Psoriatic Arthritis

Key clinical point: Axial psoriatic arthritis (PsA) can be categorized as a distinct subtype of PsA because it exhibits clinical and radiological symptoms that are different from those of ankylosing spondylitis (AS) with psoriasis.

Major finding: Compared with patients with AS and psoriasis, patients with human leukocyte antigen (HLA)-B27-negative axial PsA had lesser inflammatory pain (P = .002), anterior uveitis (P = .014), and structural damage (P < .001) along with a higher prevalence of nail disease (P = .009) and were more likely to present with psoriasis before spondyloarthritis onset (P = .020). However, patients with HLA-B27-positive axial PsA vs AS and psoriasis reported lesser structural damage as revealed by Bath Ankylosing Spondylitis Radiology Index scores (P < .001).

Study details: This cross-sectional study included 109 patients with axial PsA and 127 patients with AS and current presentation or a history of skin psoriasis from the REGISPONSER registry.

Disclosures: The REGISPONSER registry is funded by the Spanish Society for Rheumatology. The authors declared no conflicts of interest.

Source: Michelena X et al. Characterising the axial phenotype of psoriatic arthritis: a study comparing axial psoriatic arthritis and ankylosing spondylitis with psoriasis from the REGISPONSER registry. RMD Open. 2022;8:e002513 (Dec 5). Doi: 10.1136/rmdopen-2022-002513

Key clinical point: Axial psoriatic arthritis (PsA) can be categorized as a distinct subtype of PsA because it exhibits clinical and radiological symptoms that are different from those of ankylosing spondylitis (AS) with psoriasis.

Major finding: Compared with patients with AS and psoriasis, patients with human leukocyte antigen (HLA)-B27-negative axial PsA had lesser inflammatory pain (P = .002), anterior uveitis (P = .014), and structural damage (P < .001) along with a higher prevalence of nail disease (P = .009) and were more likely to present with psoriasis before spondyloarthritis onset (P = .020). However, patients with HLA-B27-positive axial PsA vs AS and psoriasis reported lesser structural damage as revealed by Bath Ankylosing Spondylitis Radiology Index scores (P < .001).

Study details: This cross-sectional study included 109 patients with axial PsA and 127 patients with AS and current presentation or a history of skin psoriasis from the REGISPONSER registry.

Disclosures: The REGISPONSER registry is funded by the Spanish Society for Rheumatology. The authors declared no conflicts of interest.

Source: Michelena X et al. Characterising the axial phenotype of psoriatic arthritis: a study comparing axial psoriatic arthritis and ankylosing spondylitis with psoriasis from the REGISPONSER registry. RMD Open. 2022;8:e002513 (Dec 5). Doi: 10.1136/rmdopen-2022-002513

Key clinical point: Axial psoriatic arthritis (PsA) can be categorized as a distinct subtype of PsA because it exhibits clinical and radiological symptoms that are different from those of ankylosing spondylitis (AS) with psoriasis.

Major finding: Compared with patients with AS and psoriasis, patients with human leukocyte antigen (HLA)-B27-negative axial PsA had lesser inflammatory pain (P = .002), anterior uveitis (P = .014), and structural damage (P < .001) along with a higher prevalence of nail disease (P = .009) and were more likely to present with psoriasis before spondyloarthritis onset (P = .020). However, patients with HLA-B27-positive axial PsA vs AS and psoriasis reported lesser structural damage as revealed by Bath Ankylosing Spondylitis Radiology Index scores (P < .001).

Study details: This cross-sectional study included 109 patients with axial PsA and 127 patients with AS and current presentation or a history of skin psoriasis from the REGISPONSER registry.

Disclosures: The REGISPONSER registry is funded by the Spanish Society for Rheumatology. The authors declared no conflicts of interest.

Source: Michelena X et al. Characterising the axial phenotype of psoriatic arthritis: a study comparing axial psoriatic arthritis and ankylosing spondylitis with psoriasis from the REGISPONSER registry. RMD Open. 2022;8:e002513 (Dec 5). Doi: 10.1136/rmdopen-2022-002513

Key clinical point: Smoking and alcohol consumption were associated with a lower prevalence of arthritis and peripheral manifestations in patients with psoriatic arthritis (PsA).

Major finding: Smoking was associated with a lower prevalence of arthritis ever (odds ratio [OR] 0.63; 95% CI 0.41-0.95), and current alcohol consumption was associated with a lower prevalence of current arthritis or enthesitis (OR 0.61; 95% CI 0.47-0.79), current arthritis alone (OR 0.69; 95% CI 0.53-0.90), and current enthesitis alone (OR 0.49; 95% CI, 0.34-0.71).

Study details: Findings are from a multinational, cross-sectional study including patients with axial spondyloarthritis (n = 2717), peripheral spondyloarthritis (n = 432), and PsA (n = 1032).

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Ladehesa-Pineda ML et al. Smoking and alcohol consumption are associated with peripheral musculoskeletal involvement in patients with spondyloarthritis (including psoriatic arthritis). Results from the ASAS-PerSpA study. Semin Arthritis Rheum. 2022;58:152146 (Nov 30). Doi: 10.1016/j.semarthrit.2022.152146

Key clinical point: Smoking and alcohol consumption were associated with a lower prevalence of arthritis and peripheral manifestations in patients with psoriatic arthritis (PsA).

Major finding: Smoking was associated with a lower prevalence of arthritis ever (odds ratio [OR] 0.63; 95% CI 0.41-0.95), and current alcohol consumption was associated with a lower prevalence of current arthritis or enthesitis (OR 0.61; 95% CI 0.47-0.79), current arthritis alone (OR 0.69; 95% CI 0.53-0.90), and current enthesitis alone (OR 0.49; 95% CI, 0.34-0.71).

Study details: Findings are from a multinational, cross-sectional study including patients with axial spondyloarthritis (n = 2717), peripheral spondyloarthritis (n = 432), and PsA (n = 1032).

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Ladehesa-Pineda ML et al. Smoking and alcohol consumption are associated with peripheral musculoskeletal involvement in patients with spondyloarthritis (including psoriatic arthritis). Results from the ASAS-PerSpA study. Semin Arthritis Rheum. 2022;58:152146 (Nov 30). Doi: 10.1016/j.semarthrit.2022.152146

Key clinical point: Smoking and alcohol consumption were associated with a lower prevalence of arthritis and peripheral manifestations in patients with psoriatic arthritis (PsA).

Major finding: Smoking was associated with a lower prevalence of arthritis ever (odds ratio [OR] 0.63; 95% CI 0.41-0.95), and current alcohol consumption was associated with a lower prevalence of current arthritis or enthesitis (OR 0.61; 95% CI 0.47-0.79), current arthritis alone (OR 0.69; 95% CI 0.53-0.90), and current enthesitis alone (OR 0.49; 95% CI, 0.34-0.71).

Study details: Findings are from a multinational, cross-sectional study including patients with axial spondyloarthritis (n = 2717), peripheral spondyloarthritis (n = 432), and PsA (n = 1032).

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Ladehesa-Pineda ML et al. Smoking and alcohol consumption are associated with peripheral musculoskeletal involvement in patients with spondyloarthritis (including psoriatic arthritis). Results from the ASAS-PerSpA study. Semin Arthritis Rheum. 2022;58:152146 (Nov 30). Doi: 10.1016/j.semarthrit.2022.152146

Key clinical point: Cognitive abilities were altered in patients with psoriatic arthritis (PsA) compared with non-rheumatology reference individuals, with significant impairment in selective attention.

Major finding: Patients with PsA reported significant deficits in selective attention (mean difference [MD] −4.5), no effect on working memory (P = .662) and improvement in episodic short-term memory (MD 3.0; both P < .001) compared with matched reference subjects.

Study details: Findings are from a cross-sectional, exploratory study including 101 patients with axial spondyloarthritis, 117 patients with PsA, and matched non-rheumatology reference subjects without any diseases relevant to cognitive performance.

Disclosures: This study was funded by the RHADAR GbR, Germany. Some authors, including the lead author, declared receiving grants, consulting fees, speaker’s fees, travel support, honoraria, or advisory board support from several sources.

Source: Kleinert S et al. Impairment in cognitive function in patients with axial spondyloarthritis and psoriatic arthritis. Rheumatol Int. 2022 (Nov 28). Doi: 10.1007/s00296-022-05248-4

Key clinical point: Cognitive abilities were altered in patients with psoriatic arthritis (PsA) compared with non-rheumatology reference individuals, with significant impairment in selective attention.

Major finding: Patients with PsA reported significant deficits in selective attention (mean difference [MD] −4.5), no effect on working memory (P = .662) and improvement in episodic short-term memory (MD 3.0; both P < .001) compared with matched reference subjects.

Study details: Findings are from a cross-sectional, exploratory study including 101 patients with axial spondyloarthritis, 117 patients with PsA, and matched non-rheumatology reference subjects without any diseases relevant to cognitive performance.

Disclosures: This study was funded by the RHADAR GbR, Germany. Some authors, including the lead author, declared receiving grants, consulting fees, speaker’s fees, travel support, honoraria, or advisory board support from several sources.

Source: Kleinert S et al. Impairment in cognitive function in patients with axial spondyloarthritis and psoriatic arthritis. Rheumatol Int. 2022 (Nov 28). Doi: 10.1007/s00296-022-05248-4

Key clinical point: Cognitive abilities were altered in patients with psoriatic arthritis (PsA) compared with non-rheumatology reference individuals, with significant impairment in selective attention.

Major finding: Patients with PsA reported significant deficits in selective attention (mean difference [MD] −4.5), no effect on working memory (P = .662) and improvement in episodic short-term memory (MD 3.0; both P < .001) compared with matched reference subjects.

Study details: Findings are from a cross-sectional, exploratory study including 101 patients with axial spondyloarthritis, 117 patients with PsA, and matched non-rheumatology reference subjects without any diseases relevant to cognitive performance.

Disclosures: This study was funded by the RHADAR GbR, Germany. Some authors, including the lead author, declared receiving grants, consulting fees, speaker’s fees, travel support, honoraria, or advisory board support from several sources.

Source: Kleinert S et al. Impairment in cognitive function in patients with axial spondyloarthritis and psoriatic arthritis. Rheumatol Int. 2022 (Nov 28). Doi: 10.1007/s00296-022-05248-4

Key clinical point: Increasing disease activity and joint damage were significant risk factors for requiring musculoskeletal (MSK) surgery in patients with psoriatic arthritis (PsA).

Major finding: A greater number of damaged joints (hazard ratio [HR] 1.032; P < .001), presence of nail lesions (HR 2.079; P < .006), higher health assessment questionnaire scores (HR 2.012; P < .001), an elevated erythrocyte sedimentation rate (HR 2.365; P = .017), a greater number of actively inflamed joints (HR 1.037; P = .007), and human leukocyte antigen-B*27 positivity (HR 2.217; P = .048) were associated with an increased risk for surgery.

Study details: Findings are from a longitudinal, observational cohort study including 1574 patients with PsA, of which 11.8% underwent ≥1 MSK surgery attributable to PsA.

Disclosures: This study was supported by the Krembil Foundation, Toronto. The authors declared no conflicts of interest.

Source: Kwok TSH et al. Musculoskeletal surgery in psoriatic arthritis: Prevalence and risk factors. J Rheumatol. 2022 (Nov 15). Doi: 10.3899/jrheum.220908

Key clinical point: Increasing disease activity and joint damage were significant risk factors for requiring musculoskeletal (MSK) surgery in patients with psoriatic arthritis (PsA).

Major finding: A greater number of damaged joints (hazard ratio [HR] 1.032; P < .001), presence of nail lesions (HR 2.079; P < .006), higher health assessment questionnaire scores (HR 2.012; P < .001), an elevated erythrocyte sedimentation rate (HR 2.365; P = .017), a greater number of actively inflamed joints (HR 1.037; P = .007), and human leukocyte antigen-B*27 positivity (HR 2.217; P = .048) were associated with an increased risk for surgery.

Study details: Findings are from a longitudinal, observational cohort study including 1574 patients with PsA, of which 11.8% underwent ≥1 MSK surgery attributable to PsA.

Disclosures: This study was supported by the Krembil Foundation, Toronto. The authors declared no conflicts of interest.

Source: Kwok TSH et al. Musculoskeletal surgery in psoriatic arthritis: Prevalence and risk factors. J Rheumatol. 2022 (Nov 15). Doi: 10.3899/jrheum.220908

Key clinical point: Increasing disease activity and joint damage were significant risk factors for requiring musculoskeletal (MSK) surgery in patients with psoriatic arthritis (PsA).

Major finding: A greater number of damaged joints (hazard ratio [HR] 1.032; P < .001), presence of nail lesions (HR 2.079; P < .006), higher health assessment questionnaire scores (HR 2.012; P < .001), an elevated erythrocyte sedimentation rate (HR 2.365; P = .017), a greater number of actively inflamed joints (HR 1.037; P = .007), and human leukocyte antigen-B*27 positivity (HR 2.217; P = .048) were associated with an increased risk for surgery.

Study details: Findings are from a longitudinal, observational cohort study including 1574 patients with PsA, of which 11.8% underwent ≥1 MSK surgery attributable to PsA.

Disclosures: This study was supported by the Krembil Foundation, Toronto. The authors declared no conflicts of interest.

Source: Kwok TSH et al. Musculoskeletal surgery in psoriatic arthritis: Prevalence and risk factors. J Rheumatol. 2022 (Nov 15). Doi: 10.3899/jrheum.220908

Key clinical point: Psoriatic arthritis (PsA) was positively associated with Crohn’s disease and genetically predicted Crohn’s disease was associated with an increased risk for PsA, indicating a bidirectional causal relationship between the 2 diseases.

Major finding: PsA was associated with a 31.9% increased risk for Crohn’s disease (odds ratio [OR] 1.319; P < .001) and genetically predicted Crohn’s disease was linked to a 44.8% higher risk for PsA (OR 1.448; P = .001).

Study details: Findings are from a bidirectional 2-sample mendelian randomization study including 4510 patients with psoriasis, 1637 patients with PsA, and 212,242 control individuals along with 657 patients with Crohn’s disease, 2251 patients with ulcerative colitis, and 210,300 control individuals.

Disclosures: This study did not report the source of funding. The authors declared no conflicts of interest.

Source: Sun Y et al. The causal relationship between psoriasis, psoriatic arthritis, and inflammatory bowel diseases. Sci Rep. 2022;12:20526 (Nov 28). Doi: 10.1038/s41598-022-24872-5

Key clinical point: Psoriatic arthritis (PsA) was positively associated with Crohn’s disease and genetically predicted Crohn’s disease was associated with an increased risk for PsA, indicating a bidirectional causal relationship between the 2 diseases.

Major finding: PsA was associated with a 31.9% increased risk for Crohn’s disease (odds ratio [OR] 1.319; P < .001) and genetically predicted Crohn’s disease was linked to a 44.8% higher risk for PsA (OR 1.448; P = .001).

Study details: Findings are from a bidirectional 2-sample mendelian randomization study including 4510 patients with psoriasis, 1637 patients with PsA, and 212,242 control individuals along with 657 patients with Crohn’s disease, 2251 patients with ulcerative colitis, and 210,300 control individuals.

Disclosures: This study did not report the source of funding. The authors declared no conflicts of interest.

Source: Sun Y et al. The causal relationship between psoriasis, psoriatic arthritis, and inflammatory bowel diseases. Sci Rep. 2022;12:20526 (Nov 28). Doi: 10.1038/s41598-022-24872-5

Key clinical point: Psoriatic arthritis (PsA) was positively associated with Crohn’s disease and genetically predicted Crohn’s disease was associated with an increased risk for PsA, indicating a bidirectional causal relationship between the 2 diseases.

Major finding: PsA was associated with a 31.9% increased risk for Crohn’s disease (odds ratio [OR] 1.319; P < .001) and genetically predicted Crohn’s disease was linked to a 44.8% higher risk for PsA (OR 1.448; P = .001).

Study details: Findings are from a bidirectional 2-sample mendelian randomization study including 4510 patients with psoriasis, 1637 patients with PsA, and 212,242 control individuals along with 657 patients with Crohn’s disease, 2251 patients with ulcerative colitis, and 210,300 control individuals.

Disclosures: This study did not report the source of funding. The authors declared no conflicts of interest.

Source: Sun Y et al. The causal relationship between psoriasis, psoriatic arthritis, and inflammatory bowel diseases. Sci Rep. 2022;12:20526 (Nov 28). Doi: 10.1038/s41598-022-24872-5

Key clinical point: Nailfold capillary abnormalities were more prevalent in patients with psoriatic arthritis (PsA) than in patients with psoriasis vulgaris (PsV) and predicted the development of PsA in patients with psoriasis.

Major finding: Nailfold bleeding (NFB; 84.5% vs 34.7%) and enlarged capillaries (100.0% vs 25.4%; both P < .0001) were more prevalent in patients with PsA vs PsV, with both NFB (hazard ratio [HR] 2.75; P = .004) and enlarged capillaries (HR 4.49; P < .0001) predicting the development of PsA in patients with PsV.

Study details: Findings are from a prospective cohort study including 236 patients with PsV and 213 patients with PsA.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Fukasawa T et al. Utility of nailfold capillary assessment for predicting psoriatic arthritis based on a prospective observational cohort study. Rheumatology (Oxford). 2022 (Nov 28). Doi: 10.1093/rheumatology/keac664

Key clinical point: Nailfold capillary abnormalities were more prevalent in patients with psoriatic arthritis (PsA) than in patients with psoriasis vulgaris (PsV) and predicted the development of PsA in patients with psoriasis.

Major finding: Nailfold bleeding (NFB; 84.5% vs 34.7%) and enlarged capillaries (100.0% vs 25.4%; both P < .0001) were more prevalent in patients with PsA vs PsV, with both NFB (hazard ratio [HR] 2.75; P = .004) and enlarged capillaries (HR 4.49; P < .0001) predicting the development of PsA in patients with PsV.

Study details: Findings are from a prospective cohort study including 236 patients with PsV and 213 patients with PsA.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Fukasawa T et al. Utility of nailfold capillary assessment for predicting psoriatic arthritis based on a prospective observational cohort study. Rheumatology (Oxford). 2022 (Nov 28). Doi: 10.1093/rheumatology/keac664

Key clinical point: Nailfold capillary abnormalities were more prevalent in patients with psoriatic arthritis (PsA) than in patients with psoriasis vulgaris (PsV) and predicted the development of PsA in patients with psoriasis.

Major finding: Nailfold bleeding (NFB; 84.5% vs 34.7%) and enlarged capillaries (100.0% vs 25.4%; both P < .0001) were more prevalent in patients with PsA vs PsV, with both NFB (hazard ratio [HR] 2.75; P = .004) and enlarged capillaries (HR 4.49; P < .0001) predicting the development of PsA in patients with PsV.

Study details: Findings are from a prospective cohort study including 236 patients with PsV and 213 patients with PsA.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Fukasawa T et al. Utility of nailfold capillary assessment for predicting psoriatic arthritis based on a prospective observational cohort study. Rheumatology (Oxford). 2022 (Nov 28). Doi: 10.1093/rheumatology/keac664

Key clinical point: Bimekizumab improved the signs and symptoms of psoriatic arthritis (PsA) in patients with previous inadequate response to or intolerance of tumor necrosis factor-alpha (TNFα) inhibitors without causing any unprecedented adverse events (AE).

Major finding: At week 16, a significantly higher proportion of patients receiving bimekizumab vs placebo achieved ≥50% improvement in American College of Rheumatology response (43% vs 7%; odds ratio 11.1; P < .0001), with treatment-emergent AE being reported by 40% of patients receiving bimekizumab and 33% of patients receiving placebo.

Study details: Findings are from the multicenter, phase 3 BE COMPLETE study including 400 patients with active PsA and previous inadequate response to or intolerance of TNFα inhibitors who were randomly assigned to receive 160 mg subcutaneous bimekizumab every 4 weeks or placebo.

Disclosures: This study was funded by UCB Pharma. Five authors declared being employees and shareholders of UCB Pharma, and the other authors reported ties with several sources, including UCB Pharma.

Source: Merola JF et al. Bimekizumab in patients with active psoriatic arthritis and previous inadequate response or intolerance to tumour necrosis factor-α inhibitors: A randomised, double-blind, placebo-controlled, phase 3 trial (BE COMPLETE). Lancet. 2022 (Dec 6). Doi: 10.1016/S0140-6736(22)02303-0

Key clinical point: Bimekizumab improved the signs and symptoms of psoriatic arthritis (PsA) in patients with previous inadequate response to or intolerance of tumor necrosis factor-alpha (TNFα) inhibitors without causing any unprecedented adverse events (AE).

Major finding: At week 16, a significantly higher proportion of patients receiving bimekizumab vs placebo achieved ≥50% improvement in American College of Rheumatology response (43% vs 7%; odds ratio 11.1; P < .0001), with treatment-emergent AE being reported by 40% of patients receiving bimekizumab and 33% of patients receiving placebo.

Study details: Findings are from the multicenter, phase 3 BE COMPLETE study including 400 patients with active PsA and previous inadequate response to or intolerance of TNFα inhibitors who were randomly assigned to receive 160 mg subcutaneous bimekizumab every 4 weeks or placebo.

Disclosures: This study was funded by UCB Pharma. Five authors declared being employees and shareholders of UCB Pharma, and the other authors reported ties with several sources, including UCB Pharma.

Source: Merola JF et al. Bimekizumab in patients with active psoriatic arthritis and previous inadequate response or intolerance to tumour necrosis factor-α inhibitors: A randomised, double-blind, placebo-controlled, phase 3 trial (BE COMPLETE). Lancet. 2022 (Dec 6). Doi: 10.1016/S0140-6736(22)02303-0

Key clinical point: Bimekizumab improved the signs and symptoms of psoriatic arthritis (PsA) in patients with previous inadequate response to or intolerance of tumor necrosis factor-alpha (TNFα) inhibitors without causing any unprecedented adverse events (AE).

Major finding: At week 16, a significantly higher proportion of patients receiving bimekizumab vs placebo achieved ≥50% improvement in American College of Rheumatology response (43% vs 7%; odds ratio 11.1; P < .0001), with treatment-emergent AE being reported by 40% of patients receiving bimekizumab and 33% of patients receiving placebo.

Study details: Findings are from the multicenter, phase 3 BE COMPLETE study including 400 patients with active PsA and previous inadequate response to or intolerance of TNFα inhibitors who were randomly assigned to receive 160 mg subcutaneous bimekizumab every 4 weeks or placebo.

Disclosures: This study was funded by UCB Pharma. Five authors declared being employees and shareholders of UCB Pharma, and the other authors reported ties with several sources, including UCB Pharma.

Source: Merola JF et al. Bimekizumab in patients with active psoriatic arthritis and previous inadequate response or intolerance to tumour necrosis factor-α inhibitors: A randomised, double-blind, placebo-controlled, phase 3 trial (BE COMPLETE). Lancet. 2022 (Dec 6). Doi: 10.1016/S0140-6736(22)02303-0

Key clinical point: A booster dose of BNT162b2 messenger ribonucleic acid (mRNA) SARS-CoV-2 vaccine (BioNTech-Pfizer) restored the anti-SARS-CoV-2 immunoglobulin G (IgG) levels in patients with psoriatic arthritis (PsA) who were receiving tumor necrosis factor (TNF) inhibitors.

Major finding: Although the mean anti-SARS-CoV-2 IgG levels were significantly lower in patients with PsA vs matched control individuals (2009.22 vs 6206.59 AU/mL; P = .0006) 4 months after two doses of vaccination, the mean IgG levels were similar between both groups after the booster dose (P = .20).

Study details: Findings are from a prospective study including 40 patients with PsA on TNF inhibitors and 40 matched control individuals who received two shots of the BNT162b2 mRNA vaccine.

Disclosures: This study did not report the source of funding. The authors declared no conflicts of interest.

Source: Venerito V et al. Anti-SARS-CoV-2 antibody decay after vaccination and immunogenicity of the booster dose of the BNT162b2 mRNA vaccine in patients with psoriatic arthritis on TNF inhibitors. Clin Exp Rheumatol. 2022 (Nov 24). Doi: 10.55563/clinexprheumatol/hptln9

Key clinical point: A booster dose of BNT162b2 messenger ribonucleic acid (mRNA) SARS-CoV-2 vaccine (BioNTech-Pfizer) restored the anti-SARS-CoV-2 immunoglobulin G (IgG) levels in patients with psoriatic arthritis (PsA) who were receiving tumor necrosis factor (TNF) inhibitors.

Major finding: Although the mean anti-SARS-CoV-2 IgG levels were significantly lower in patients with PsA vs matched control individuals (2009.22 vs 6206.59 AU/mL; P = .0006) 4 months after two doses of vaccination, the mean IgG levels were similar between both groups after the booster dose (P = .20).

Study details: Findings are from a prospective study including 40 patients with PsA on TNF inhibitors and 40 matched control individuals who received two shots of the BNT162b2 mRNA vaccine.

Disclosures: This study did not report the source of funding. The authors declared no conflicts of interest.

Source: Venerito V et al. Anti-SARS-CoV-2 antibody decay after vaccination and immunogenicity of the booster dose of the BNT162b2 mRNA vaccine in patients with psoriatic arthritis on TNF inhibitors. Clin Exp Rheumatol. 2022 (Nov 24). Doi: 10.55563/clinexprheumatol/hptln9

Key clinical point: A booster dose of BNT162b2 messenger ribonucleic acid (mRNA) SARS-CoV-2 vaccine (BioNTech-Pfizer) restored the anti-SARS-CoV-2 immunoglobulin G (IgG) levels in patients with psoriatic arthritis (PsA) who were receiving tumor necrosis factor (TNF) inhibitors.

Major finding: Although the mean anti-SARS-CoV-2 IgG levels were significantly lower in patients with PsA vs matched control individuals (2009.22 vs 6206.59 AU/mL; P = .0006) 4 months after two doses of vaccination, the mean IgG levels were similar between both groups after the booster dose (P = .20).

Study details: Findings are from a prospective study including 40 patients with PsA on TNF inhibitors and 40 matched control individuals who received two shots of the BNT162b2 mRNA vaccine.

Disclosures: This study did not report the source of funding. The authors declared no conflicts of interest.

Source: Venerito V et al. Anti-SARS-CoV-2 antibody decay after vaccination and immunogenicity of the booster dose of the BNT162b2 mRNA vaccine in patients with psoriatic arthritis on TNF inhibitors. Clin Exp Rheumatol. 2022 (Nov 24). Doi: 10.55563/clinexprheumatol/hptln9

Key clinical point: Bimekizumab demonstrated superior efficacy outcomes compared with placebo and was well-tolerated with a consistent safety profile in patients with active psoriatic arthritis (PsA) who were naive to biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: At week 16, a significantly higher proportion of patients receiving bimekizumab vs placebo achieved ≥50% improvement in American College of Rheumatology response (44% vs 10%; odds ratio 7.1; P < .0001). Treatment-emergent adverse events were reported by 60% vs 49% of patients in the bimekizumab vs placebo arm, respectively, and no deaths occurred.

Study details: Findings are from the phase 3 BE OPTIMAL study including 852 patients with active PsA who were naive to bDMARD and were randomly assigned to receive bimekizumab, placebo, or adalimumab.

Disclosures: This study was funded by UCB Pharma. Five authors declared being employees and shareholders of UCB Pharma, and the other authors declared receiving grants, fees, honoraria, or having other ties with several sources, including UCB Pharma.

Source: McInnes IB et al. Bimekizumab in patients with psoriatic arthritis, naive to biologic treatment: A randomised, double-blind, placebo-controlled, phase 3 trial (BE OPTIMAL). Lancet. 2022 (Dec 5). Doi: 10.1016/S0140-6736(22)02302-9

Key clinical point: Bimekizumab demonstrated superior efficacy outcomes compared with placebo and was well-tolerated with a consistent safety profile in patients with active psoriatic arthritis (PsA) who were naive to biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: At week 16, a significantly higher proportion of patients receiving bimekizumab vs placebo achieved ≥50% improvement in American College of Rheumatology response (44% vs 10%; odds ratio 7.1; P < .0001). Treatment-emergent adverse events were reported by 60% vs 49% of patients in the bimekizumab vs placebo arm, respectively, and no deaths occurred.

Study details: Findings are from the phase 3 BE OPTIMAL study including 852 patients with active PsA who were naive to bDMARD and were randomly assigned to receive bimekizumab, placebo, or adalimumab.

Disclosures: This study was funded by UCB Pharma. Five authors declared being employees and shareholders of UCB Pharma, and the other authors declared receiving grants, fees, honoraria, or having other ties with several sources, including UCB Pharma.

Source: McInnes IB et al. Bimekizumab in patients with psoriatic arthritis, naive to biologic treatment: A randomised, double-blind, placebo-controlled, phase 3 trial (BE OPTIMAL). Lancet. 2022 (Dec 5). Doi: 10.1016/S0140-6736(22)02302-9

Key clinical point: Bimekizumab demonstrated superior efficacy outcomes compared with placebo and was well-tolerated with a consistent safety profile in patients with active psoriatic arthritis (PsA) who were naive to biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: At week 16, a significantly higher proportion of patients receiving bimekizumab vs placebo achieved ≥50% improvement in American College of Rheumatology response (44% vs 10%; odds ratio 7.1; P < .0001). Treatment-emergent adverse events were reported by 60% vs 49% of patients in the bimekizumab vs placebo arm, respectively, and no deaths occurred.

Study details: Findings are from the phase 3 BE OPTIMAL study including 852 patients with active PsA who were naive to bDMARD and were randomly assigned to receive bimekizumab, placebo, or adalimumab.

Disclosures: This study was funded by UCB Pharma. Five authors declared being employees and shareholders of UCB Pharma, and the other authors declared receiving grants, fees, honoraria, or having other ties with several sources, including UCB Pharma.

Source: McInnes IB et al. Bimekizumab in patients with psoriatic arthritis, naive to biologic treatment: A randomised, double-blind, placebo-controlled, phase 3 trial (BE OPTIMAL). Lancet. 2022 (Dec 5). Doi: 10.1016/S0140-6736(22)02302-9

Patients with rheumatic disease are at least half as likely to develop long COVID after a SARS-CoV-2 infection if they have been fully vaccinated against COVID-19, according to research published in Annals of the Rheumatic Diseases (2022 Nov 28. doi: 10.1136/ard-2022-223439).

“Moreover, those who were vaccinated prior to getting COVID-19 had less pain and fatigue after their infection,” Zachary S. Wallace, MD, MSc, an assistant professor of medicine at Harvard Medical School, Boston, and a study author, said in an interview. “These findings reinforce the importance of vaccination in this population.”

Messaging around the value of COVID vaccination has been confusing for some with rheumatic disease “because our concern regarding a blunted response to vaccination has led many patients to think that they do not provide much benefit if they are on immunosuppression,” Dr. Wallace said. “In our cohort, which included many patients on immunosuppression of varying degrees, being vaccinated was quite beneficial.”

Leonard H. Calabrese, DO, director of the R.J. Fasenmyer Center for Clinical Immunology and a professor of medicine at the Cleveland Clinic, said in an interview that the study is an “extremely important contribution to our understanding of COVID-19 and its pattern of recovery in patients with immune-mediated inflammatory diseases [IMIDs].” Remaining unanswered questions are “whether patients with IMIDs develop more frequent PASC [post–acute sequelae of COVID-19] from COVID-19 and, if so, is it milder or more severe, and does it differ in its clinical phenotype?”
 

Long COVID risk assessed at 4 weeks and 3 months after infection

The researchers prospectively tracked 280 adult patients in the Mass General Brigham health care system in the greater Boston area who had systemic autoimmune rheumatic diseases and had an acute COVID-19 infection between March 2020 and July 2022. Patients were an average 53 years old, and most were White (82%) and female (80%). More than half (59%) had inflammatory arthritis, a quarter (24%) had connective tissue disease, and most others had a vasculitis condition or multiple conditions.

filadendron/E+/Getty Images

A total of 11% of patients were unvaccinated, 28% were partially vaccinated with one mRNA COVID-19 vaccine dose, and 41% were fully vaccinated with two mRNA vaccine doses or one Johnson & Johnson dose. The 116 fully vaccinated patients were considered to have a breakthrough infection while the other 164 were considered to have a nonbreakthrough infection. The breakthrough and nonbreakthrough groups were similar in terms of age, sex, race, ethnicity, smoking status, and type of rheumatic disease. Comorbidities were also similar, except obesity, which was more common in the non–breakthrough infection group (25%) than the breakthrough infection group (10%).

The researchers queried patients on their COVID-19 symptoms, how long symptoms lasted, treatments they received, and hospitalization details. COVID-19 symptoms assessed included fever, sore throat, new cough, nasal congestion/rhinorrhea, dyspnea, chest pain, rash, myalgia, fatigue/malaise, headache, nausea/vomiting, diarrhea, anosmia, dysgeusia, and joint pain.

Patients completed surveys about symptoms at 4 weeks and 3 months after infection. Long COVID, or PASC, was defined as any persistent symptom at the times assessed.
 

Vaccinated patients fared better across outcomes

At 4 weeks after infection, 41% of fully vaccinated patients had at least one persistent symptom, compared with 54% of unvaccinated or partially vaccinated patients (P = .04). At 3 months after infection, 21% of fully vaccinated patients had at least one persistent symptom, compared with 41% of unvaccinated or partially vaccinated patients (P < .0001).

Vaccinated patients were half as likely to have long COVID at 4 weeks after infection (adjusted odds ratio, 0.49) and 90% less likely to have long COVID 3 months after infection (aOR, 0.1), after adjustment for age, sex, race, comorbidities, and use of any of four immune-suppressing medications (anti-CD20 monoclonal antibodies, methotrexate, mycophenolate, or glucocorticoids).

Fully vaccinated patients with breakthrough infections had an average 21 additional days without symptoms during follow-up, compared with unvaccinated and partially vaccinated patients (P = .04).

Reduced risk of long COVID did not change for vaccinated patients after sensitivity analyses for those who did not receive nirmatrelvir/ritonavir (Paxlovid) or monoclonal antibodies, those who didn’t receive any COVID-19-related treatment, those who completed their questionnaires within 6 months after infection, and those who were not hospitalized.

“One important message is that among those who did get PASC, the severity appears similar among those with and without a breakthrough infection,” Dr. Wallace said. “This highlights the need for ongoing research to improve recognition, diagnosis, and treatment of PASC.”

Many more breakthrough infections (72%) than nonbreakthrough infections (2%) occurred during Omicron. The authors acknowledged that different variants might play a role in different long COVID risks but said such potential confounding is unlikely to fully explain the results.

“Even with data suggesting that the Omicron variants may be intrinsically less severe, vaccination still has an impact on severity of infection, rates of hospitalization, and other outcomes and thus may play a role in the risk of PASC,” lead author Naomi Patel, MD, an instructor at Harvard Medical School and a rheumatologist at Massachusetts General Hospital, said in an interview. “A study evaluating the proportions with PASC by vaccination status during the time in which a single variant is predominant, such as the early Omicron era, could help to better assess the more isolated impact of vaccination on PASC.”

Dr. Calabrese said he is convinced that Omicron infections are less likely to result in more severe forms of acute COVID than pre-Omicron infections, and he suspects Omicron infections are also less likely to result in long COVID, although less evidence currently supports this hypothesis.

Hospitalization was more common in unvaccinated/partly vaccinated patients than in vaccinated patients (27% vs. 5%; P = .001). Although pain and fatigue were lower in those with breakthrough infections, functional scores and health-related quality of life were similar in both groups.

Some symptoms significantly differed between vaccinated and unvaccinated/partly vaccinated groups, possibly caused partly by different variants. Nasal congestion was more common (73%) in those with breakthrough infections than in those with nonbreakthrough infections (46%; P < .0001). Those who were unvaccinated/partly vaccinated were significantly more likely to have loss of smell (46% vs. 22%) or taste (45% vs. 28%) or to have joint pain (11% vs. 4%).

Treatment with nirmatrelvir/ritonavir was also more common in vaccinated patients (12%) than in unvaccinated/partly vaccinated patients (1%; P < .0001), as was treatment with monoclonal antibodies (34% vs. 8%; P < .0001).

The study was limited by its low diversity and being at a single health care system, the authors said. Study coauthor Jeffrey A. Sparks, MD, MMSc, an assistant professor of medicine at Brigham and Women’s Hospital and Harvard Medical School, said in an interview that the group is planning additional studies as their cohort grows, including “investigating the relationships between COVID-19 and specific rheumatic diseases and immunomodulating medications, expansion of autoimmunity and systemic inflammation, and lung damage among specific patient populations.”

Dr. Calabrese said it will be important for follow-up study of the symptomatic patients to “determine how many of these patients will fit the clinical picture of long COVID or long-haul phenotypes over the months and years ahead, including documenting exertional malaise and quality of life.

This study only assessed patients who received zero, one, or two doses of a vaccine, but many patients with rheumatic disease today will likely have received booster doses. However, Dr. Calabrese said it would be difficult to quantify whether a third, fourth, or fifth dose offers additional protection from long-term COVID complications after full vaccination or hybrid vaccination.

The research was funded by the Rheumatology Research Foundation, the National Institutes of Health, the R. Bruce and Joan M. Mickey Research Scholar Fund, and the Llura Gund Award for Rheumatoid Arthritis Research and Care. Dr. Wallace has received research support from Bristol-Myers Squibb and Principia/Sanofi and consulting fees from Zenas BioPharma, Horizon, Sanofi, Shionogi, Viela Bio, and Medpace. Dr. Sparks has received research support from Bristol-Myers Squibb and consulting fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, Inova Diagnostics, Janssen, Optum, and Pfizer. Dr. Patel has received consulting fees from FVC Health. Calabrese has consulted for Genentech, Sanofi-Regeneron, AstraZeneca, and GlaxoSmithKline.

A version of this article first appeared on Medscape.com.

Patients with rheumatic disease are at least half as likely to develop long COVID after a SARS-CoV-2 infection if they have been fully vaccinated against COVID-19, according to research published in Annals of the Rheumatic Diseases (2022 Nov 28. doi: 10.1136/ard-2022-223439).

“Moreover, those who were vaccinated prior to getting COVID-19 had less pain and fatigue after their infection,” Zachary S. Wallace, MD, MSc, an assistant professor of medicine at Harvard Medical School, Boston, and a study author, said in an interview. “These findings reinforce the importance of vaccination in this population.”

Messaging around the value of COVID vaccination has been confusing for some with rheumatic disease “because our concern regarding a blunted response to vaccination has led many patients to think that they do not provide much benefit if they are on immunosuppression,” Dr. Wallace said. “In our cohort, which included many patients on immunosuppression of varying degrees, being vaccinated was quite beneficial.”

Leonard H. Calabrese, DO, director of the R.J. Fasenmyer Center for Clinical Immunology and a professor of medicine at the Cleveland Clinic, said in an interview that the study is an “extremely important contribution to our understanding of COVID-19 and its pattern of recovery in patients with immune-mediated inflammatory diseases [IMIDs].” Remaining unanswered questions are “whether patients with IMIDs develop more frequent PASC [post–acute sequelae of COVID-19] from COVID-19 and, if so, is it milder or more severe, and does it differ in its clinical phenotype?”
 

Long COVID risk assessed at 4 weeks and 3 months after infection

The researchers prospectively tracked 280 adult patients in the Mass General Brigham health care system in the greater Boston area who had systemic autoimmune rheumatic diseases and had an acute COVID-19 infection between March 2020 and July 2022. Patients were an average 53 years old, and most were White (82%) and female (80%). More than half (59%) had inflammatory arthritis, a quarter (24%) had connective tissue disease, and most others had a vasculitis condition or multiple conditions.

filadendron/E+/Getty Images

A total of 11% of patients were unvaccinated, 28% were partially vaccinated with one mRNA COVID-19 vaccine dose, and 41% were fully vaccinated with two mRNA vaccine doses or one Johnson & Johnson dose. The 116 fully vaccinated patients were considered to have a breakthrough infection while the other 164 were considered to have a nonbreakthrough infection. The breakthrough and nonbreakthrough groups were similar in terms of age, sex, race, ethnicity, smoking status, and type of rheumatic disease. Comorbidities were also similar, except obesity, which was more common in the non–breakthrough infection group (25%) than the breakthrough infection group (10%).

The researchers queried patients on their COVID-19 symptoms, how long symptoms lasted, treatments they received, and hospitalization details. COVID-19 symptoms assessed included fever, sore throat, new cough, nasal congestion/rhinorrhea, dyspnea, chest pain, rash, myalgia, fatigue/malaise, headache, nausea/vomiting, diarrhea, anosmia, dysgeusia, and joint pain.

Patients completed surveys about symptoms at 4 weeks and 3 months after infection. Long COVID, or PASC, was defined as any persistent symptom at the times assessed.
 

Vaccinated patients fared better across outcomes

At 4 weeks after infection, 41% of fully vaccinated patients had at least one persistent symptom, compared with 54% of unvaccinated or partially vaccinated patients (P = .04). At 3 months after infection, 21% of fully vaccinated patients had at least one persistent symptom, compared with 41% of unvaccinated or partially vaccinated patients (P < .0001).

Vaccinated patients were half as likely to have long COVID at 4 weeks after infection (adjusted odds ratio, 0.49) and 90% less likely to have long COVID 3 months after infection (aOR, 0.1), after adjustment for age, sex, race, comorbidities, and use of any of four immune-suppressing medications (anti-CD20 monoclonal antibodies, methotrexate, mycophenolate, or glucocorticoids).

Fully vaccinated patients with breakthrough infections had an average 21 additional days without symptoms during follow-up, compared with unvaccinated and partially vaccinated patients (P = .04).

Reduced risk of long COVID did not change for vaccinated patients after sensitivity analyses for those who did not receive nirmatrelvir/ritonavir (Paxlovid) or monoclonal antibodies, those who didn’t receive any COVID-19-related treatment, those who completed their questionnaires within 6 months after infection, and those who were not hospitalized.

“One important message is that among those who did get PASC, the severity appears similar among those with and without a breakthrough infection,” Dr. Wallace said. “This highlights the need for ongoing research to improve recognition, diagnosis, and treatment of PASC.”

Many more breakthrough infections (72%) than nonbreakthrough infections (2%) occurred during Omicron. The authors acknowledged that different variants might play a role in different long COVID risks but said such potential confounding is unlikely to fully explain the results.

“Even with data suggesting that the Omicron variants may be intrinsically less severe, vaccination still has an impact on severity of infection, rates of hospitalization, and other outcomes and thus may play a role in the risk of PASC,” lead author Naomi Patel, MD, an instructor at Harvard Medical School and a rheumatologist at Massachusetts General Hospital, said in an interview. “A study evaluating the proportions with PASC by vaccination status during the time in which a single variant is predominant, such as the early Omicron era, could help to better assess the more isolated impact of vaccination on PASC.”

Dr. Calabrese said he is convinced that Omicron infections are less likely to result in more severe forms of acute COVID than pre-Omicron infections, and he suspects Omicron infections are also less likely to result in long COVID, although less evidence currently supports this hypothesis.

Hospitalization was more common in unvaccinated/partly vaccinated patients than in vaccinated patients (27% vs. 5%; P = .001). Although pain and fatigue were lower in those with breakthrough infections, functional scores and health-related quality of life were similar in both groups.

Some symptoms significantly differed between vaccinated and unvaccinated/partly vaccinated groups, possibly caused partly by different variants. Nasal congestion was more common (73%) in those with breakthrough infections than in those with nonbreakthrough infections (46%; P < .0001). Those who were unvaccinated/partly vaccinated were significantly more likely to have loss of smell (46% vs. 22%) or taste (45% vs. 28%) or to have joint pain (11% vs. 4%).

Treatment with nirmatrelvir/ritonavir was also more common in vaccinated patients (12%) than in unvaccinated/partly vaccinated patients (1%; P < .0001), as was treatment with monoclonal antibodies (34% vs. 8%; P < .0001).

The study was limited by its low diversity and being at a single health care system, the authors said. Study coauthor Jeffrey A. Sparks, MD, MMSc, an assistant professor of medicine at Brigham and Women’s Hospital and Harvard Medical School, said in an interview that the group is planning additional studies as their cohort grows, including “investigating the relationships between COVID-19 and specific rheumatic diseases and immunomodulating medications, expansion of autoimmunity and systemic inflammation, and lung damage among specific patient populations.”

Dr. Calabrese said it will be important for follow-up study of the symptomatic patients to “determine how many of these patients will fit the clinical picture of long COVID or long-haul phenotypes over the months and years ahead, including documenting exertional malaise and quality of life.

This study only assessed patients who received zero, one, or two doses of a vaccine, but many patients with rheumatic disease today will likely have received booster doses. However, Dr. Calabrese said it would be difficult to quantify whether a third, fourth, or fifth dose offers additional protection from long-term COVID complications after full vaccination or hybrid vaccination.

The research was funded by the Rheumatology Research Foundation, the National Institutes of Health, the R. Bruce and Joan M. Mickey Research Scholar Fund, and the Llura Gund Award for Rheumatoid Arthritis Research and Care. Dr. Wallace has received research support from Bristol-Myers Squibb and Principia/Sanofi and consulting fees from Zenas BioPharma, Horizon, Sanofi, Shionogi, Viela Bio, and Medpace. Dr. Sparks has received research support from Bristol-Myers Squibb and consulting fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, Inova Diagnostics, Janssen, Optum, and Pfizer. Dr. Patel has received consulting fees from FVC Health. Calabrese has consulted for Genentech, Sanofi-Regeneron, AstraZeneca, and GlaxoSmithKline.

A version of this article first appeared on Medscape.com.

Patients with rheumatic disease are at least half as likely to develop long COVID after a SARS-CoV-2 infection if they have been fully vaccinated against COVID-19, according to research published in Annals of the Rheumatic Diseases (2022 Nov 28. doi: 10.1136/ard-2022-223439).

“Moreover, those who were vaccinated prior to getting COVID-19 had less pain and fatigue after their infection,” Zachary S. Wallace, MD, MSc, an assistant professor of medicine at Harvard Medical School, Boston, and a study author, said in an interview. “These findings reinforce the importance of vaccination in this population.”

Messaging around the value of COVID vaccination has been confusing for some with rheumatic disease “because our concern regarding a blunted response to vaccination has led many patients to think that they do not provide much benefit if they are on immunosuppression,” Dr. Wallace said. “In our cohort, which included many patients on immunosuppression of varying degrees, being vaccinated was quite beneficial.”

Leonard H. Calabrese, DO, director of the R.J. Fasenmyer Center for Clinical Immunology and a professor of medicine at the Cleveland Clinic, said in an interview that the study is an “extremely important contribution to our understanding of COVID-19 and its pattern of recovery in patients with immune-mediated inflammatory diseases [IMIDs].” Remaining unanswered questions are “whether patients with IMIDs develop more frequent PASC [post–acute sequelae of COVID-19] from COVID-19 and, if so, is it milder or more severe, and does it differ in its clinical phenotype?”
 

Long COVID risk assessed at 4 weeks and 3 months after infection

The researchers prospectively tracked 280 adult patients in the Mass General Brigham health care system in the greater Boston area who had systemic autoimmune rheumatic diseases and had an acute COVID-19 infection between March 2020 and July 2022. Patients were an average 53 years old, and most were White (82%) and female (80%). More than half (59%) had inflammatory arthritis, a quarter (24%) had connective tissue disease, and most others had a vasculitis condition or multiple conditions.

filadendron/E+/Getty Images

A total of 11% of patients were unvaccinated, 28% were partially vaccinated with one mRNA COVID-19 vaccine dose, and 41% were fully vaccinated with two mRNA vaccine doses or one Johnson & Johnson dose. The 116 fully vaccinated patients were considered to have a breakthrough infection while the other 164 were considered to have a nonbreakthrough infection. The breakthrough and nonbreakthrough groups were similar in terms of age, sex, race, ethnicity, smoking status, and type of rheumatic disease. Comorbidities were also similar, except obesity, which was more common in the non–breakthrough infection group (25%) than the breakthrough infection group (10%).

The researchers queried patients on their COVID-19 symptoms, how long symptoms lasted, treatments they received, and hospitalization details. COVID-19 symptoms assessed included fever, sore throat, new cough, nasal congestion/rhinorrhea, dyspnea, chest pain, rash, myalgia, fatigue/malaise, headache, nausea/vomiting, diarrhea, anosmia, dysgeusia, and joint pain.

Patients completed surveys about symptoms at 4 weeks and 3 months after infection. Long COVID, or PASC, was defined as any persistent symptom at the times assessed.
 

Vaccinated patients fared better across outcomes

At 4 weeks after infection, 41% of fully vaccinated patients had at least one persistent symptom, compared with 54% of unvaccinated or partially vaccinated patients (P = .04). At 3 months after infection, 21% of fully vaccinated patients had at least one persistent symptom, compared with 41% of unvaccinated or partially vaccinated patients (P < .0001).

Vaccinated patients were half as likely to have long COVID at 4 weeks after infection (adjusted odds ratio, 0.49) and 90% less likely to have long COVID 3 months after infection (aOR, 0.1), after adjustment for age, sex, race, comorbidities, and use of any of four immune-suppressing medications (anti-CD20 monoclonal antibodies, methotrexate, mycophenolate, or glucocorticoids).

Fully vaccinated patients with breakthrough infections had an average 21 additional days without symptoms during follow-up, compared with unvaccinated and partially vaccinated patients (P = .04).

Reduced risk of long COVID did not change for vaccinated patients after sensitivity analyses for those who did not receive nirmatrelvir/ritonavir (Paxlovid) or monoclonal antibodies, those who didn’t receive any COVID-19-related treatment, those who completed their questionnaires within 6 months after infection, and those who were not hospitalized.

“One important message is that among those who did get PASC, the severity appears similar among those with and without a breakthrough infection,” Dr. Wallace said. “This highlights the need for ongoing research to improve recognition, diagnosis, and treatment of PASC.”

Many more breakthrough infections (72%) than nonbreakthrough infections (2%) occurred during Omicron. The authors acknowledged that different variants might play a role in different long COVID risks but said such potential confounding is unlikely to fully explain the results.

“Even with data suggesting that the Omicron variants may be intrinsically less severe, vaccination still has an impact on severity of infection, rates of hospitalization, and other outcomes and thus may play a role in the risk of PASC,” lead author Naomi Patel, MD, an instructor at Harvard Medical School and a rheumatologist at Massachusetts General Hospital, said in an interview. “A study evaluating the proportions with PASC by vaccination status during the time in which a single variant is predominant, such as the early Omicron era, could help to better assess the more isolated impact of vaccination on PASC.”

Dr. Calabrese said he is convinced that Omicron infections are less likely to result in more severe forms of acute COVID than pre-Omicron infections, and he suspects Omicron infections are also less likely to result in long COVID, although less evidence currently supports this hypothesis.

Hospitalization was more common in unvaccinated/partly vaccinated patients than in vaccinated patients (27% vs. 5%; P = .001). Although pain and fatigue were lower in those with breakthrough infections, functional scores and health-related quality of life were similar in both groups.

Some symptoms significantly differed between vaccinated and unvaccinated/partly vaccinated groups, possibly caused partly by different variants. Nasal congestion was more common (73%) in those with breakthrough infections than in those with nonbreakthrough infections (46%; P < .0001). Those who were unvaccinated/partly vaccinated were significantly more likely to have loss of smell (46% vs. 22%) or taste (45% vs. 28%) or to have joint pain (11% vs. 4%).

Treatment with nirmatrelvir/ritonavir was also more common in vaccinated patients (12%) than in unvaccinated/partly vaccinated patients (1%; P < .0001), as was treatment with monoclonal antibodies (34% vs. 8%; P < .0001).

The study was limited by its low diversity and being at a single health care system, the authors said. Study coauthor Jeffrey A. Sparks, MD, MMSc, an assistant professor of medicine at Brigham and Women’s Hospital and Harvard Medical School, said in an interview that the group is planning additional studies as their cohort grows, including “investigating the relationships between COVID-19 and specific rheumatic diseases and immunomodulating medications, expansion of autoimmunity and systemic inflammation, and lung damage among specific patient populations.”

Dr. Calabrese said it will be important for follow-up study of the symptomatic patients to “determine how many of these patients will fit the clinical picture of long COVID or long-haul phenotypes over the months and years ahead, including documenting exertional malaise and quality of life.

This study only assessed patients who received zero, one, or two doses of a vaccine, but many patients with rheumatic disease today will likely have received booster doses. However, Dr. Calabrese said it would be difficult to quantify whether a third, fourth, or fifth dose offers additional protection from long-term COVID complications after full vaccination or hybrid vaccination.

The research was funded by the Rheumatology Research Foundation, the National Institutes of Health, the R. Bruce and Joan M. Mickey Research Scholar Fund, and the Llura Gund Award for Rheumatoid Arthritis Research and Care. Dr. Wallace has received research support from Bristol-Myers Squibb and Principia/Sanofi and consulting fees from Zenas BioPharma, Horizon, Sanofi, Shionogi, Viela Bio, and Medpace. Dr. Sparks has received research support from Bristol-Myers Squibb and consulting fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, Inova Diagnostics, Janssen, Optum, and Pfizer. Dr. Patel has received consulting fees from FVC Health. Calabrese has consulted for Genentech, Sanofi-Regeneron, AstraZeneca, and GlaxoSmithKline.

A version of this article first appeared on Medscape.com.