New-onset inflammatory diseases ‘may be triggered’ by COVID-19 infection, vaccination
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Key takeaways:
- The possible new-onset manifestations include inflammatory joint diseases, polymyalgia rheumatica, connective tissue diseases and vasculitis.
- The researchers added that it is “highly plausible” that the risk from SARS-CoV-2 infection remains the greater concern, and that the COVID-19 vaccines are safe and efficacious.
Certain new-onset inflammatory rheumatic diseases, including polymyalgia rheumatica and vasculitis, may be triggered by SARS-CoV-2 infection or vaccination against COVID-19, according to data published in RMD Open.
“Post acute COVID-19 syndrome (PACS) has now been defined as an extremely heterogeneous condition following COVID-19 and characterized by a multitude of signs and symptoms, including complaints of rheumatological interest,” Francesco Ursini, MD, of the Istituto Ortopedico Rizzo, in Bologna, Italy, and colleagues wrote. “Musculoskeletal pain, indeed, is reported in almost 10% of individuals infected by SARS-CoV-2 at some time during the first year after the infection and, as suggested in a previous study published by our group, most of these patients satisfy the classification criteria for fibromyalgia.
“On the other hand, it was previously speculated that also the exposure to vaccines may elicit autoimmunity,” they added. “The controversial autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome), in example, is believed to result from the exposure to common vaccine adjuvants. Also in this case, reports of IRD following vaccination with available anti-COVID-19 vaccines appeared in literature since the earliest phases of the vaccine campaign.”
To assess the potential of new-onset inflammatory rheumatic diseases following SAR-CoV-2 infection or COVID-19 vaccination, Ursini and colleagues analyzed a series of cases submitted by members of the Italian COVID-19 and Autoimmune Systemic Diseases collaborative research group, encountered between Nov. 1, 2021, and Oct. 31, 2022. The researchers included patients with disease manifestation within 4 weeks of COVID-19 infection or vaccine administration. Patients were excluded if they presented with a history of inflammatory rheumatic diseases or had received a diagnosis of long COVID.
The researchers used an anonymous online survey to collect data including demographic information, prior SARS-CoV-2 exposure, vaccination status, interesting clinical features, autoantibody status and first-line therapies received. In patients who were found to have arthritis or polymyalgia rheumatica, disease activity data were recorded before and after 4 weeks of therapy.
The final analysis included a total of 267 patients. Of those, 122 were infected with SARS-CoV-2 and 145 received COVID-19 vaccines. According to the researchers, inflammatory joint arthritis was more common among those infected with SARS-CoV-2 (P = .013), while polymyalgia rheumatica was more common in the group that received COVID-19 vaccines (P = .032). There were no major differences in the rates of connective tissue disease or vasculitis between the groups.
During the follow-up period, patients with inflammatory joint disease demonstrated an approximate 30% improvement in disease activity score from baseline, while patients with polymyalgia rheumatica exhibited an improvement of approximately 70% in disease activity.
“Our article reports the largest cohort published to date and supports the hypothesis that new-onset IRD may be triggered by SARS-CoV-2 infection or COVID-19 vaccines and that the spectrum of possible clinical manifestations is broad and includes [inflammatory joint diseases, polymyalgia rheumatica, connective tissue diseases] and vasculitis,” Ursini and colleagues wrote. “However, it is highly plausible that the risk conferred by SARS-CoV-2 infection is higher and thus the usefulness and safety of vaccines, in our opinion, are not to be questioned.”
Perspective
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The findings of this observational study are not surprising. Our office has seen a large uptick in newly diagnosed inflammatory conditions and flares of existing conditions, occurring with both exposure to the virus and to vaccines. Many patients also devolved centralized pain disorder/fibromyalgia after exposure to the virus. Despite similar risks for rheumatic conditions in both groups, millions of people are deceased due to the virus, but not the vaccine. As always, we must weigh benefit vs. risk.
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