New-onset systemic vasculitis following SARS-CoV-2 infection and vaccination: the trigger, phenotype, and outcome

Mv, Prakashini; Auanassova, Akerke; Yessirkepov, Marlen; Zimba, Olena; Gasparyan, Armen Yuri; Kitas, George D.; Ahmed, Sakir

doi:10.1007/s10067-023-06694-6

Cited by 9 publications

(5 citation statements)

References 73 publications

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“…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]. However, there are also reports of more severe, life-threatening cases of autoimmune and autoinflammatory syndromes after the new vaccination, including dermatomyositis complicated by lung disease [13] and adultonset Still disease [14].…”

Section: Introductionmentioning

confidence: 91%

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

Kapten,

Orczyk,

Maeser

et al. 2024

JCM

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Background: As the SARS-CoV-2 virus remains one of the main causes of severe respiratory system infections, the Food and Drug Administration strongly advises the continuation of current vaccination programs, including the distribution of updated boosters, especially in high-risk groups of patients. Therefore, there is an unceasing need for further research on the safety and, no less importantly, the clinical effectivity of the vaccines, with an extra focus on cohorts of patients with underlying health problems. This study aimed to assess the efficacy of the SARS-CoV-2 vaccine in possibly immunocompromised children with rheumatic disease while utilizing the interferon-gamma release assay (IGRA) as a marker for COVID-19 immunity in the study follow-up. Methods: This prospective study was performed in a group of 55 pediatric patients diagnosed with juvenile idiopathic arthritis. Eight participants were immunized with the Comirnaty mRNA vaccine before the research commenced, while the rest of the group (n = 47) had not been vaccinated against SARS-CoV-2. At the study baseline, the cellular response to the virus antigen was measured using a specific quantitative IGRA in whole blood; subsequently, the anti-SARS-CoV-2 test was performed, marking the antibodies’ levels in serum. Around four months after the enrollment of the last patient in the study, a follow-up survey regarding the events of COVID-19 infection within the cohort was conducted. Results: The study confirmed that all the vaccinated children developed specific T-cell (p = 0.0016) and humoral (p = 0.001 for IgA antibodies, p = 0.008 for IgG antibodies) responses to the inoculation, including those receiving biological treatment and those on conventional disease-modifying anti-rheumatic drugs. The study also showed the different patterns of immunity elicited both after infection and post-vaccination, with higher levels of antibodies and T-cell response after inoculation than after natural exposure to the pathogen. According to the follow-up survey, six children developed PCR-confirmed SARS-CoV-2 infection, whereas the additional 10 patients admitted to having COVID-like symptoms with no laboratory verification. Conclusions: SARS-CoV-2 vaccinations elicit valid immune responses in pediatric rheumatic patients. Including the assessment of T-cell immunity in the evaluation of inoculation-induced immunization can enhance the accuracy of sole humoral response assays.

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Section: Introductionmentioning

confidence: 91%

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

Kapten,

Orczyk,

Maeser

et al. 2024

JCM

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“…It's unclear how many of these symptoms persisted, and whether some returned after they had disappeared. After three days of dexamethasone, patients reported remission of their arthritis [23].…”

Section: Case-1mentioning

confidence: 99%

“…However, the typical time for a T-cell mediated event to manifest clinically is 3-4 weeks, which is the usual delay between the triggering event and the formation of ReA. This may mean that the arthritis is only a hypersensitivity reaction to vaccine components or adjuvants rather than ReA [23]. The majority of post-COVID ReA resolves after 6-12 weeks, whereas at least one third of traditional ReA develops into a chronic condition [26].…”

Section: Case-1mentioning

confidence: 99%

Reactive Arthritis Following COVID-19 Vaccination: Report of Three Cases

Tasgöz,

Acar,

Sülükcü

et al. 2024

Aktuelle Rheumatologie

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the coronavirus disease 19 (COVID-19) pandemic, which has affected the entire world. The development of COVID-19 vaccines has helped to slow the spread of the virus. However, as with vaccines against other infectious diseases, adverse events can occur with COVID-19 vaccines. Here we present 3 cases of acute arthritis following COVID-19 vaccination and a comprehensive review of the existing literature.

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“…Both the virus and vaccines can induce inflammatory arthritis [16][17][18], and various cases of rare systemic inflammatory disorders like vasculitis [19] adult, Still disease [20] and dermatomyositis [21] are reported.…”

Section: Introductionmentioning

confidence: 99%

“…It is important for clinicians to gain a better understanding of these conditions, which are often under or misdiagnosed. They are commonly perceived as less significant than idiopathic diseases, with a belief that they will run their natural course, resolving spontaneously and responding to steroids [19]. Otherwise, in the literature, the real esteem of their true incidence, treatment strategy, and genetic predisposition is still missing.…”

Section: Introductionmentioning

confidence: 99%

Post-COVID-19 and Post-COVID-19 Vaccine Arthritis, Polymyalgia Rheumatica and Horton’s Arteritis: A Single-Center Assessment of Clinical, Serological, Genetic, and Ultrasonographic Biomarkers

Bandinelli,

Pagano,

Vallecoccia

2023

JCM

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The potential role of the COVID-19 vaccine and infection to induce autoimmunity is currently underestimated despite the literature emphasizing arthralgia as a common adverse event. We aimed to study the impact of rheumatological complications post-COVID-19 (PC) and post-COVID-19 vaccine (PCV), comparing undifferentiated arthritis (UA) to Polymyalgia Rheumatica, Horton’s Arteritis (PMR-HA) and isolated arthritis to UA with “connective-like” accompanying symptoms. We retrospectively included 109 patients with at least 6 months of follow-up, analyzing serum biomarkers, joint ultrasound (US), lung HRCT, DLCO, and HLA haplotypes. There were 87 UA patients showing increased gastrointestinal and lung involvement (p = 0.021 and p = 0.012), higher anti-spike protein IgG levels (p = 0.003), and anti-SARS-CoV-2 IgG positivity (p = 0.003). Among them, 66 cases progressed to ACR-EULAR 2010 early arthritis after 3 months, whereas PMR-HA patients were more commonly PCV (81.8%, p = 0.008), demonstrating higher CRP (p = 0.007) and ESR (p = 0.006) levels, a lower rate of ANA positivity (p = 0.005), and a higher remission rate after six months (p = 0.050). In UA patients, the prevalent HLA was DRB1*11 and C*07 (36.8% and 42.1%). Serum calprotectin, interleukin-6, and C*07 (p = 0.021, 0.041, 0.018) seemed more specific for isolated UA. Conversely, “connective-like” arthritis showed poorer DLCO (p = 0.041) and more frequent US synovitis (p = 0.041). In conclusion, UA is a frequent common PC and PCV complication and may persist over time when compared to PMR-HA.

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New-onset systemic vasculitis following SARS-CoV-2 infection and vaccination: the trigger, phenotype, and outcome

Cited by 9 publications

References 73 publications

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

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

Reactive Arthritis Following COVID-19 Vaccination: Report of Three Cases

Post-COVID-19 and Post-COVID-19 Vaccine Arthritis, Polymyalgia Rheumatica and Horton’s Arteritis: A Single-Center Assessment of Clinical, Serological, Genetic, and Ultrasonographic Biomarkers

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