Does COVID-19 Vaccination Worsen Ankylosing Spondylitis Symptoms?

Q: Does COVID-19 Vaccination Worsen Ankylosing Spondylitis Symptoms?

Hello, thank you for your inquiry. <br>Here are my responses：<br>1) In your clinical experience, how common is it for patients with rheumatic diseases to experience worsening conditions after receiving the COVID-19 vaccine? --> I only have personal experience and no national stat

Will getting the COVID-19 vaccine worsen the condition of ankylosing spondylitis?

Hello Doctor: My child is a patient with ankylosing spondylitis and has been taking Secukinumab for a year.
The inflammatory markers have been under control.
On September 27, he received the first dose of the BNT vaccine, and on November 17, the inflammatory markers were retested, showing an increase from a CRP of 0.3 mg/dL to 0.6 mg/dL, and an ESR increase from 12 to 45.
It seems that the vaccination has worsened the markers.
I found some articles online stating that COVID-19 vaccination generally does not significantly worsen rheumatic diseases, but there is still a possibility.
Even the American College of Rheumatology acknowledges that there may be a risk of exacerbating pre-existing rheumatic diseases after vaccination.
I would like to ask the doctor: 1) In your clinical experience, how common is it to see cases where rheumatic diseases have worsened after receiving the COVID-19 vaccine? 2) Among those with such conditions, what types of rheumatic patients are most affected? Which vaccines did they receive, and after how many doses did these issues arise? 3) My child has already received the first dose of BNT.
If I am concerned that the increase in inflammatory markers is related to the BNT vaccine, what other vaccines could be considered for the second dose that are less likely to exacerbate the existing condition? 4) Should I just let my child receive only one dose of BNT? (I understand that some countries allow individuals under 18 to receive only one dose of BNT, although my child is 18.5 years old.) Thank you, Doctor.

Hao, 40~49 year old female. Ask Date: 2022/01/20

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
Here are my responses:
1) In your clinical experience, how common is it for patients with rheumatic diseases to experience worsening conditions after receiving the COVID-19 vaccine? --> I only have personal experience and no national statistics.
I believe that the likelihood of rheumatology patients experiencing worsening conditions after vaccination may be higher than that of the general population.
Therefore, I usually recommend that patients receive the vaccine only after their condition is stable.
2) Among those who experience such conditions, what types of rheumatic patients are most affected? Which vaccines did they receive, and after which dose did these situations occur? --> Similarly, I only have personal experience and cannot specify which types of patients or which vaccines are associated with more side effects.
Among my patients, those with rheumatoid arthritis seem to experience side effects more frequently, while allergic patients do as well; patients with ankylosing spondylitis tend to fare better.
3) My child has received the first dose of the BNT vaccine.
If I am concerned that the increase in inflammatory markers is related to the BNT vaccine, what other vaccines could my child receive for the second dose that would be less likely to exacerbate the original condition? --> Currently, there is no research on this topic, so I cannot answer your question.
Additionally, there are many reasons for an increase in inflammatory markers, and attributing it solely to the vaccine requires further evaluation.
4) Should I just let my child receive only one dose of the BNT vaccine (it seems that in some countries, individuals under 18 are only given one dose of BNT, although my child is 18.5 years old)? --> If a patient experiences severe side effects after vaccination and there is strong suspicion that they are related to the vaccine, you can ask your physician for documentation or advice.
Typically, if a physician assesses that the risks of vaccination are too high, they will not insist that the patient receive the vaccine.
Therefore, I recommend discussing this matter with your child's physician to clarify the reasons and causal relationships before deciding whether to proceed with the next dose of the vaccine.
Department of Allergy, Immunology, and Rheumatology, Changhua Hospital, Ministry of Health and Welfare.
We care about you.

Reply Date: 2022/01/20

More Info

The concerns regarding the potential impact of COVID-19 vaccination on pre-existing conditions, such as ankylosing spondylitis (AS), are valid and warrant careful consideration. Here’s a detailed response to your questions based on current medical knowledge and clinical experience.

1. Incidence of Worsening Symptoms Post-Vaccination: In my clinical experience, while there have been reports of patients experiencing flares of autoimmune conditions following vaccination, these cases are relatively rare. The majority of patients with rheumatic diseases, including ankylosing spondylitis, have tolerated COVID-19 vaccines well. The American College of Rheumatology and other health organizations have generally recommended vaccination for patients with autoimmune diseases, emphasizing the benefits of vaccination in preventing severe COVID-19 illness outweigh the risks of potential disease exacerbation.

2. Types of Patients and Vaccines Involved: Among those who have reported worsening symptoms post-vaccination, many have been patients with various autoimmune conditions, including rheumatoid arthritis and lupus, in addition to ankylosing spondylitis. The vaccines involved have varied, with both mRNA vaccines (like BNT) and vector vaccines being used. Most reports of exacerbation have occurred after the second dose, but there are also instances following the first dose. It’s important to note that the exacerbation of symptoms can also be influenced by other factors, such as stress, illness, or changes in medication.

3. Options for Second Dose: If you are concerned about the potential for increased inflammation following the second dose of the BNT vaccine, it is essential to discuss this with your healthcare provider. They may consider monitoring your child's inflammatory markers closely after the second dose. Alternatively, if there are significant concerns, you could discuss the possibility of delaying the second dose or considering other vaccines. However, it’s crucial to understand that while some vaccines may have different side effect profiles, the overall recommendation is to complete the vaccination series to ensure adequate protection against COVID-19.

4. Single Dose Consideration: Allowing your child to receive only one dose of the vaccine is an option, but it is essential to weigh the risks and benefits. Many countries have adopted different vaccination strategies based on age and risk factors, but the consensus among health authorities is that completing the vaccination series provides better immunity against COVID-19. If your child is 18.5 years old, they are eligible for the full vaccination schedule, and it may be beneficial to complete it unless there are compelling medical reasons not to.

In conclusion, while there is a possibility of exacerbation of autoimmune conditions following vaccination, the overall risk is low, and the benefits of vaccination in preventing severe COVID-19 disease are significant. It is crucial to maintain open communication with your healthcare provider to monitor your child's condition and make informed decisions regarding vaccination. Regular follow-ups and monitoring of inflammatory markers can help manage any potential flare-ups effectively.

Similar Q&A

Impact of COVID-19 Vaccine on Ankylosing Spondylitis: What to Know

Hello Doctor, I previously asked you about the worsening of my ankylosing spondylitis condition after receiving the first dose of the BNT vaccine (where my medication became ineffective in controlling inflammation levels and pain) (<a href="https://adoctor.tw/article/1778...

Dr. Zeng Guosen reply Internal Medicine
Hello, the COVID-19 vaccine does not necessarily worsen ankylosing spondylitis; however, it is true that approximately 5% of patients with autoimmune rheumatic diseases may experience instability in their condition after vaccination. The reasons for this are unclear, and the degr...

Impact of COVID-19 Vaccination on Ankylosing Spondylitis Symptoms

Hello Doctor, I am a patient with ankylosing spondylitis. I would like to ask you: 1) If the COVID-19 vaccine has exacerbated my pre-existing stiffness, is it possible that this exacerbation could last a long time (for example, 1-2 years, or even longer, possibly a lifetime)? 2) ...

Dr. Gao Jiankai reply Internal Medicine
Hello, thank you for your question. Here are my responses: 1) If the COVID-19 vaccine exacerbates a pre-existing rigid condition, is it possible that this exacerbation could last for a long time (for example, 1-2 years, or even longer, potentially a lifetime)? --> Currently,...

Can Patients with Ankylosing Spondylitis Receive the COVID-19 Vaccine?

Hello Dr. Gao: I am a patient with ankylosing spondylitis. I have been treated with a cancer-killing medication for about two years, and my inflammatory markers have now decreased to normal levels. I have stopped taking the cancer medication for one month and am currently only ta...

Dr. Gao Jiankai reply Internal Medicine
Hello, thank you for your inquiry. Based on your current medication status, you are eligible to receive the COVID-19 vaccine. If you are continuously taking anti-cancer medication, a temporary adjustment to your medication may be necessary. This message is from the Allergy, Immun...

Could Vaccination Trigger Ankylosing Spondylitis Symptoms?

Hello, after recently receiving the BNT vaccine, I experienced several inflammatory symptoms. After multiple rounds of examinations at the hospital, I was diagnosed with ankylosing spondylitis. However, the symptoms appeared suddenly and coincidentally after the vaccination. I wo...

Dr. Gao Jiankai reply Internal Medicine
Hello, thank you for your question. I believe that the BNT vaccine is unlikely to trigger the occurrence of ankylosing spondylitis. However, current COVID-19 vaccines, including BNT, may indeed induce muscle and joint pain, resulting in symptoms similar to rheumatic diseases. I s...