Background/Purpose: DMARDs, which are essential for controlling the progression of inflammatory arthritis (IA), are mostly immunomodulators that significantly increase the risk of severe infections. Therefore, several vaccinations are recommended for patients receiving these treatments. In the recent pandemic context of Covid-19, vaccination of these patients against SARS-Cov2 seems to be a major issue in their management and is recommended by scientific societies. Better identification of patients reluctant to receive this vaccination would make it possible to adapt the information to encourage their adherence.

Methods: An observational cross-sectional monocentric study in current practice was conducted to include 150 adult patients treated with DMARDs for IA at the rheumatology outpatient clinic of the Hôpital Nord Franche-Comté between June and December 2021. The main objective of this study was to determine the factors associated with refusal of vaccination against SARS-CoV-2. During routine visits, a questionnaire was administered to the patients after obtaining their consent. This questionnaire contained demographic and pathology-related data (type of IA, activity level, disease duration), treatment-related data (type of DMARD, use of corticosteroids, number of targeted therapies, number of DMARD lines), other vaccinations, and recommended follow-ups during IA (gynecological, oral, etc.), as well as diets (vegetarian, vegan, etc.). Patients who did not wish to be vaccinated answered questions regarding the reasons for their refusal. The primary endpoint was willingness to be vaccinated against SARS-CoV-2. The factors associated with willingness or refusal were also studied. Statistical analyses were performed using R++ software (ClinicalTrials.gov Identifier: NCT04970550).

Results: 100 women and 49 men, mean age of 57.9 years, with a mean BMI of 27.0 were included. The percentage of vaccinated patients was 72.5%. There was no difference between vaccinated and non-vaccinated patients in terms of sex, type of current DMARD, number of lines of DMARDs, level of education, other vaccinations (hepatitis, pneumococcus), recommended follow-up (gynecological, dermatological, oral), diet, or use of alternative medicines. The non-vaccinated patients were significantly younger (p=0.03), more worried about adverse effects (among others, cancer, and vaccine-related Covid contamination), and that it triggered a flare-up of IA (all p=0.0004). They had less confidence in the pharmaceutical industry and in new technologies (p=0.0004). They were less likely to be vaccinated against influenza (p=0.003). Their partners were less frequently vaccinated against Covid-19 (p=0.002).

Conclusion: Slightly less than 75% of patients were vaccinated against Covid-19. The factors associated with refusal of vaccination were younger age, unvaccinated spouse, fear of adverse events, and refusal of the influenza vaccination. The type of DMARD or IA (RA, AS, PsA, or other SpA) did not influence the decision to vaccinate. However, non-vaccinated patients were not less compliant with other vaccinations (except for influenza) and follow-up recommendations inherent to their treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/vaccination-against-sars-cov-2-in-inflammatory-arthritis-and-factors-determining-its-decision/