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Flu vaccine not associated with flares in patients with rheumatoid disorders

Question clinique

Is inactivated influenza vaccine associated with an increase in the risk for rheumatic disease flares?

L’Essentiel

In patients with rheumatoid arthritis, lupus, or spondylarthritis, the administration of inactivated influenza vaccine does not increase the likelihood of a disease flare; if anything, it provides a small reduction over the subsequent 3 months. 1c

Référence

Nakafero G, Grainge MJ, Myles PR, et al. Association between inactivated influenza vaccine and primary care consultations for autoimmune rheumatic disease flares: a self-controlled case series study using data from the Clinical Practice Research Datalink. Ann Rheum Dis 2019;78:1122-1126.

Plan de l'etude: Case series

Financement: Government

Cadre: Population-based

Sommaire

These researchers searched a longitudinal database of more than 15 million people registered in over 700 general practices in the United Kingdom. The database contains records for 14,928 patients with rheumatic diseases, mostly (80.1%) rheumatoid arthritis, who received an inactivated influenza vaccine during the study period. For these patients, the researchers looked in the database for evidence of disease flare before and after vaccination, specifically office visits for a flare of rheumatoid arthritis and a new corticosteroid prescription, or vaccine hypersensitivity resulting in vasculitis or fever nonrelated to infection. By comparing baseline rates with postvaccination rates, each patient served as his or her own control. There was no evidence of an association between vaccination and any of these outcomes; in fact, patients on average had fewer visits for joint pain in the 90 days following vaccination (rate ratio 0.91; 95% CI 0.87 - 0.94).

Reviewer

Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA


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Commentaires

Was the vaccine adjuvanted?

It would be helpful to know if the vaccine used in this study was adjuvanted or not. Adjuvants increase inflammation (see: McDonald JU, Zhong Z, Groves HT, Tregoning JS. Inflammatory responses to influenza vaccination at the extremes of age. Immunology. 2017;151:451-463.) so this might be relevant in looking at the effects of vaccination on autoimmune disease flares.

septembre 11, 2019
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