POS0541 INFLAMMATORY RHEUMATIC DISEASES (IRD) WITH ONSET AFTER SARS-COV-2 INFECTION OR COVID-19 VACCINATION: A COHORT STUDY FROM THE COVID-19 & ASD COLLABORATIVE STUDY GROUP

Abstract

BackgroundA growing number of articles describe new-onset inflammatory rheumatic diseases (IRD) - including inflammatory joint diseases (IJD), polymyalgia rheumatica (PMR), connective tissue diseases (CTD) and vasculitis - in close temporal association with SARS-CoV-2 infection (1). On the other hand, also the exposure to vaccines may elicit autoimmunity and reports of IRD following vaccination with anti-COVID-19 vaccines appeared in literature since the earliest phases of the vaccination campaign (2,3).ObjectivesThe aim of the present study was to contribute to the knowledge on the spectrum of new-onset post-COVID-19 and post-vaccine IRD with a comparative analysis from a large multicentric observational study.MethodsIn the present cohort study, we collected consecutive cases of IRD or acrosyndrome encountered during routine clinical practice from November 2021 to October 2022 (12 months) satisfying one of the following inclusion criteria: a) onset of the rheumatic manifestations within four weeks from SARS-CoV-2 infection, confirmed by nasopharyngeal swab OR, b) onset of the rheumatic manifestations within four weeks from the administration of one of the COVID-19 vaccines approved for administration in Italy during the collection period. Exclusion criteria were a past history of any IRD or acrosyndrome.ResultsA total of 270 cases were entered in the database. Three records were excluded because identified as mechanical pain (n = 1) or fibromyalgia (n = 2). The final analysis cohort comprised a total of 267 patients, of which 122 (45.2%) patients in the post-COVID-19 (age 54 ± 17 years, 69.7% females) and 145 (54.8%) patients (age 58 ± 16 years, 66.2% females) in the post-vaccine cohorts. Mean delay between COVID-19 diagnosis or vaccine administration and rheumatic manifestations development was 14.5 ± 7.8 vs 13.9 ± 8.5 days, respectively (p = 0.59).Distribution of various IRD categories differed between the two cohorts (Figure 1): the post-COVID-19 cohort had a higher percentage of patients classified as having IJD (52.5% vs 37.2%, p = 0.013) while the post-vaccine cohort had a higher prevalence of patients classified as PMR (33.1% vs 21.3%, p = 0.032). No differences were detected in the percentage of patients diagnosed with CTD (19.7% vs 20.7%, p = 0.837) or vasculitis (6.6% vs 9.0%, p = 0.467).ConclusionAlthough temporal association does not imply causation, our study reports the largest cohort of post-COVID-19 and post-vaccine IRD described to date and supports the hypothesis that new-onset IRD may be triggered by SARS-CoV-2 infection or COVID-19 vaccines. The spectrum of possible clinical manifestations is broad and includes different IJD, PMR, CTD and vasculitis in both cohorts. Our data also suggest a differential pattern of expression: while IJD are the most common IRD following SARS-CoV-2 infection, PMR is relatively more frequent after vaccine administration.