the Link Between Ankylosing Spondylitis and Vaccination

Q: the Link Between Ankylosing Spondylitis and Vaccination

Hello, thank you for your question. <br>Here are my responses： <br>1) Is my chest pain more likely caused by the vaccine or by smoking? --> Ankylosing spondylitis can also cause chest pain, and the likelihood may be higher than the side effects from the vaccine, so it is unlikely

The relationship between ankylosing spondylitis and vaccines?

Hello Doctor, I am a 51-year-old male patient with ankylosing spondylitis.
I received my first dose of the BNT vaccine in October last year and the second dose in January this year.
I would like to ask if the symptoms I describe below could be related to the BNT vaccine.
Since being diagnosed with ankylosing spondylitis at age 46 by my rheumatologist, my CRP and ESR levels have never exceeded the normal range.
Occasionally, I experience buttock pain or morning stiffness, which I manage with medication, and everything returns to normal.
However, I have recently developed a new symptom of chest pain.
I have seen both a cardiologist and a pulmonologist, and they have ruled out any heart or lung issues.
My CRP is 0.3 and my ESR is 3, both of which are still within normal limits.
I started smoking about a year ago but quit two months ago.
I would like to ask the doctor: 1) Is my chest pain more likely related to the vaccine or to smoking? 2) If it is not related to the vaccine, could you briefly explain why it is unlikely to be vaccine-related? 3) If it is related to the vaccine, shouldn't the CRP and ESR levels typically show a significant increase? Is my thinking correct? Additionally, could you please clarify if it is possible for a patient with ankylosing spondylitis to have normal inflammatory markers (CRP, ESR) but still experience morning stiffness? In other words, is morning stiffness not necessarily correlated with inflammatory markers in the context of ankylosing spondylitis? Thank you, Doctor.

Yong, 50~59 year old female. Ask Date: 2022/05/18

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1) Is my chest pain more likely caused by the vaccine or by smoking? --> Ankylosing spondylitis can also cause chest pain, and the likelihood may be higher than the side effects from the vaccine, so it is unlikely to be vaccine-related.
Smoking, especially when combined with chronic cough, is more likely to lead to chest pain.
2) If it is not caused by the vaccine, can the doctor briefly explain why it is unlikely to be vaccine-related? --> As mentioned above.
Additionally, if chest pain is suspected to be related to the vaccine, further examinations to assess lung and heart function are necessary, and a personal evaluation of the patient would provide a more accurate assessment.
3) If it is caused by the vaccine, should the CRP and ESR levels "usually" show significant deterioration? Is my thinking correct? --> Not necessarily.
Some vaccine side effects do not cause an inflammatory response, so it is still important for a physician to personally evaluate the patient for a more accurate diagnosis.
Also, Doctor, is it possible for patients with ankylosing spondylitis to have normal inflammatory markers (CRP, ESR) but still experience morning stiffness? In other words, is morning stiffness not necessarily correlated with inflammatory markers in ankylosing spondylitis? --> Yes, it is possible.
Some inflammatory responses may be mild, and the test results may not be significantly elevated, yet the patient can still experience morning stiffness.
Therefore, when assessing patients, we often need to consider blood test results in conjunction with clinical symptoms for a more precise evaluation.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2022/05/18

More Info

Understanding the relationship between Ankylosing Spondylitis (AS) and vaccination, particularly in the context of your recent experiences, is important for managing your health. Let’s break down your questions and concerns regarding the potential link between your symptoms and the BNT vaccination, as well as the implications of your inflammatory markers.

1. Chest Pain and Its Potential Causes:
Your recent onset of chest pain could be attributed to several factors. Given your history of Ankylosing Spondylitis, it is essential to consider that AS can sometimes lead to inflammation in the chest area, particularly affecting the costovertebral joints or the sternum, which can manifest as chest pain. Additionally, your smoking history, although you have recently quit, is a significant risk factor for various pulmonary and cardiovascular issues. It’s good that you have consulted with cardiology and pulmonology, and they have ruled out heart and lung problems.
Regarding the BNT vaccine, while some individuals report transient side effects post-vaccination, including chest pain, these are typically mild and resolve quickly. The fact that your CRP and ESR levels remain within normal ranges suggests that there is no significant systemic inflammation occurring, which is often associated with vaccine reactions.
2. Why Your Symptoms Are Less Likely Related to the Vaccine:
Vaccines, including the BNT, can cause mild side effects such as soreness at the injection site, fatigue, and sometimes mild fever or muscle aches. However, serious side effects are rare. The absence of elevated inflammatory markers (CRP and ESR) strongly indicates that your chest pain is unlikely to be vaccine-related. Vaccination typically triggers an immune response, which would usually reflect in these markers if significant inflammation were present.
3. Understanding CRP and ESR in Relation to Symptoms:
It is indeed possible for individuals with Ankylosing Spondylitis to experience symptoms like morning stiffness (or "morning stiffness") even when CRP and ESR levels are normal. This phenomenon can occur because these markers do not always correlate perfectly with the presence of inflammation in the joints or soft tissues. In AS, the inflammatory process can be localized and may not always result in elevated systemic inflammatory markers. Therefore, morning stiffness can persist even when blood tests show normal inflammatory responses.

4. Conclusion and Recommendations:
Given your situation, it would be prudent to continue monitoring your symptoms. If the chest pain persists or worsens, or if you develop new symptoms, it would be advisable to follow up with your healthcare provider for further evaluation. Additionally, maintaining a healthy lifestyle, including regular exercise tailored to your condition and avoiding smoking, can help manage your AS symptoms effectively.

In summary, while your recent symptoms are concerning, they are likely multifactorial. The evidence suggests that they are not directly related to the BNT vaccination, especially given your normal inflammatory markers. It’s essential to maintain open communication with your healthcare providers about any new or worsening symptoms, as they can provide tailored advice and management strategies for your condition.

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