COVID-19 vaccine-associated autoimmune inflammatory rheumatic diseases

ABSTRACT

Background/Purpose: Vaccination against the most recently COVID-19 is one of the critical tools to provide herd immunity, reduce mortality, and control the pandemic worldwide. Despite the immense benefits of vaccination, an occasional association between vaccination and autoimmunity induction has been detected in human subjects. The current study presented fourteen cases of autoimmune rheumatic diseases (ARDs) following various COVID-19 vaccines. Method(s) This observational two-center study was conducted in the rheumatology clinics of the Connective Tissue Diseases Research Center at Tabriz University of Medical Sciences and Kashan University of Medical Sciences. All patients were referred to clinics with ARDs symptoms after implementing the COVID-19 vaccination program in Iran from April 2021 and were considered for enrollment in the study. Inclusion criteria were the onset of ARDs symptoms at four weeks post-vaccination, age >=16, no previous history of ARDs, meeting the classification criteria of one of the ARDs, and staying in the follow-up. Result(s) Between April 2021 and January 2022, 22 adult patients with symptoms of ARDs after COVID-19 vaccination were considered for eligibility. Eventually, 14 patients were diagnosed with ARDs based on classification criteria, and whose symptoms had started within four weeks after vaccination were included in the study. The duration of follow-up was 2-10 months. The vaccines used in these patients were Sinopharm [7 cases (50%)], AstraZeneca [6 cases (42.9%)], and COVIran Barakat [1 case (7.1%)]. It should be noted that vaccines that have been used for public vaccination in Iran until January 2022 were Sinopharm (78.9%), AstraZeneca (11.7%), and COVIran Barekat (8.1%), and Sputnik (1.3%). Crosstabulaton analysis showed that ARD was significantly more common in subjects who received AstraZenca vaccine than in subjects who received other vaccines (P < 0.001). Based on the results, the involved patients were diagnosed with RA or one of its subtypes (five cases), vasculitis (four cases), SLE (three cases), and peripheral SpA (pSpA) (two cases). In eleven cases, symptoms started two weeks after vaccination. However, diagnosis in eight patients was delayed for more than four weeks. Except for one patient with self-limitation of ARD, others required treatment with anti-inflammatory drugs and disease-modifying antirheumatic drugs, which even one of them developed irreversible neurological complications. Conclusion(s) Indeed, our data can warn physicians about the possibility of ARDs post-vaccination, lead to faster diagnosis, prevent loss of window of opportunity for treatment, and prevent irreversible organ damages.