New-Onset Arthritis Following COVID-19 Vaccination: A Systematic Review of Case Reports

Abstract

Coronavirus disease 2019 (COVID-19) vaccine has effectively suppressed the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and alleviated its symptoms, but there are also many adverse events. Joint diseases caused by COVID-19 vaccine have been reported in many studies. Some are well-controlled arthritis patients who developed arthritis after COVID-19 vaccination, while others are new-onset joint pain and swelling problems after COVID-19 vaccination. The purpose of this systematic review is to examine the literature reports in existing databases and analyze the incidence of new-onset arthritis after COVID-19 vaccination. We included 31 eligible articles and described 45 patients, ranging in age from 17 to over 90, with more females than males. The majority (71.2%) of patients received the adenovirus vector vaccine (ChAdOx1) and the mRNA-based vaccine (BNT126b2 and mRNA-1273). Most (64.4%) patients developed joint-related symptoms after the first dose of vaccine, and 64.4% developed symptoms within the first week of vaccination. The joint symptoms involved were mainly joint swelling, joint pain, limited range of motion, and so on. A total of 71.1% of the patients involved multiple joints, both large and small; 28.9% of patients involved only a single joint. Some (33.3%) patients were confirmed by imaging, and the most common diagnoses were bursitis and synovitis. Two nonspecific inflammatory markers, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), were monitored in almost all cases, and all patients showed varying degrees of increase in these two markers. Most of the patients received the treatment of glucocorticoid drugs or nonsteroidal anti-inflammatory drugs (NSAIDs). Clinical symptoms markedly improved in most patients, with 26.7% making a full recovery and no relapse after a few months of follow-up. To determine whether there is a causal relationship between COVID-19 vaccination and the triggering of arthritis, large-scale and well-controlled research studies are needed in the future to verify this relationship and to further study its pathogenesis in detail. Clinicians should raise awareness of this complication with a view to early diagnosis and appropriate treatment.

New-Onset Rheumatic Immune-Mediated Inflammatory Diseases Following SARS-CoV-2 Vaccinations until May 2023: A Systematic Review

“…Another SR published in 2022 studied new-onset arthritis following SARS-CoV-2 vaccinations. Among the 45 patients they studied, the majority (64.4%) developed joint symptoms within the first week of vaccination, predominantly after the first dose [195].…”

New Onset Autoimmune Diseases after the Sputnik Vaccine

“…Several mechanisms have been proposed for the induction of autoimmunity in these patients, including molecular mimicry, epitope spreading, bystander activation, or superantigenic T-cell activation. Although the exact mechanism by which these vaccines induce autoimmune disease is not yet known, we have seen an increasing number of reports of arthralgias and arthritis after COVID-19 vaccination in recent years, which have also been explained by molecular mimicry [28,29].…”

Interferon-γ Release Assay in the Assessment of Cellular Immunity—A Single-Centre Experience with mRNA SARS-CoV-2 Vaccine in Patients with Juvenile Idiopathic Arthritis

“…However, the lack of data from well-controlled trials questions the significance of these findings. Additionally, in most of the patients, the clinical symptoms subsided after the use of nonsteroidal anti-inflammatory drugs or glucocorticoids without the need to introduce disease-modifying antirheumatic drugs (DMARDs) [11]. A similar response to steroid therapy, with a tendency to resolve spontaneously in some cases, was observed in SARS-CoV-2 vaccine-induced vasculitides [12].…”