This is a summary, written by members of the CITF Secretariat, of:

Lee JJY, Bernatsky S, Kwong JC, Li Q, Kwok TSH, Widdifield J. Safety and health care utilization following COVID-19 vaccination among adults with rheumatoid arthritis – A population-based self-controlled case series analysis. J Rheumatol. 2023 Oct 1. doi:

The results and/or conclusions contained in the research do not necessarily reflect the views of all CITF members.

A CITF-funded study, published in Journal of Rheumatology, provides reassurance that COVID-19 vaccination in individuals with rheumatoid arthritis (RA) does not increase overall risk of adverse events of special interest (AESI). In fact, vaccination was associated with fewer emergency department (ED) visits and hospitalizations. This study was conducted by the Safety and immUnogenicity of Covid-19 vaCcines in systEmic immunE mediated inflammatory Diseases (SUCCEED) team, led by Dr. Jessica Widdifield, in collaboration with Drs. Jennifer Lee, Jeff Kwong, and Sasha Bernatsky (nominated principal investigator of SUCCEED).

Key findings:

  • A similar incidence of adverse events of special interest (AESIs) was seen following COVID-19 vaccination in adults with rheumatoid arthritis (RA) compared to those without RA, regardless of vaccine dose number. One exception was after dose three, where vaccination in RA was associated with a slightly higher incidence of AESIs compared to individuals without RA.
  • Compared to pre-vaccination control periods, AESIs were not increased. There was an increase in ED visits after the second dose in both RA and non-RA individuals, but this decreased after dose three. RA individuals experienced fewer ED visits and hospitalizations than non-RA individuals after the fourth dose.
  • Hospitalizations were lower after each of the first three COVID-19 doses in people with RA compared to control periods.
  • Overall healthcare use (ED visits and hospitalizations) remained similar or decreased after vaccination in both RA and non-RA individuals.
  • Compared to control periods, people with RA had more rheumatology visits after dose one, and fewer visits after doses two and three. There was no difference in the number of visits after dose four.

Because people with RA were excluded from clinical trials for COVID-19 vaccines, it is important to understand the full safety profiles of vaccination in this population. These findings can help boost confidence in COVID-19 vaccinations among people with RA and inform vaccination recommendations. Ongoing surveillance is necessary to assess the safety of newer COVID-19 vaccine formulations, including boosters.

This study involved the recruitment of adults with rheumatoid arthritis (RA) and non-RA comparators who were matched on sex, age, and region of residence. These individuals had received at least one COVID-19 vaccination from June 14, 2020 to August 1, 2021, in Ontario. People with RA also served as their own controls, with pre-vaccination findings compared to those following COVID-19 vaccination.