Abstract
The rare occurrence of polymyalgia rheumatica (PMR) in married couples has been reported in the literature. Susceptibility to PMR is contributed by genetic and environmental factors and cases of PMR developing after influenza vaccine have also been described, in a debated phenomenon known as ‘ASIA’ syndrome. We report the case of two cohabitating married patients developing PMR few weeks after the first dose of ChAdOx1-S SARS-CoV-2 vaccine. Both patients presented with typical symptoms suggestive of PMR. Laboratory findings and ultrasound examination confirmed the diagnosis. Glucocorticoid therapy led to rapid improvment of symptoms. Anti-receptor-binding domain IgG titre was tested and, eight weeks after vaccination, both patients showed no antibody response. It has been suggested that vaccines might trigger autoimmune or inflammatory states in predisposed individuals and various hypotheses have been made regarding the pathogenesis of PMR. Although the causative effect of vaccines cannot be determined, the close temporal correlation observed in our case supports the potential role of environmental factors in triggering the onset of PMR. However, the literature indicates that post-COVID19 vaccination immune-mediated or inflammatory adverse events are extremely rare and vaccination should be encouraged since the benefit largely outweighs possible risks.
Highlights
Polymyalgia rheumatica (PMR) is an inflammatory disorder characterized by severe bilateral muscle pain, usually in the neck, shoulders and pelvic girdles, associated with prolonged morning stiffness
Previous reports of PMR in married couples described in the literature suggested the potential role of environmental factors in the pathogenesis of the disease
Data suggested that exposure to influenza vaccination was more often linked to autoinflammatory diseases, while autoimmune diseases were significantly associated with Hepatitis B Virus (HBV) vaccine
Summary
Polymyalgia rheumatica (PMR) is an inflammatory disorder characterized by severe bilateral muscle pain, usually in the neck, shoulders and pelvic girdles, associated with prolonged morning stiffness. Constitutional symptoms such as fatigue and malaise may be present. Several cases of familial aggregation of both PMR and GCA have been described, including four siblings and a genetically unrelated husband within the same family [12,13] In both studies, the hypothesis was that environmental triggers, probably of infectious origin, had contributed to the synchronous disease onset. We report the case of two unrelated and cohabitating married patients developing PMR after the first dose of ChAdOx1-S SARS-CoV-2 vaccine (Vaxzevria, Oxford-AstraZeneca)
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