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James Hamilton, M. D.
Mike McL.,
Interesting question about Rheumatoid Arthritis (RA) and the Covid Vaccines and I shall try to give you a (relatively) brief answer. But I cannot comment fully on your daughter's individual case since I obviously have not examined her nor do I know her medications or her entire history. Her personal physician/rheumatologist would be best informed to diagnose what is causing her wrist symptoms.
When the vaccines, particularly the mRNA ones, first came out there were some questions whether they would be safe in patients with various autoimmune diseases since there was not a lot of data that had been collected and evaluated on that subgroup of vaccinees. Since any vaccine is designed to stimulate an immune response these were valid concerns. However, as time has elapsed, most of these concerns have faded and severe side effects have not been very common. In fact the COVID vaccines are reccommended for these patients as the risk of getting COVID-19 far outweighs any risk of side effects. Additionally, severe COVID disease can overstimulate the immune system (remember "cytokine storm") and can even worsen autoimmune disorders.
Autoimmune disesases themselves take many years to develop in a patient and our understanding of that process is still not complete. The spike proteins in the mRNA vaccines are very short lived (days) in the body and probably have negligible effect on the actual autoimmune disorder itself.
Flares of RA are the rule and, even in well treated and controlled disease, do occur for many different reasons. Most RA patients are on some sort of chronic medication(s) most of which alter (supress) parts of the immune system. Sometimes, depending on which immunosupressive agent the patient is on and what the prescribing physician recommends, the medicine may be stoppped for a period of time around vaccination so as not to interfere with the vaccine's working. That could potentially cause a flare.
Inflammation usually occurs with flares and the hallmarks of inflammation are rubor (red in color), tumor (swelling), calor (warmth), dolor (pain) and Funcio Laesa (loss of function/mobility). We know your daughter had pain, the others would be determined by a physical exam of her wrist by one familiar with her baseline anatomy and any chronic deformities.
Of course her RA does not make her unable to have pain from any other wrist problem that any of us can get - overuse, sprains, injuries, etc.
Bottom line: yes, a temporary flare could, I believe, have been due to the shot itself but it does not sound like she got a severe worsening of her RA.
Even if it was due to the vaccine she is better off with the shot than without it.
Jim
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