IgA vasculitis with transient glomerular hematuria, diarrhea, and pericarditis following COVID-19 mRNA vaccination in a young patient with possible pre-existing ulcerative colitis.

Exacerbations or de novo autoimmune/autoinflammatory disease have been reported after COVID-19 vaccination. A young male presented with cutaneous IgA vasculitis with glomerular hematuria, diarrhea and pericarditis following his second COVID-19 mRNA vaccination. He also showed positivity for proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA) and anti-cardiolipin antibody. Skin biopsy was compatible to IgA vasculitis. His purpura subsided and hematuria spontaneously disappeared. Treatment with anti-inflammatory medications and prednisolone resolved the pericarditis. He had a history of persistent diarrhea, and colonic biopsies showed possible ulcerative colitis without vasculitis. Kidney biopsy after prednisolone therapy revealed minor glomerular abnormalities without any immune reactants and did not show vasculitis. After prednisolone treatment, PR3-ANCA decreased in a medium degree despite of improvement of symptoms and inflammatory data, suggesting that his PR3-ANCA may be associated with ulcerative colitis. The cause of the transient glomerular hematuria was unclear, however, it might be caused by focal glomerular active lesions (glomerular vasculitis) due to vaccine-induced IgA vasculitis with nephritis. This case highlights that COVID-19 mRNA vaccination can activate multiple autoimmune/autoinflammatory systems. The conditions might help us better understand the mutual mechanisms of the relevant disorders.

Psoriasis patient preferences for the use of biologics during the coronavirus era.

Understanding patient preferences concerning the use of biologics for psoriasis treatment can support proper treatment selection to satisfy their needs. In Japan, limited studies have reported psoriasis patients' preferences for the use of biologics, and many of those focused on the improvement of skin symptoms. The present study was conducted as a web-based questionnaire survey using the discrete choice experiment approach to investigate the preferences of psoriasis patients for the use of biologics, as well as to describe social and clinical factors that influence these preferences. The following attributes were selected for the discrete choice experiment: efficacy at 1 year, risk of serious infections requiring hospitalization, incidence of injection site reactions, administration route and visits, co-payment, indications, and efficacy on skin symptoms and other manifestations (the last two have not been evaluated in previous studies). Data were collected from October 4 to October 8, 2021. An analysis of data from 357 psoriasis patients indicated that the most preferred attributes for biologics selection were administration route and visits, followed by the risk of serious infections requiring hospitalization. Some differences were observed among specific subgroups. This study demonstrated that patients with psoriasis prefer biologics with a less frequent administration route and visit schedule and a lower risk of serious infections requiring hospitalization, which contrasts with the results obtained in previous studies where the highest importance was placed on drug effectiveness. These results may reflect the personal and social impact of the coronavirus disease outbreak at the time of the survey. The results of this study might help physicians properly select biologics that satisfy psoriasis patients' needs, leading to better treatment adherence.

Impact of the COVID-19 pandemic on biologic treatment in psoriasis patients: A single-center retrospective study in Japan.

The impact of the COVID-19 pandemic on biologic treatment for psoriasis in Japan remains to be elucidated. This study aimed to investigate changes in biologic treatment and patients' behavior of visiting our department, especially in psoriasis patients treated with biologics before and during the pandemic. Data were collected from medical records retrospectively. The numbers of new psoriasis patients before (2019) and during (2020) the pandemic were compared. Patients' behavior of visiting our department was evaluated. The number of new psoriasis patients who visited our department in 2020 decreased by 35.7% compared with that in 2019. The reduction rate of new patients with psoriasis vulgaris was 49.3%, whereas the numbers of new patients with psoriatic arthritis (PsA) and generalized pustular psoriasis (GPP) were almost the same in 2019 and 2020. The number of patients who newly initiated biologics did not decrease in 2020 compared with that in 2019. As of January 1, 2020, 215 psoriasis patients were treated with biologics. Six patients (2.8%) discontinued biologics treatment possibly due to COVID-19 in 2020. Among 212 patients with good adherence to visiting our department in the previous year, 24 patients (11.3%) refrained from their visits for at least 1 month. In most cases, refrainment was observed in April and May when the first state of emergency was in effect in Japan. In conclusion, the COVID-19 pandemic hindered patients from visiting our department. However, its impact on patients who needed intensive care, such as patients with PsA and GPP, and psoriasis patients treated with biologics, was limited.