Abstract
Joint pain or arthralgia is a common complaint among girls who have received immunization with the human papillomavirus (HPV) vaccine, but the pathogenesis of this disorder has not been completely understood. We report 2 cases of joint lesions after HPV vaccination. In one case, a 13-year-old patient showed transient arthropathy in the right wrist joint after the first dose of Gardasil® administered in her left shoulder. In the other case, an 18-year-old patient had migrating joint pain with redness and swelling after the third dose of Cervarix®. Her serum C-reactive protein and anti-MMP-3 levels were slightly elevated, but no autoantibodies, including rheumatoid factor and anti-CCP antibody, were detected. Although various nonsteroidal anti-inflammatory drugs produced no relief, small doses of both tacrolimus and prednisolone were highly effective for her polyarthritis. The development of reactive joint lesions after HPV vaccination was noteworthy.
Highlights
Immunization of adolescent girls with the human papillomavirus (HPV) vaccine was initiated to prevent uterineHow to cite this paper: Abe, R., Kinoshita, T., Hineno, A. and Ikeda, S. (2016) Monoarthropathy or Polyarthritis in Adolescent Japanese Girls Who Received Immunization with the Human Papillomavirus Vaccine
Our previous report showed that the main disorders observed in these post-vaccination girls consisted of complex regional pain syndrome (CRPS)I, orthostatic hypotension (OH), and postural orthostatic tachycardia syndrome (POTS), all of which were ascribed to peripheral sympathetic nerve dysfunction [4]
The new term autoimmune syndrome induced by adjuvants (ASIA) has been proposed to cover four similar conditions consisting of silicosis, the Gulf War syndrome, the macrophagic myofasciitis syndrome, and post-vaccination phenomena [10] [15]
Summary
Immunization of adolescent girls with the human papillomavirus (HPV) vaccine was initiated to prevent uterine. Migrating joint pains or arthralgias were frequent systemic reactions to HPV vaccination [7], but usually lacked any inflammatory findings, including elevated serum C-reactive protein (CRP) levels. These joint pains were interpreted as a manifestation of CRPS-I [8] [9]. In June 2013, a 13-year-old girl received her first dose of Gardasil® in the left shoulder The evening, she felt pain in the right wrist joint, which lasted for a few days. Magnetic resonance imaging (MRI) revealedslight fluid accumulation in her right wrist joint (Figure 1), without signal change on articular soft tissues or bones
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