Background: Coronavirus disease 2019 (covid-19) has now spread to millions of persons worldwide to become a global pandemic. Covid-19 is asymptomatic for some individuals and for others it can cause symptoms ranging from flu-like to acute respiratory distress syndrome, pneumonia and death. Several vaccine candidates are now available, and patients with chronic inflammatory disease such as rheumatoid arthritis (RA) are encouraged to get vaccinated.

Objectives: The aim of this study was to determine perceptions of RA patients about the covid-19 vaccine.

Methods: We conducted a cross-sectional study including Tunisian patients with RA (ACR/EULAR 2010). Demographic and disease parameters were collected: age, gender, educational status, disease duration, erythrocyte sedimentation rate (ESR), disease activity score (DAS28), and treatments being used. All patients responded to a questionnaire on their perceptions and concerns about the covid-19 vaccine, and whether they intended to get vaccinated or not. A p value inferior to 0.05 was considered significant.

Results: We included 54 patients (45 women and nine men) with a mean age of 55±11 years old [23-69]. Thirty-one percent of patients were illiterate. The mean disease duration was 9.9±5.9 years [0-20]. The mean DAS28 ESR was 4.68±1.35 [1.50-7.16].

NSAIDs were used in 13% of patients, corticosteroids in 63% of patients at a mean daily dose of 8mg [2.5-20] of prednisone equivalent, methotrexate in 63% of patients, sulphasalazine in 13% of patients, leflunomide in 3.7%, and biologics in 22.2% of patients.

None of these patients had contracted the covid-19. Seventeen percent of patients had been in close contact with someone positive for the disease. All the patients reported that they respected the preventive measures. Fifteen percent of patients had stopped their treatment because they were afraid of the covid-19: Methotrexate (n=4), sulphasalazine (n=1), tocilizumab (n=2), and rituximab (n=1).

More than half of patients (67.7%) reported that they didn’t want to get vaccinated against covid-19. The reasons given by these patients were: presumed adverse events (100%), religious beliefs (86.7%). presumed inefficiency (83.3%), no recommendation from their doctor (80%), fear that the vaccine would interact with their treatment (76.7%), lack of trust in the pharmaceutical laboratories (76.7%), fear from vaccines in general (53.3%), fear that the vaccine would make RA worse (50%), and presumed overprice of the vaccine (30%).

A significant association was noted between educational status and, religious beliefs (p=0.001), lack of trust in the pharmaceutical laboratories (p=0.007), fear that the vaccine would make RA worse (p=0.008) or interact with other treatments (p=0.022), and presumed overprice of vaccine (p<0.001).

Conclusion: Most of RA patients expressed their unwillingness to get vaccinated against covid-19. Doubts about the vaccine’s efficiency and security and religious beliefs were the main reasons for this choice.

Disclosure of Interests: None declared