Can Vaccination Trigger Flare-Ups in Ankylosing Spondylitis Months Later?

Q: Can Vaccination Trigger Flare-Ups in Ankylosing Spondylitis Months Later?

Hello, thank you for your question. <br>Here are my responses： 1. <br>Continuing to take Xarelto should maintain its therapeutic effect; if there are any changes in efficacy, you can schedule an earlier follow-up for evaluation. <br>2. <br>Most vaccine-related side effects occur

If vaccination can exacerbate ankylosing spondylitis, would the worsening typically begin three months later?

Hello Doctor, I have ankylosing spondylitis, and I am currently 19 years old.
I have been suffering from this condition for over 2 years.
I would like to ask you:
1) Is it possible for a patient with ankylosing spondylitis, who has been effectively managing pain and inflammation with Celebrex daily, to suddenly experience a deterioration in their condition without any changes in lifestyle or medication? In other words, can a patient who is currently responding well to Celebrex find that it becomes less effective or ineffective after 2-3 months of continued use?
2) I have received my first dose of the BNT vaccine, and I suspect that my ankylosing spondylitis has worsened since receiving it, but I am not certain, which is why I am hesitant to get the second dose.
I would like to know, if the vaccine could potentially worsen my condition, what is the likelihood that symptoms would begin to worsen 3 months after vaccination? I experienced that for the first 2-3 months after receiving the vaccine, my condition remained manageable with Celebrex, but starting from the third month, the pain returned, and my inflammatory markers worsened.
Thank you, Doctor.

Zhong, 10~19 year old female. Ask Date: 2022/05/19

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses: 1.
Continuing to take Xarelto should maintain its therapeutic effect; if there are any changes in efficacy, you can schedule an earlier follow-up for evaluation.
2.
Most vaccine-related side effects occur within a month; however, some side effects, including rheumatic symptoms, may appear several months later.
Therefore, if you have concerns, please return for a discussion with your physician.
In principle, if the evaluation suggests a possible link to the vaccine, we would recommend receiving a different type of vaccine next time.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, cares about you.

Reply Date: 2022/05/19

More Info

Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, leading to pain and stiffness. It is important to understand that the management of AS often involves a combination of medication, physical therapy, and lifestyle modifications. Your concerns regarding the potential impact of vaccination on your condition are valid and warrant a thorough discussion.

1. Fluctuations in Disease Activity: It is indeed possible for patients with ankylosing spondylitis to experience fluctuations in disease activity, even when they are on a stable medication regimen like Secukinumab (also known as Cosentyx). The reasons for these fluctuations can be multifactorial. Factors such as stress, infections, changes in physical activity, or even seasonal variations can influence the inflammatory process. Additionally, the body’s response to medication can change over time, leading to a situation where a previously effective treatment may seem less effective. This phenomenon is not uncommon in chronic inflammatory diseases, and it is essential to communicate any changes in symptoms to your healthcare provider for appropriate adjustments in your treatment plan.

2. Vaccination and Disease Flare-Ups: Regarding your concerns about the BNT vaccine (Pfizer-BioNTech COVID-19 vaccine), there is currently no strong evidence to suggest that vaccinations trigger flare-ups in ankylosing spondylitis. Vaccines work by stimulating the immune system to produce a response against specific pathogens, and while they can cause mild, temporary side effects (such as fever or fatigue), these are generally short-lived and not indicative of a flare-up of an underlying autoimmune condition. However, it is essential to recognize that individual responses to vaccines can vary. Some patients may report changes in their symptoms following vaccination, but this could be coincidental rather than causative.

3. Timing of Symptoms: The timeline you described—where symptoms worsened approximately three months after vaccination—could be coincidental. It is important to consider other potential triggers for your symptoms during this period. For example, if you experienced increased stress, changes in physical activity, or even an unrelated illness, these could contribute to the resurgence of symptoms. It is crucial to maintain a detailed record of your symptoms, including any changes in medication, lifestyle, or stressors, to help your healthcare provider identify patterns and potential triggers.

4. Next Steps: If you are concerned about the vaccine's impact on your condition, it is advisable to discuss this with your rheumatologist. They can provide personalized advice based on your medical history and current treatment plan. If you decide to proceed with the second dose of the vaccine, it may be beneficial to monitor your symptoms closely and report any significant changes to your healthcare provider.

5. General Recommendations: Continue to adhere to your prescribed medication regimen and maintain regular follow-ups with your healthcare provider. Engaging in physical therapy and exercises tailored for ankylosing spondylitis can also help manage symptoms and improve mobility. Additionally, consider discussing any dietary changes or supplements that may support your overall health and inflammatory response.

In conclusion, while it is understandable to be concerned about the potential effects of vaccination on your ankylosing spondylitis, it is crucial to approach this matter with a comprehensive understanding of your condition and open communication with your healthcare provider. They can help you navigate these concerns and ensure that you receive the best possible care for your ankylosing spondylitis.

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