Impact of COVID-19 Vaccines on Inflammatory Markers in Patients with Ankylosing Spondylitis

COVID-19 Vaccines and Inflammatory Markers

Hello Doctor: I am a patient with ankylosing spondylitis and have been taking Secukinumab for a year.
My inflammatory markers were under control, but after receiving the first dose of the BNT vaccine on September 27, I noticed an increase in my inflammatory markers when I tested again on November 17.
My CRP rose from 0.3 mg/dL before September 27 to 0.6 mg/dL, and my ESR increased from 12 to 45.
It seems that my inflammatory markers worsened after the vaccination.
I found some articles online that generally state that receiving the COVID-19 vaccine 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 you: 1) In your clinical experience, how common is it for patients to experience worsening inflammatory markers after receiving the COVID-19 vaccine? 2) Among those who have experienced worsening inflammatory markers after vaccination, what types of rheumatic patients are they? Which vaccines did they receive? 3) How long does the impact of worsening inflammatory markers due to the COVID-19 vaccine typically last? 4) I have already received the first dose of BNT.
If I am concerned that the increase in my inflammatory markers is related to the BNT vaccine, what other vaccines could I consider for the second dose that are less likely to exacerbate my inflammatory markers? Thank you, Doctor.

Yong, 20~29 year old female. Ask Date: 2022/01/21

Dr. Zeng Guosen reply Internal Medicine

1) In outpatient experience, there have been cases where inflammation markers worsened after receiving the COVID-19 vaccine, with literature reporting approximately 5%.
2) This has been observed in various rheumatic patients and with different vaccines.
3) The duration of the impact on inflammation markers due to the COVID-19 vaccine varies, but it generally lasts for several months.
4) The increase in inflammation markers is associated with the BNT vaccine; for the second dose, the High-End vaccine can be chosen, and for those traveling abroad, Moderna is an option.
Thank you.

Reply Date: 2022/01/21

More Info

The impact of COVID-19 vaccines on inflammatory markers in patients with ankylosing spondylitis (AS) is a topic of considerable interest, especially for those managing chronic inflammatory conditions. As a patient with AS who has experienced an increase in inflammatory markers following vaccination, it is understandable to have concerns regarding the relationship between the vaccine and your condition.

1. Clinical Experience with Vaccine-Induced Inflammation: In my clinical experience, there have been cases where patients with autoimmune or inflammatory diseases, including ankylosing spondylitis, have reported an increase in inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) following vaccination. However, these occurrences are generally not the norm. Most patients do not experience significant exacerbations of their underlying conditions post-vaccination. The increase in inflammatory markers can be attributed to the immune response triggered by the vaccine, which is a normal physiological reaction as the body mounts an immune defense against the introduced antigens.

2. Types of Patients Affected: The patients who tend to report exacerbations of inflammatory markers post-vaccination are often those with pre-existing autoimmune conditions. While specific data on the types of rheumatic diseases affected is limited, it has been noted that patients with conditions like rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis may experience fluctuations in their inflammatory markers. The vaccines administered have varied, with mRNA vaccines like BNT (Pfizer-BioNTech) and Moderna being the most common. Some patients have reported similar reactions with viral vector vaccines like Johnson & Johnson.

3. Duration of Increased Inflammation: The duration of increased inflammatory markers following vaccination can vary. In most cases, any elevation in CRP or ESR is transient and tends to resolve within a few weeks as the immune system stabilizes after the initial response to the vaccine. Continuous monitoring of these markers is essential, and if they remain elevated or worsen, further evaluation may be warranted to rule out other underlying issues.

4. Choosing Future Vaccines: If you are concerned about the potential for increased inflammatory markers with the second dose of the BNT vaccine, it is important to discuss your options with your healthcare provider. While there is no definitive evidence suggesting that one vaccine is less likely to cause an inflammatory response than another, some patients have reported fewer side effects with different vaccine platforms. For instance, some may consider viral vector vaccines or other mRNA vaccines, depending on availability and personal health considerations. Ultimately, the decision should be made in consultation with your rheumatologist, who can provide personalized advice based on your medical history and current health status.

In conclusion, while there is a possibility of increased inflammatory markers following COVID-19 vaccination in patients with ankylosing spondylitis, this is generally a temporary response. It is crucial to maintain open communication with your healthcare provider to monitor your condition and make informed decisions regarding vaccination. The benefits of vaccination in preventing severe COVID-19 disease often outweigh the risks, especially for individuals with underlying health conditions.

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