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Spectrum of short-term inflammatory musculoskeletal manifestations after COVID-19 vaccine administration: a report of 66 cases
  1. Francesco Ursini1,2,
  2. Piero Ruscitti3,
  3. Vincenzo Raimondo4,
  4. Rossella De Angelis5,
  5. Fabio Cacciapaglia6,
  6. Erika Pigatto7,
  7. Domenico Olivo8,
  8. Ilenia Di Cola9,
  9. Felice Galluccio10,
  10. Francesca Francioso5,
  11. Rosario Foti11,
  12. Antonio Tavoni12,
  13. Salvatore D'Angelo13,
  14. Corrado Campochiaro14,
  15. Francesca Motta15,
  16. Maria De Santis15,
  17. Silvia Bilia12,
  18. Caterina Bruno16,
  19. Giacomo De Luca14,
  20. Marcella Visentini17,
  21. Jacopo Ciaffi1,
  22. Luana Mancarella1,
  23. Veronica Brusi1,
  24. Martina D’Onghia1,
  25. Giovanna Cuomo18,
  26. Enrico Fusaro19,
  27. Lorenzo Dagna14,
  28. Serena Guiducci10,
  29. Riccardo Meliconi1,2,
  30. Florenzo Iannone20,
  31. Annamaria Iagnocco21,
  32. Roberto Giacomelli22,
  33. Clodoveo Ferri4,23
  1. 1 Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
  2. 2 Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
  3. 3 Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, Università degli Studi dell'Aquila, L'Aquila, Italy
  4. 4 Rheumatology Unit, Rheumatology Hospital 'Madonna dello Scoglio', Cotronei, Italy
  5. 5 Rheumatology Clinic, Università Politecnica delle Marche, Ancona, Italy
  6. 6 Rheumatology Unit, Department of Emergence Medicine and Transplantation, Università degli Studi di Bari Aldo Moro, Bari, Italy
  7. 7 Rheumatology Outpatient Clinic, Villa Salus Hospital, Mestre, Italy
  8. 8 Rheumatology Outpatient Clinic, San Giovanni di Dio Hospital, Crotone, Italy
  9. 9 Department of Biotechnological and Applied Clinical Sciences, Università degli Studi dell'Aquila, L'Aquila, Italy
  10. 10 Department of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
  11. 11 Rheumatology Unit, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Catania, Italy
  12. 12 Department of Clinical Immunology, University of Pisa, Pisa, Italy
  13. 13 Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, Regional Hospital San Carlo, Potenza, Italy
  14. 14 Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele, Milano, Italy
  15. 15 Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
  16. 16 Rheumatology Outpatient Clinic, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
  17. 17 Department of Translational and Precision Medicine, University of Rome La Sapienza, Rome, Italy
  18. 18 Clinical Immunology Outpatient Clinic, University of Campania Luigi Vanvitelli, Caserta, Italy
  19. 19 Rheumatology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
  20. 20 Rheumatology Unit, Department of Emergence Medicine and Transplantation (DETO), Università degli Studi di Bari Aldo Moro, Bari, Italy
  21. 21 Academic Rheumatology Centre, MFRU and Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
  22. 22 Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Campus Bio-Medico University Hospital, Roma, Italy
  23. 23 Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
  1. Correspondence to Professor Clodoveo Ferri, Rheumatology Unit, University of Modena and Reggio Emilia, Modena 41124, Italy; clferri{at}

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In the past months, mass vaccination represented the turning point of the global battle against the COVID-19 pandemic, an unprecedented challenge for physicians, healthcare professionals, health systems and pharmaceutical companies. More than 6 billion doses of vaccine have been administered to date, covering nearly 50% of the world’s population. Although the vaccination campaign is still thwarted by spread of fake news disseminated by a ubiquitous antivaxxer movement, accumulating real-life data1 confirm the favourable safety profile already demonstrated in phase III clinical trials.2

Despite the lack of a steady literature evidence,3 the potential role of vaccines in promoting autoimmunity continues to intrigue many researchers. The theoretical basis of this association relies on the possible molecular mimicry between macromolecular components of the vaccine and specific human proteins and the exuberant immune response elicited by adjuvants contained in vaccines.4

Adverse events (AEs) associated with COVID-19 vaccines are usually mild and mainly restricted to injection site reactions. Interestingly, among systemic AEs, arthralgia is one of the most common.2 To the best of our knowledge, only isolated cases5 of arthritis developed after COVID-19 …

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  • Handling editor Josef S Smolen

  • Contributors FU and CF designed the study, analysed the results and prepared the first draft of the letter. All the other authors contributed to the data collection and critical revision of the draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.