• hepatitis B vaccine
• adverse effects
• arthritis
• rheumatoid arthritis

Recently, medical and public interest in the safety of vaccination, particularly against hepatitis B, has been heightened by reports in medical journals and in the media of possible adverse effects, especially of suspected vaccination-induced autoimmune disorders. Although these suspected effects most commonly belong to the neurological area, a number of authors have published cases of rheumatic disease, notably rheumatoid arthritis (RA), following hepatitis B vaccination.^1–10 This editorial does not aim to review the relationship between vaccination and autoimmune disorders, which has already been discussed in several recent and interesting papers,^11–13 but to centre the discussion on the possible connection between hepatitis B vaccination and RA.

The rheumatic disorders described following hepatitis B vaccination are heterogeneous but can be divided into three groups. Firstly, transient conditions such as vasculitis, post-vaccinal arthritis or erythema nodosum might be due to the deposition of immune complexes containing viral antigen and anti-hepatitis B antibodies, as seen in some hepatitis B infections, or to hypersensitivity to components of the vaccine like thimesoral or yeast proteins.^14,15 Recently, the VAERS (Vaccination Adverse Events Reporting System) database (from July 1990 to August 1999) reported that hepatitis B vaccination was associated with a number of potentially serious arthritic adverse reactions, particularly in the adult female population (female/male ratio = 4.45/1).¹⁶ Secondly, it was recently suggested that macrophagic myofasciitis might be induced by intramuscular injection of vaccines containing aluminium hydroxide such as hepatitis B vaccine.¹⁷ Thirdly, there are reports of the onset of chronic autoimmune disease and, in particular, of RA.

Several hypotheses can be put forward for the occurrence …