Inactivated COVID-19 Vaccine Response in SLE, Rheumatoid Arthritis

Vaccine Phials and Syringe
Researchers investigated the seroreactivity of COVID-19 vaccination and adverse events among patients with systemic lupus erythematosus and rheumatoid arthritis.

The inactivated COVID-19 vaccine is efficacious and safe for patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), according to study results published in Biomedicine & Pharmacotherapy.

Prior research suggests that the inactivated virus vaccine may have limited efficacy in patients with certain autoimmune conditions, including SLE and RA. The researchers evaluated individuals who received an inactivated COVID-19 vaccine regimen and compared the serum antibody levels against SARS-CoV-2 of healthy participants with serum antibody levels of patients with autoimmune disease.

Patients with RA and patients with SLE were recruited from 2 independent hospitals in Anhui, China, between August and September of 2021. Age- and sex-matched volunteers without rheumatic disease were recruited from the surrounding community. All enrollees had received 2 doses of inactivated COVID-19 vaccine more than 2 weeks before serum collection. Serum samples were tested for immunoglobin G (IgG) and M (IgM) antibodies against SARS-CoV-2. A signal/cut-off value of at least 1.00 was interpreted as positive for IgG and IgM. Demographic and clinical data were obtained through medical record review and self-report questionnaire. Seroprevalence results were compared between patients and healthy participants.

The study cohort was comprised of a total of 165 participants: 60 patients with SLE, 70 patients with RA, and 35 healthy controls. No patients had prior COVID-19 infection. Overall, 30 patients with SLE (50.0%), 40 patients with RA (57.1%), and 23 healthy controls (65.7%) had positive test results for IgG antibodies against SARS-CoV-2. Five patients with SLE (8.3%), 6 patients with RA (8.6%), and 1 healthy volunteer (2.9%) were positive for IgM antibodies against SARS-CoV-2. Seroprevalence rates of IgG and IgM were not significantly different between participant groups.

Vaccination-related adverse events were not more frequent in patients compared to control participants (P =.617). However, among patients with SLE, those with a positive IgG result were more likely to experience rash than patients with a negative IgG result. Patients with a positive IgG result were also less likely to have anti-Sjögren-syndrome-related antigen A autoantibodies than patients with a negative IgG result. In the RA group, patients with a positive IgG result were less likely to be rheumatoid factor positive than patients with a negative IgG result (42.5% vs 66.7%).

These results indicate that patients with autoimmune disorders mount a similar IgG/IgM antibody response to the inactivated COVID-19 vaccine as healthy individuals. The rates of adverse events were not significantly different between study groups.

Limitations of the study included the small cohort size and the use of a single, static measure of IgG/IgM antibody levels, rather than multiple measurements over time. Only a small proportion of patients reported SLE or RA medication use, meaning the impact of immunosuppressant agents on the inactivated vaccine remains unclear.

The study authors concluded, “Our findings might reassure patients who remain hesitant about COVID-19 vaccinations, and help physicians in guiding their patients towards accepting such vaccines.”


Wang P, Ni J, Chu YY, et al. Seroprevalence of SARS-CoV-2-specific antibodies and vaccination-related adverse events in systemic lupus erythematosus and rheumatoid arthritis. Biomed Pharmacother. Published online April 26, 2022. doi:10.1016/j.biopha.2022.112997