P061 Polymyalgia rheumatica following COVID-19 vaccination: presentation of four patients

Abstract

Background/AimsVaccination against coronavirus is a cornerstone in the fight against the COVID-19 pandemic. Although the safety and efficacy of vaccines was established prior to roll out, long-term data and reports of rare adverse reactions remain inadequate. Literature reviews revealed two cases of PMR-like syndrome, left elbow arthritis and a case of rheumatoid arthritis (RA) flare following COVID-19 vaccination. Additionally, a case of new onset RA and case of reactive arthritis was reported with COVID infection.MethodsWe present four patients with polymyalgia rheumatica (PMR) following COVID-19 vaccination. The clinical details of the four patients are outlined in the table: P061 Table 1Patient 1Patient 2Patient 3Patient 4Demographic data76-year-old Caucasian male68-year-old Caucasian male73-year-old African male65-year-old Caucasian maleType of COVID-19 vaccineAstraZenecaPfizerAstraZenecaAstraZenecaOnset of symptoms after the second dose of COVID-19 vaccinationWithin 1 weekWithin 2 weeksWithin 1 weekWithin 1 weekClinical symptoms-Inflammatory joint pain mainly in shoulders and hand with two hours morning stiffness -Bilateral knee and ankle swelling. -Significant restriction of self-care activities in daily living (ADL)-Severe shoulder pain and morning stiffness -Hand pain affecting ADL-Widespread painful joints affecting the neck, pelvic girdle, and hands -Significant restriction of self-care activities-Sudden onset of pain and stiffness of both shoulders and pelvic girdle -Requiring a walking stick. -Significant morning stiffnessClinical signs- Limited shoulder abduction -Tenderness over PIP and MCP without synovitis- Limitation of shoulder movement-Limitation of shoulder movement-Limitation of both shoulder movementAutoimmune profile (RF, CCP, ANA, ANCA and protein electrophoresis)NegativeNegativeNegativeNegativeFull blood countHaemoglobin (Hb) 125 g/l and white blood cells (WBCs) 17 10 × 9/1Hb 147 g/l and WBCs 11.5 10× 9/1Hb 160 g/l WBCs 14 10× 9/1Hb 124 g/l and WBCs 9.8 10× 9/1CRP at the onset of symptoms96 mg/l61 mg/l105 mg/l161 mg/lPrednisolone dose30 mg per day as there was no response to 15 mg and tapered as per PMR regime15 mg per day tapered as per PMR regime40 mg per day by A & E; and tapered as per PMR regime15 mg per day tapered as per PMR regimeUltrasound (US) revealed typical finding of bilateral sub deltoid bursitis and biceps tendonitis in the first patient and there was severe right sub deltoid bursitis with biceps tendonitis in the second patient. None of the patients had features to suggest malignancy, giant cell arteritis, seronegative spondyloarthropathies or connective tissue disease.ResultsAfter exclusion of other inflammatory causes of shoulder pain, they were diagnosed with PMR based on clinical judgement and high inflammatory marker at time of presentations, ultrasound findings and significant improvement with prednisolone.ConclusionPMR following COVID-19 vaccination is exceptional and cannot be proven. In these patients post vaccination chronology of events favours this diagnosis. It is known that immunological illness may start after viral infection or vaccination (hapten or immune stimulation). The patients have responded well to the prednisolone similar to typical PMR cases. We need further studies to look at possible link between COVID-19 vaccination and PMR.Disclosure M. Mohareb: None. A. Bharadwaj: None. A. Nandagudi: None.