AB1363 FIRST PRESENTATION OF AUTOIMMUNE RHEUMATIC DISEASES AFTER COVID-19 VACCINATION: A SYSTEMATIC REVIEW

Abstract

BackgroundCovid-19 vaccination prevents 52% of expected infections, 56% of expected hospitalizations, and 58% of expected deaths in adults 18 years or older [1]. Nevertheless, some case reports and series have demonstrated the new-onset rheumatologic syndromes after vaccination.ObjectivesThe aim of this systematic review is to establish the frequency, clinical features, and treatment response of new onset autoimmune rheumatic diseases after COVID-19 vaccination.MethodsSystematic search for original research articles published between January 2021 and January 2023 was formulated. The search process was carried out following the PRISMA guidelines. Electronic searches were performed in Medline, EMBASE, Cochrane, Scopus, EBSCO, WoS and LILACS using the following key terms in all possible combinations: “Rheumatic diseases”, “Systemic Vasculitis”, “Myositis”, “Polymyositis”, “Systemic Lupus Erythematosus,”, “Antiphospholipid Syndrome”, “Adult onset Still disease”, “Rheumatoid arthritis”, “ANCA-associated vasculitis”, “Spondyloarthritis”, “Reactive arthritis”, “Sjogren’s syndrome”, “Systemic sclerosis”, “Covid-19 vaccine” and “SARS-CoV-2 vaccine”.Cohort studies, case reports or case series were included if the patients fulfilled the specific diagnostic/classification criteria and/or nomenclature for each rheumatic autoimmune disease. Publications were excluded if they did not fulfill the above criteria.ResultsThe electronic search yielded 280 publications. A total of 163 articles were evaluated and 59 reports with 108 patients (GCA 10, IgA vasculitis 9, SLE 14, ANCA vasculitis 24, adult-onset Still’s disease 12, reactive arthritis 2, Rheumatoid Arthritis 5, Sjögren’s syndrome 3, Systemic Sclerosis 2, Takayasu’s arteritis 2, cryoglobulinemic vasculitis 1, Kawasaki disease 3, Polymyalgia rheumatica 16, PAN 1, SpA 2, Overlap syndrome 1, and Antisynthetase syndrome 1) were included. 44.4% were men and 43.5% were women with a median age of 60 years (IQR 40-74 y/o), 47.2% developed rheumatic disease after the first dose and 35.2% after the second dose, with a median of 10 days (IQR 5.5-14.5 days). 67.6% received corticosteroids (16.7% High-dose and 15.7% Pulse), 31.5% received immunosuppressant (cyclophosphamide 7.4%, rituximab 2.8, hydroxychloroquine 4.6, methotrexate 6.5, tocilizumab 2.8, mycophenolate 2.8, immunoglobulin 8.3 y 4.6% others). The 55.6% had complete remission, 24.1% partial and 6.5% non-response.Conclusion1. After Covid 19 vaccine, a minority of patients may develop for the first time an autoimmune rheumatic disease. Despite the increasing number of documented cases, the incidence remains low compared to the benefits of vaccination.2. Patients present a high variability of clinical manifestations and most patients respond favorably to treatment.3. The complex interaction between the vaccine component and the immune system must be studied.Reference[1]Steele MK, Couture A, Reed C, Iuliano D, Whitaker M, Fast H, Hall AJ, MacNeil A, Cadwell B, Marks KJ, Silk BJ. Estimated Number of COVID-19 Infections, Hospitalizations, and Deaths Prevented Among Vaccinated Persons in the US, December 2020 to September 2021. JAMA Netw Open. 2022;5(7):e2220385. doi: 10.1001/jamanetworkopen.2022.20385.Acknowledgements:NIL.Disclosure of InterestsNone Declared.