FIRST PRESENTATION OF AUTOIMMUNE RHEUMATIC DISEASES
AFTER COVID-19 VACCINATION: A SYSTEMATIC REVIEW
Authors: C. Soto et al.
Covid-19 vaccination prevents about 52% of expected infections, 56% of expected hospitalizations, and 58% of expected deaths in adults 18 years or older. Nevertheless, some case reports and series have demonstrated new-onset rheumatologic syndromes after vaccination.
This systematic review examined the frequency, clinical features, and treatment response of new onset autoimmune rheumatic diseases after COVID-19 vaccination.
The review yielded 280 publications. A total of 163 articles were evaluated and 59 reports with 108 patients. The autoimmune rheumatic diseases were: 10 cases of GCA, 9 IgA vasculitis, 14 SLE, 24 ANCA-vasculitis 24, 12 adult-onset Still’s disease, 2 reactive Arthritis, 5 rheumatoid Arthritis, 3 Sjögren’s syndrome, 2 systemic Sclerosis, 2 Takayasu’s arteritis, cryoglobulinemic vasculitis 1, Kawasaki disease 3, Polymyalgia rheumatica 16, PAN 1, SpA 2, Overlap syndrome 1, and Antisynthetase syndrome 1.
47.2% developed rheumatic disease after the first dose and 35.2% after the second dose, with a median of 10 days after vaccination.
67.6% received corticosteroids, 31.5% received immunosuppressants (among cyclophosphamide, rituximab, hydroxychloroquine, methotrexate, tocilizumab, mycophenolate, immunoglobulin). 55.6% had complete remission, 24.1% partial and 6.5% non-response.
After Covid-19 vaccine a minority of patients may develop for the first time an autoimmune rheumatic disease. Despite the increasing number of documented cases, the incidence remains low compared to the benefits of vaccination. Patients presented in this systematic review had a high variability of clinical manifestations and most patients respond favourably to treatment.
It is well known that autoimmune rheumatic diseases occur after vaccination. The reason for this might be the stimulation of the immune system caused by the vaccination. Whether this phenomenon is more frequent after SARS-CoV-2 mRNA vaccinations remains open.