, Singapore General Hospital, Academia, Level 4, 20 College Road, Singapore, 169856, Singapore.
Ying Ying LeungDepartment of Rheumatology and Immunology, Singapore General Hospital, Academia, Level 4, 20 College Road, Singapore, 169856, Singapore.
Margaret MaDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Amelia SantosaDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Kok Ooi KongRheumatology, Tan Tock Seng Hospital, Singapore, Singapore.
Chuanhui XuRheumatology, Tan Tock Seng Hospital, Singapore, Singapore.
Gim Gee TengDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Anselm MakDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Sen Hee TayDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Tyng Yu ChuahRheumatology, Sengkang General Hospital, Singapore, Singapore.
Nur Emillia RoslanRheumatology, Sengkang General Hospital, Singapore, Singapore.
Stanley AngkodjojoRheumatology, Sengkang General Hospital, Singapore, Singapore.
Kee Fong PhangDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Melonie SriranganathanRheumatology, Changi General Hospital, Singapore, Singapore.
Teck Choon TanRheumatology, Khoo Teck Puat Hospital, Singapore, Singapore.
Peter CheungDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Manjari LahiriDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine prevalence and factors associated with flares post Coronavirus disease 2019 (COVID-19) mRNA vaccination in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthritis (SpA).

methodsA retrospective multi-centre study was conducted (January 2021 to February 2022). Data were collected during index visit, defined as first post-vaccine visit in which the patient had a physician-defined flare, or if at least 3 months had elapsed since first vaccine dose, whichever came first. Factors associated with flares were identified using mixed effects Cox regression and expressed as hazard ratio (HR) and 95% confidence interval (CI).

resultsTotal of 2377 patients were included (1563 RA, 415 PsA and 399 SpA). Among patients with RA, PsA and SpA, 21.3%, 24.1% and 21.8% experienced a flare respectively. Of those who experienced a flare, only 10.2%, 11.0% and 14.9% were severe in patients with RA, PsA and SpA respectively. Patients with low or moderate/high disease were more likely to flare compared to those in remission in patients with RA only (HR: 1.68, 95% CI 1.22-2.31; HR: 2.28, 95% CI 1.50-3.48, respectively). Receiving the Moderna vaccine was associated with a higher HR of flare compared to the Pfizer vaccine in patients with PsA only (HR: 2.21, 95% CI 1.20-4.08). Patients who had two vaccine doses were found to be less likely to flare (HR: 0.08, 95% CI 0.06-0.10). HRs of flares were not significantly different among RA, PsA and SpA.

conclusionAbout one-fifth of patients experienced a disease flare post COVID-19 mRNA vaccination, but most flares were non-severe. Patients with active disease prior to vaccination should be monitored closely for disease flares, especially in patients with RA.

Indexed as

Arthritis, PsoriaticArthritis, RheumatoidCOVID-19SpondylarthritisCohort StudiesHumansPrevalenceVaccinationAutoimmune inflammatory rheumatic diseasesCOVID-19FlaresmRNA vaccine

Identifiers

PMID37528453

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.