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Systemic rheumatic disease flares after SARS-CoV-2 vaccination among rheumatology outpatients in New York City
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  • Published on:
    SARS-CoV-2 vaccine : a trigger of rheumatoid arthritis ?
    • Marion COUDERC, Rheumatologist Rheumatology department, University Hospital, Clermont-Ferrand, France
    • Other Contributors:
      • Marie-Eva PICKERING, Rheumatologist
      • Martin SOUBRIER, Rheumatologist
      • Anne TOURNADRE, Rheumatologist
      • Jean-Jacques DUBOST, Rheumatologist

    Sir,

    We read with great interest the letter from M. Barbhaiya et al. on systemic rheumatic disease flares after SARS-Cov-2 vaccination.[1] Whether COVID-19 vaccines could trigger rheumatoid arthritis remains unclear. To date, only few cases have been reported on this topic.[2,3]

    We report the case of a 44-year-old man, working as a teacher, without medical history or treatment, who had arthralgia affecting the hands and feet without joint swelling since early 2020. There was no clinical synovitis and the joint ultrasound showed doppler positive bursitis of the 3rd bilateral interdigital space. Acute phase reactant (C-reactive protein and sedimentation rate) were in the normal range, rheumatoid factors and antinuclear antibodies were negative unlike anti-CCP (48 UI/ L, uppper limit of normal [ULN] 3UI/L). X-rays of the hands and forefoots were normal. Treatment with hydroxychloroquine 200 mg twice a day was started in November 2020 associated with corticosteroid injections in each bursitis with a good improvement at three months.

    In early May 2021, the patient received a first injection of the anti SARS-CoV-2 BNT162b2 vaccine (BioNTech-Pfizer). A week later, he reported a flare of rheumatoid arthritis (RA) with pain and synovitis of 2 proximal interphalangeal joints and the right wrist, and pain in both shoulders with morning stiffness. DAS28-CRP was 4.2, DAS28-ESR 3.7. No skin rash was observed. Treatment with methotrexate at a dose of 20 mg/week subcu...

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    Conflict of Interest:
    None declared.
  • Published on:
    Disease, drugs or vaccine?
    • Arghya Chattopadhyay, Rheumatologist IPGME&R, KOLKATA
    • Other Contributors:
      • Rashmi Roongta, Rheumatologist

    Vaccinations can induce autoimmunity through mechanisms like polyclonal B cell activation, epitope spreading and molecular mimicry. [1] A theoretical risk of vaccine induced flare of rheumatic diseases exists. However, it is poorly backed by evidence. [2] Two cases of previously quiescent rheumatic diseases flaring post COVID vaccination have been reported. [3,4] Barbhaiya et al in their article on “Systemic rheumatic disease flares after SARSCoV-2 vaccination among rheumatology outpatients in New York City'' showed approximately 15% patients had flare following vaccination. [5] The potential risk of a flare was one of the main concerns in the VAXICOV study in which 45.8% of 1266 patients with autoimmune or rheumatic diseases were uncertain or unwilling to take the COVID vaccine, [6] and data from this observation by Barbhaiya et al. may add more concerns in patients planning for vaccination against COVID-19. Hence, a few issues need to be addressed to have a better idea regarding the relation and risk group of post vaccination disease flare.
    First, it would have been useful to know the baseline disease activity prior to vaccination. Were patients with poorly controlled disease more vulnerable than those in remission? Did patients with higher disease activity have flares of greater severity?
    Second, the distribution of flares according to the underlying rheumatic disease would be important to know which population was most vulnerable.
    Third, r...

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    Conflict of Interest:
    None declared.