DOI: 10.1002/acr.25288 ISSN: 2151-464X

Association of COVID‐19 Vaccinations with Flares of Systemic Rheumatic Disease: A Case‐Crossover Study

Genna Braverman, Medha Barbhaiya, Minerva Nong, Vivian P. Bykerk, Nathaniel Hupert, Colby Lewis, Lisa A. Mandl
  • Rheumatology


To determine the association of COVID‐19 vaccination with flares of systemic rheumatic disease (SRD).


Adults with autoimmune or autoinflammatory conditions (“systemic rheumatic disease”) in a single‐center COVID‐19 Rheumatology Registry were invited to enroll in a study of flares. COVID‐19 vaccine information from 3/5/21‐9/6/22 was obtained from chart review and self‐report.

Participants self‐reported periods of SRD flare and periods without SRD flare. “Hazard periods” were defined as time before self‐report of flare, and “control periods” as time before self‐report of no flare. The association between flare and COVID‐19 vaccination was evaluated during hazard and control periods through univariate conditional logistic regression stratified by participant, using lookback windows of 2, 7 and 14 days.


434 subjects (mean age 59 years [±13], 84.1% female, 81.8% White, 64.5% inflammatory arthritis, 27.0% connective tissue diseases) contributed both hazard and control periods and were included in analysis. A total of 1316 COVID‐19 vaccinations were identified (58.5% Pfizer‐BioNTech, 39.5% Moderna, 1.4% Johnson & Johnson); 96.1% of participants received ≥1 dose and 93.1% ≥2 doses. There was no association between COVID‐19 vaccination and flares in the subsequent 2, 7 or 14 days (OR 1.46 [95% CI, 0.86‐2.46], OR 1.09 [95% CI, 0.76‐1.55], OR 0.85 [95% CI, 0.64‐1.13] respectively). Analyses stratified on sex, age, SRD subtype and vaccine manufacturer similarly showed no association between vaccination and flare.


COVID‐19 vaccination was not associated with flares in this cohort of participants with SRD. These data are reassuring and can inform shared decision‐making on COVID‐19 immunization.


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