New-onset of rheumatic diseases following COVID-19 vaccination: the report of three cases and a literature review

"Abstract

Vaccines against coronavirus disease 2019 (COVID-19) have been distributed in most countries for the prevention of onset and aggravation of COVID-19. Recently, there have been increasing numbers of reports on new-onset autoimmune and autoinflammatory diseases following COVID-19 vaccination, however, only little information is available on the long-term safety of these vaccines. Here, we experienced three cases of new-onset rheumatic diseases following COVID-19 vaccination, one case each of rheumatoid arthritis (RA), anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and systemic lupus erythematosus (SLE). The symptom onset ranged from one day to a few days following vaccination. The patients of AAV and SLE were treated successfully with glucocorticoid therapy, and the patient of RA died due to COVID-19. In the literature review of new-onset rheumatic diseases following COVID-19 vaccination, which including seven cases of RA, 37 cases of AAV and 18 cases of SLE, the mean time from vaccination to onset was approximately 11 to 12 days. Most cases improved with glucocorticoid, immunosuppressive drugs and biologic agents...

Discussion

... There are two main types of COVID-19 vaccine formulations; mRNA encoding the SARS-CoV-2 spike protein (S) encapsulated in lipid nanoparticles and adenovirus (AdV) vectors encoding the S protein. COVID-19 vaccine mRNA and AdV particles invade dendritic cells, resulting in the production of S-proteins. The adjuvant activity of the vaccine activates innate immune sensors, resulting in the production of type I interferon and multiple pro-inflammatory mediators, which activate T cells and induce immunity against SARS-CoV-2. Increased production of type I interferon and multiple pro-inflammatory mediators following vaccination may trigger the onset or exacerbation of existing pre-autoimmune conditions and develop autoimmune diseases such as RA, AAV or SLE...

Risk factors for developing autoimmune disease after vaccination include a history of symptoms after vaccination in the past, history of allergy to vaccines, immunosuppressed state, family history of autoimmune disease or known autoantibodies, and genetic predisposition are presumed. Therefore, individuals who develop symptoms of autoimmune disease after receiving the vaccine should consider the possibility that similar symptoms may occur when they receive the vaccine again."