Chronic inflammation and extracellular matrix-specific autoimmunity following inadvertent periarticular influenza vaccination

Hirsiger, Julia R; Tamborrini, Giorgio; Harder, Dorothee; Bantug, Glenn R.; Höenger, Gideon; Recher, Mike; Marx, Christian; Li, Quan-Zhen; Martín, Iván; Hess, Christoph; Scherberich, Arnaud; Daikeler, Thomas; Berger, Christoph

doi:10.1016/j.jaut.2021.102714

Cited by 8 publications

(32 citation statements)

References 49 publications

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“…[2]. Hirsiger et al [23] studied 16 individuals with suspected SIRVA and compared them with controls from a single vaccination campaign from a clinical and experimental perspective. They noted that 12 of 16 patients (all young and previously healthy) had imaging findings consistent with tissue inflammation, including six patients with bone erosions not consistent with the erosions seen in arthrosis.…”

Section: Discussionmentioning

confidence: 99%

What Do We Know About Shoulder Injury Related to Vaccine Administration? An Updated Systematic Review

MacMahon

Nayar

Srikumaran

2022

Clin Orthop Relat Res

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Background Shoulder injury related to vaccine administration (SIRVA) is postulated to be an immune-mediated inflammatory response to a vaccine antigen injected into or near the subacromial bursae or synovium, leading to shoulder pain and dysfunction. The number of studies on this topic is rapidly increasing. Recent comparative studies have reported conflicting conclusions, which suggests that a systematic review of the best-available evidence may be helpful. Questions/purposes In this systematic review, we asked: What are the (1) clinical characteristics, (2) diagnoses, and (3) management approaches and outcomes reported in association with SIRVA? Methods A search was performed on October 4, 2021, of the PubMed and Medline databases for studies related to SIRVA. Inclusion criteria were English-language comparative studies, case series, and case reports that involved shoulder pain occurring after vaccination. Studies of exclusively neurologic conditions after vaccination were excluded. Forty-two studies met the eligibility criteria, including three retrospective comparative studies (72 patients and 105 controls), five database case series (2273 patients), and 34 case reports (49 patients). Study quality was assessed for the database case series and retrospective comparative studies using the Methodological Index for Non-randomized Studies tool. Results Among patients in the case reports, the median age was 51 years (range 15-90 years), and 73% (36 of 49) were women. BMI was reported for 24% of patients (12 of 49) in case reports, with a median of 23.5 kg/m 2 (range 21-37.2 kg/m 2 ). The most common symptoms were shoulder pain and reduced ROM. The most common diagnoses were shoulder bursitis, adhesive capsulitis, and rotator cuff tears. The most frequent management modalities included physical or occupational therapy, NSAIDs, and steroid injections, followed by surgery, which was generally used for patients whose symptoms persisted despite nonsurgical management. Full resolution of symptoms was reported in 2.9% to 56% of patients. Conclusion The association between inflammatory conditions of the shoulder (such as bursitis) and vaccination appears to be exceedingly rare, occurring after approximately 1: 130,000 vaccination events according to the best-available comparative study. Currently, there is no confirmatory experimental evidence supporting the theory of an immunemediated inflammatory response to vaccine antigens. Although the clinical evidence is limited, similar to any bursitis, typical treatments appear effective, and surgery should rarely be performed. Additional research is needed to determine the best injection technique or evaluate alternate injection sites such as the anterolateral thigh that do not involve positioning a needle close to the shoulder.

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Section: Discussionmentioning

confidence: 99%

What Do We Know About Shoulder Injury Related to Vaccine Administration? An Updated Systematic Review

MacMahon

Nayar

Srikumaran

2022

Clin Orthop Relat Res

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“…Finally, experimental evidence in a Level III comparative study now exists [20], adding to the Level III epidemiologic comparative study by Hesse [18] that suggested an incidence of 1 in approximately 150,000. The Hirsiger study [20] investigated vaccine-related shoulder pain in a group of students vaccinated with the quadrivalent influenza vaccine. All of the students with pain (except for one) were vaccinated in the same medical student vaccination campaign in 2018.…”

Section: Take 5 Interview With David Ring MD Phd and Uma Srikumaran M...mentioning

confidence: 99%

“…I think we disagree on how to interpret the bestavailable experimental evidence to date. I believe two articles [18,20], representing Level III data, provide some of the experimental data that Dr. Ring seeks. Interestingly, this evidence is congruent with the Level IV and V evidence over the past decade as well as my own experience.…”

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confidence: 99%

Editor’s Spotlight/Take 5: Discussing Two Systematic Reviews With Opposing Conclusions on Shoulder Pain After Vaccine Administration

Leopold

2022

Clin Orthop Relat Res

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“…SIRVA summarizes injuries to the shoulder joint or surrounding tissues that are typically considered to be caused by vaccine misapplication [ 2 ]. While the pathogenesis is not yet fully understood, injection into the bursa or intrasynovial vaccine deposition appear to trigger a prolonged autoimmune response, targeting extracellular matrix proteins, which results in bursitis and chronic joint inflammation [ 2 ]. General awareness of SIRVA among physicians is low, making it an underdiagnosed condition [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nightly pain and shoulder weakness are also common findings. These symptoms occur in the acute stage, but often persist for more than 4 weeks and were reported even 32 weeks after vaccination [ 2 ]. Pathological findings in SIRVA include subacromial bursitis, tendonitis, myositis, bone erosions, and osteonecrosis.…”

Section: Introductionmentioning

confidence: 99%

Chronic stage magnetic resonance imaging findings in patients with shoulder injury related to vaccine administration (SIRVA)

et al. 2023

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Purpose Identify chronic shoulder MRI findings in patients with known shoulder injury related to vaccine administration (SIRVA). Materials and methods Two fellowship-trained musculoskeletal radiologists retrospectively reviewed the MRI of nine patients with clinically established SIRVA. MRI was performed at least 4 weeks after vaccination and included intravenous contrast-enhanced sequences. MRI was reviewed for the presence of erosions, tendonitis, capsulitis, synovitis, bone marrow oedema, joint effusion, bursitis, cartilage defects, rotator cuff lesions, and lymphadenopathy. The number and location of focal lesions were recorded. Results Erosions of the greater tuberosity were present in 8/9 (89%), tendonitis of the infraspinatus muscle tendon in 7/9 (78%), capsulitis, synovitis, and bone marrow oedema in 5/9 (56%) cases, respectively. Effusion was found in three, and subdeltoid bursitis, rotator cuff lesions as well as cartilage defects in one patient, respectively. None of our included subjects showed axillary lymphadenopathy. Conclusion In this case series, greater humeral tuberosity erosions, infraspinatus muscle tendonitis, capsulitis, synovitis, and bone marrow oedema were common MRI findings in chronic SIRVA.

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Chronic inflammation and extracellular matrix-specific autoimmunity following inadvertent periarticular influenza vaccination

Cited by 8 publications

References 49 publications

What Do We Know About Shoulder Injury Related to Vaccine Administration? An Updated Systematic Review

What Do We Know About Shoulder Injury Related to Vaccine Administration? An Updated Systematic Review

Editor’s Spotlight/Take 5: Discussing Two Systematic Reviews With Opposing Conclusions on Shoulder Pain After Vaccine Administration

Chronic stage magnetic resonance imaging findings in patients with shoulder injury related to vaccine administration (SIRVA)

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