COVID-19 Vaccines Safe and Well Tolerated Among Patients With Juvenile Idiopathic Arthritis Receiving TNF Inhibitors

Girl receiving vaccine.
Girl receiving vaccine.
Researchers evaluated the safety and tolerability of the BNT162b2 COVID-19 vaccine in adolescents with juvenile idiopathic arthritis receiving TNF inhibitors.

For patients with juvenile idiopathic arthritis (JIA) receiving treatment with tumor necrosis factor (TNF) inhibitors, the mRNA COVID-19 vaccines appear to be safe and well-tolerated, according to a letter to the editor published in Arthritis & Rheumatology.

Authors of the letter reported results from a single-center study that included adolescents aged 16 to 21 years diagnosed with stable JIA and receiving treatment for at least 1 year with TNF inhibitors.

All participants in the study received 2 doses of the Pfizer/BioNTech COVID-19 vaccine 3 weeks apart between April 15 and May 15, 2021. Follow-up visits occurred 1, 2, and 3 months postvaccination. Adverse reactions were defined as those lasting more than 7 days after vaccination; disease activity was evaluated using the Juvenile Arthritis Disease Activity Score (JASDAS).

All 21 participants tolerated the vaccine; local reactions were frequent (74%) and systemic reactions were relatively infrequent (19%). There were no differences among patients receiving etanercept vs adalimumab (P =.09) or among patients with different JIA types. Most reactions, both local and systemic, occurred after the second dose of the vaccine (P =.02).

At the 3-month follow-up, there were no significant changes in JASDAS or C-reactive protein levels, erythrocyte sedimentation rate, and white blood cell count (P =.417, P =.1, P =.09, and P =.4, respectively). None of the patients discontinued treatment.

Study limitations included the small sample size and limitations on the number of patients included within each JIA type and treatment group.

According to the authors, “As there is no evidence about COVID-19 vaccination in this population, further studies are needed to evaluate the immune response, analyze the immunogenicity of the [2]-dose schedule, and determine the real duration of immune protection.”


Dimopoulou D, Spyridis N, Vartzelis G, Tsolia MN, Maritsi DN. Safety and tolerability of the COVID-19 mRNA-vaccine in adolescents with juvenile idiopathic arthritis on treatment with TNF-inhibitors. Letter. Arthritis Rheumatol. Published online September 7, 2021. doi:10.1002/art.41977