A Large Cluster of New Onset Autoimmune Myositis in the Yorkshire Region Following SARS-CoV-2 Vaccination

Abstract

Background: The novel SARS-CoV-2 vaccines partially exploit intrinsic DNA or RNA adjuvanticity, with dysregulation in the metabolism of both these nucleic acids independently linked to triggering experimental autoimmune diseases, including lupus and myositis. Methods: Herein, we present 15 new onset autoimmune myositis temporally associated with SARS-CoV-2 RNA or DNA-based vaccines that occurred between February 2021 and April 2022. Musculoskeletal, pulmonary, cutaneous and cardiac manifestations, laboratory and imaging data were collected. Results: In total, 15 cases of new onset myositis (11 polymyositis/necrotizing/overlap myositis; 4 dermatomyositis) were identified in the Yorkshire region of approximately 5.6 million people, between February 2021 and April 2022 (10 females/5 men; mean age was 66.1 years; range 37–83). New onset disease occurred after first vaccination (5 cases), second vaccination (7 cases) or after the third dose (3 cases), which was often a different vaccine. Of the cases, 6 had systemic complications including skin (3 cases), lung (3 cases), heart (2 cases) and 10/15 had myositis associated autoantibodies. All but 1 case had good therapy responses. Adverse event following immunization (AEFI) could not be explained based on the underlying disease/co-morbidities. Conclusion: Compared with our usual regional Rheumatology clinical experience, a surprisingly large number of new onset myositis cases presented during the period of observation. Given that antigen release inevitably follows muscle injury and given the role of nucleic acid adjuvanticity in autoimmunity and muscle disease, further longitudinal studies are required to explore potential links between novel coronavirus vaccines and myositis in comparison with more traditional vaccine methods.

A case series of dermatomyositis following SARS-CoV-2 vaccination

“…There have been several other reports of dermatomyositis and idiopathic inflammatory myopathies developing or relapsing after SARS-CoV-2 vaccination, which supports our findings ( 18 – 22 ). Overall it is difficult to conclude whether there is a true correlation between dermatomyositis exacerbation and vaccination, however, there is emerging literature describing several mechanisms that propose how vaccinations may promote the development of inflammatory diseases such as DM.…”

COVID-19 vaccine-associated myositis: a comprehensive review of the literature driven by a case report

“…There is evidence that the pathological findings vary among cases. From our assessment, we identified several cases with vasculitic changes without MAA or MSA [8], cases with evidence of inflammatory myositis [2,13,[19][20][21][22], cases with necrotic changes [13,23], and cases with immune-mediated necrotizing myositis [24,25]. At times, these differences in biopsy findings correlate with the presence of antigen-specific autoantibodies and the discrepancies in clinical presentation, alluding to the complexity of muscle inflammation pathogenesis.…”

“…This observation could, nevertheless, be explained by the fact that these vaccines were predominantly used in several countries, and thus, more patients were exposed to them and more adverse events are anticipated. In our review, there were also 3 patients with anti-HMGCR + myositis that were receiving statins [13].…”

Development of Autoantibodies Following BNT162b2 mRNA COVID-19 Vaccination and Their Association with Disease Flares in Adult Patients with Autoimmune Inflammatory Rheumatic Diseases (AIIRD) and the General Population: Results of 1-Year Prospective Follow-Up Study

“…In the case of non-mRNA vaccines, examples of such reported post-vaccination autoimmunity include Guillain–Barré Syndrome (GBS) as the most frequently reported autoimmune neurological adverse event following seasonal influenza vaccination in the Vaccine Adverse Event Reporting System (VAERS) [ 27 ], or Henoch–Schonlein purpura, with the induction of aPL antibodies in the reported pediatric cases following influenza vaccination [ 28 , 29 , 30 ]. Specifically in the case of mRNA COVID-19 vaccines, a growing body of evidence associates these vaccinations with several autoimmune conditions, including myocarditis [ 31 ], immune thrombocytopenic purpura [ 22 , 32 ], and immune-medicated myositis [ 33 ]. As in previous non-mRNA vaccinations, the number of cases of reported autoimmune manifestations following COVID-19 are small, and whether the association between COVID-19 vaccines and autoimmune manifestations is coincidental or causal remains to be elucidated.…”