SARS-CoV-2 vaccine roll-out has been successful in the UK and other parts of the world; however, there are increasing concerns about adverse events. A 44-year-old woman presented to a UK hospital with left upper arm pain at the vaccine site a couple of days after receiving the Pfizer-BioNTech mRNA vaccine, which progressed to fever, diarrhoea and abdominal pain over the next few days. She had an erythematous rash on the chest with subcutaneous oedema. Her C reactive protein was 539 mg/L, white cell count of 17×109/L (1.8–7.5), troponin-T of 1013 ng/L and creatine kinase of 572 u/L. She developed an unprovoked pulmonary embolism with acute kidney injury. After administration of intravenous methylprednisolone, the muscle oedema, skin rashes and acute kidney injury resolved. Although multisystem inflammatory syndrome (MIS) is described in children (MIS-C) and adults (MIS-A) following SARS-CoV-2 infection, we highlight the first reported MIS-V case after the SARS-CoV-2 vaccine.

Background Delay to diagnosis in axial SpA (axSpA) is longer than in many other rheumatic diseases. Prolonged delay is associate with poorer outcomes, including functional impairment and quality of life. Our aims were to describe global variation in delay to diagnosis, factors associated with delay, and delay compared with PsA. Methods We searched MEDLINE, PubMed, Embase and Web of Science using a predefined protocol. Diagnostic delay was defined as years between the age at symptom onset and at diagnosis. We pooled the mean delay using random effects inverse variance meta-analysis. We examined variations in pooled estimates using prespecified subgroup analyses and sources of heterogeneity using meta-regression. Results A total of 64 studies reported the mean diagnostic delay in axSpA patients. The pooled mean delay was 6.7 years (95% CI 6.2, 7.2) with high levels of heterogeneity. Delay to diagnosis did not improve over time when stratifying results by year of publication. Studies from high-income countries (defined by the World Bank) reported longer delays than those from middle-income countries. Factors consistently reported to be associated with longer delays were lower education levels, younger age at symptom onset and absence of extra-articular manifestations (EAMs). The pooled estimate for diagnostic delay from 8 PsA studies was significantly shorter, at 2.6 years (95% CI 1.6, 3.6). Conclusion For axSpA patients, delay to diagnosis remains unacceptably prolonged in many parts of the world. Patient factors (e.g. education) and disease presentation (onset age and EAMs) should inform campaigns to improve delay.

COVID-19 has significantly affected healthcare systems around the world. To prepare for this unprecedented emergency, elective patient care was put on hold across the National Health Service (NHS). Rheumatology service had to be reorganised with a cancellation of elective clinics and clinical reconfiguration to continue to deliver care to patients, support frontline, and prevent viral transmission. The rheumatology community's responsibility of providing a continuity of care for patients had to be balanced with measures to reduce the risk of viral transmission and also protection of both the patients and staff. We describe our experience of delivering rheumatology service as recommended by the National Institute for Health and Care Excellence (NICE NG167) guidelines at a district general hospital during the current pandemic.

The COVID-19 pandemic has disrupted healthcare services and rheumatology staff were redeployed to the frontline. The purpose of this survey was to evaluate the impact of the COVID-19 pandemic on the provision of rheumatology services as viewed by rheumatologists in the UK. Survey monkey questionnaire weblink was sent to 804 clinicians including consultant rheumatologists, speciality trainees, nurse specialists, and allied health professionals in 4 regions of the UK to evaluate personal effects of COVID-19 and redeployment, impact on current out-patient clinic activity, immunosuppressive drug use, and future rheumatology care. Response rate was 21%. One-fifth of the responders reported that their rheumatology departments were functioning less than 50% capacity during the pandemic. Two-third of responders felt anxious about the ill-effects of COVID-19 on their health and well-being, and one-third of them were redeployed. During the peak of the pandemic, 75% of clinicians stopped intravenous biologics. Although access to video consultation was available for up to three-fourths of the clinicians, the majority (90%) used this modality in less than 1 in 4 consultations. This survey highlights rheumatologists' perception in the delivery of future care and anxiety they faced. As demonstrated by this survey, the National Institute for Health and Care Excellence (NICE) guidance did not influence clinician decision making in some aspects of patient care. Underutilization of tele-rheumatology in this survey should be considered whilst planning the restoration of rheumatology services in the post-COVID era.

IntroductionSince the World Health Organization declared the COVID-19 global pandemic in early March 2020, over 153 million coronavirus cases and 3.2 million deaths were reported worldwide. 1 The effective and rapid roll-out of the COVID-19 vaccine in the UK and other parts of the world has brought hope that the pandemic is coming to an end. 2,3 Unfortunately, the long-term devastating effects of COVID-19 are here to stay. There has been increasing attention recently about the longterm sequel of COVID-19 called 'Long COVID' or post COVID-19 syndrome. Long COVID or post COVID-19 syndrome has been defi ned as 'signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis'. 4 The epidemiology, clinical characteristics, pathogenesis, and complications of patients with acute COVID-19 have been explicitly described, but the long-term consequences and predictors of the illness remain largely unclear.A recent study showed that multiple acute COVID-19 symptoms during the fi rst week of illness predicted long COVID. 5 Other studies have reported consequences of COVID-19 infection up to 6 months. 6,7 Thus, we conducted an observational study with the aim to describe the long COVID symptoms at 3, 6 and 9 months and to determine the risk factors predisposing the development of long COVID following patient hospital discharge. MethodsWe included all patients with confi rmed COVID-19 admitted to a district general hospital, in the UK, between 15 February 2020 and 31 July 2020. All patients tested positive on admission for SARS-CoV-2 on a reverse transcriptase polymerase chain reaction assay after a nasopharyngeal swab. Four of the authors contacted all patients via telephone after hospital discharge between 5 January 2021 and 22 January 2021. We carried out a cross-sectional survey of patients using a standardised questionnaire. Subsequently, we assessed patients' presence and severity of long COVID symptoms at 9 months after their hospital discharge following hospital admissions with acute COVID-19 illness. During the same telephone survey, all patients interviewed were asked to recollect their symptoms for long COVID at 3 and 6 months. Patients who did not answer our initial telephone calls were re-contacted at least three times. Patients who had diffi culty hearing, dementia, care home residents, and those unwilling to participate were excluded.Background Studies to evaluate long COVID symptoms and their risk factors are limited. We evaluated the presence of long COVID and its risk factors in patients discharged from a hospital with COVID-19 illness.Methods This observational study included 271 COVID-19 patients admitted between February and July 2020 in a hospital in the UK. The primary outcome measure was to assess the duration and severity of long COVID and its predictors at 3, 6 and 9 months. Logistic regression was performed to assess the potential risk factors for long COVID.Results Out of 89 patients interviewed, ...