Characteristics of emerging new autoimmune diseases after COVID-19 vaccination: A sub-study by the COVAD group.

Limited evidence on long-term COVID-19 vaccine safety in patients with idiopathic inflammatory myopathies (IIMs) continues to contribute to vaccine hesitancy. We studied delayed-onset vaccine adverse events (AEs) in patients with IIMs, other systemic autoimmune and inflammatory disorders (SAIDs), and healthy controls (HCs), using data from the second COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. A validated self-reporting e-survey was circulated by the COVAD study group (157 collaborators, 106 countries) from Feb–June 2022. We collected data on demographics, comorbidities, IIM/SAID details, COVID-19 history, and vaccination details. Delayed-onset (> 7 day) AEs were analyzed using regression models. A total of 15165 respondents undertook the survey, of whom 8759 responses from vaccinated individuals [median age 46 (35–58) years, 74.4% females, 45.4% Caucasians] were analyzed. Of these, 1390 (15.9%) had IIMs, 50.6% other SAIDs, and 33.5% HCs. Among IIMs, 16.3% and 10.2% patients reported minor and major AEs, respectively, and 0.72% (n = 10) required hospitalization. Notably patients with IIMs experienced fewer minor AEs than other SAIDs, though rashes were expectedly more than HCs [OR 4.0; 95% CI 2.2–7.0, p < 0.001]. IIM patients with active disease, overlap myositis, autoimmune comorbidities, and ChadOx1 nCOV-19 (Oxford/AstraZeneca) recipients reported AEs more often, while those with inclusion body myositis, and BNT162b2 (Pfizer) recipients reported fewer AEs. Vaccination is reassuringly safe in individuals with IIMs, with AEs, hospitalizations comparable to SAIDs, and largely limited to those with autoimmune multimorbidity and active disease. These observations may inform guidelines to identify high-risk patients warranting close monitoring in the post-vaccination period.

Background:It is recommended that people with immune mediated inflammatory diseases (IMIDs) who take immunosuppressive medication receive at least 3 COVID-19 vaccinations in order to generate anti-SARSCoV2 antibody levels similar to...

Data on short-term safety of COVID-19 vaccination in patients with systemic sclerosis (SSc) were explored previously in the first COVID-19 vaccination in autoimmune diseases (COVAD) survey conducted in 2021. However, delayed adverse events (ADEs) (occurring > 7days post-vaccination) are poorly characterized in these patients with SSc. In this study, we analysed delayed COVID-19 vaccine-related ADEs among patients with SSc, other systemic autoimmune and inflammatory disorders (SAIDs) and healthy controls (HCs) using data from the second COVAD study conducted in 2022. The COVAD-2 study was a cross-sectional, patient self-reported global e-survey conducted from February to June 2022. Data on demographics, SSc/SAID disease characteristics, COVID-19 infection history, and vaccination details including delayed ADEs as defined by the Centre for Disease Control were captured and analysed. Among 17,612 respondents, 10,041 participants fully vaccinated against COVID-19 were included for analysis. Of these, 2.6% (n = 258) had SSc, 63.7% other SAIDs, and 33.7% were HCs. BNT162b2 Pfizer (69.4%) was the most administered vaccine, followed by MRNA-1273 Moderna (32.25%) and ChadOx1 nCOV-19 Oxford/AstraZeneca (12.4%) vaccines. Among patients with SSc, 18.9% reported minor, while 8.5% experienced major delayed ADEs, and 4.6% reported hospitalization. These frequencies were comparable to those of the ADEs reported by other patients with SAIDs and HCs. However, patients with SSc reported a higher frequency of difficulty in breathing than HCs [OR 2.3 (1.0-5.1), p = 0.042]. Patients with diffuse cutaneous SSc experienced minor ADEs [OR 2.1 (1.1-4.4), p = 0.036] and specifically fatigue more frequently [OR 3.9 (1.3-11.7), p = 0.015] than those with limited cutaneous SSc. Systemic sclerosis patients with concomitant myositis reported myalgia more frequently [OR 3.4 (1.1-10.7), p = 0.035], while those with thyroid disorders were more prone to report a higher frequency of joint pain [OR 5.5 (1.5-20.2), p = 0.009] and dizziness [OR 5.9 (1.3-27.6), p = 0.024] than patients with SSc alone. A diagnosis of SSc did not confer a higher risk of delayed post-COVID-19 vaccine-related ADEs overall compared with other SAIDs and HCs. However, the diffuse cutaneous phenotype and coexisting autoimmune conditions including myositis and thyroid disease may increase the risk of minor ADEs. These patients may benefit from pre-vaccination counselling, close monitoring, and early initiation of appropriate care in the post-COVID-19 vaccination period.

Musculoskeletal adverse events due to immune checkpoint inhibitors are common and can present clinically as inflammatory arthritis, polymyalgia rheumatica, or arthralgia. The pathoanatomy of musculoskeletal adverse events related to immune checkpoint inhibitors remains undefined, with a paucity of available imaging data. We aimed to investigate the whole-body imaging phenotype of arthralgia and inflammatory arthritis following exposure to immune checkpoint inhibitors, to fully characterise the pattern of inflammation in these patients and subsequently inform clinical management. In this prospective imaging study, patients aged 18 years or older with new musculoskeletal symptoms that started during or up to 6 months after receiving an immune checkpoint inhibitor and healthy controls aged 18 years or older, with no personal history of rheumatological autoimmune disease, no active cancer, and no self-reported joint pains in the 4 weeks before their MRI scan date, were recruited at the Leeds Rheumatology department of Chapel Allerton Hospital, Leeds, UK, and underwent gadolinium contrast-enhanced whole-body MRI. Joint, tendon, bursal, entheseal, and whole spinal imaging lesions were graded by two independent masked assessors and consensus reported. Inflammatory whole-body MRI patterns were analysed and patients were followed up for 6 months. People with lived experience of inflammatory arthritis and musculoskeletal toxicity related to immune checkpoint inhibitors highlighted the importance of knowing and understanding imaging findings to help inform risk versus benefit decisions about immunosuppressive treatments. Between Oct 20, 2021, and May 22, 2024, 60 patients (35 [58%] with arthralgia and 25 [42%] with inflammatory arthritis) and 20 healthy controls were recruited. The mean age of patients was 65 years (SD 11) and that of healthy controls was 62 years (7); 34 (57%) patients were men and 26 (43%) were women, and 12 (60%) healthy controls were men and eight (40%) were women. All patients and healthy controls were White. Median total joint synovitis, joint erosions, enthesitis, and tenosynovitis scores were significantly higher in patients with arthralgia or inflammatory arthritis induced by immune checkpoint inhibitors compared with healthy controls, without significant differences between the inflammatory arthritis and arthralgia subgroups. Acromioclavicular (46 [77%] of 60), glenohumeral (45 [75%] of 60), wrist (43 [73%] of 59), and metacarpophalangeal (35 [59%] of 59) joints were the most frequently affected by synovitis in all patients. There were three distinct global inflammatory patterns: peripheral inflammatory arthritis in 22 (37%) of 60 patients; polymyalgia rheumatica in seven (12%), and an overlapping phenotype of polymyalgia rheumatica and peripheral inflammatory arthritis in 12 (20%). Axial inflammation was only identified in one patient. Four of the five patients requiring disease-modifying antirheumatic drug therapy were in the peripheral inflammatory arthritis group, which also had the highest initial and ongoing glucocorticoid requirement. MRI inflammation and erosions are as prevalent in patients with arthralgia exposed to an immune checkpoint inhibitor as in those with inflammatory arthritis. This finding suggests that the overall burden of musculoskeletal toxicity associated with immune checkpoint inhibitors is currently under-recognised. Patients who develop inflammatory arthritis or arthralgia after exposure to immune checkpoint inhibitors have three main imaging patterns: polymyalgia rheumatica, peripheral inflammatory arthritis, and an overlap of polymyalgia rheumatica and inflammatory arthritis. Patients with peripheral inflammatory arthritis were most likely to require disease-modifying antirheumatic drugs. The National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre.

Objective To examine whether features of the B cell receptor (BCR) IgG repertoire correlate with disease activity and clinical phenotypes in systemic autoimmune diseases (SAIDs). Methods High-throughput sequencing was performed on IgG heavy chain repertoires from 138 patients with SAIDs, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), scleroderma (SSc), and idiopathic inflammatory myopathy (IIM), as well as 36 healthy controls (HC). We analyzed V/D/J gene usage, clonal distribution and diversity, CDR3 length distribution and amino acid usage, and the correlation between specific BCR features and clinical features. Results SAIDs showed skewed usage of V/D/J genes and V-D-J combinations, with altered CDR3 length distributions and amino acid usage in SLE, RA, SSc, and IIM. Notably, SLE and RA exhibited a pronounced expansion of mid-ranked clones and significantly higher clonal diversity compared to HC. Specific genes, including IGHD2-15, IGHV1-24, IGHV1-69-2, IGHV1-8, and IGHV4 family members, along with increased clonal diversity, were closely associated with disease activity and clinical phenotypes in SLE and RA. Conclusions IgG repertoire features reflect disease-related immune perturbations and may serve as potential biomarkers for disease progression, diagnostics and targeted therapies in SAIDs.

to be aware that polymyositis and autoimmune thyroiditis can coexist and a thorough evaluation of both conditions may be necessary in patients presenting with myalgia or muscle weakness.

Objectives: To combat the Coronavirus Disease 2019 (COVID-19) pandemic, the World Health Organization announced the emergency license for the usage of COVID-19 vaccinations. Various literature postulated a few cross-talks between autoimmune disease and COVID-19 vaccination. The molecular mimicry between autoimmune diseases as well as autoimmune antibodies and the antibodies against Severe Acute Respiratory Syndrome Coronavirus-2 S proteins triggers the development of a severe form of autoimmune disease. The causal association between autoimmune disease and COVID-19 vaccinations is still under debate. Hence, in this study, we aim to analyze the impact of COVID-19 vaccination on patients with autoimmune diseases. Material and Methods: Patients were recruited from a nationwide survey throughout India from October 1, 2021, to December 30, 2021. All patients of autoimmune diseases enrolled in this study had received a diagnosis of COVID-19. A Google form was created in the English language with relevant items, including demographic variables, COVID-19 vaccination-related variables, and its impact on autoimmune disease. Association between the COVID-19 severity, vaccination status, and autoimmune disease status was analyzed. Results: Eight hundred and forty-two patients with autoimmune disease participated in the study with 86% of vaccination rate. We noted comparable infection rates among vaccinated (37.5%, n = 272) and non-vaccinated (33.3%, n = 39) respondents with autoimmune disease (P = 0.38). Although 22.5% (n = 163) of patients with autoimmune disease demonstrated deterioration following vaccination, 75.3% (n = 546) of patients did not show any change in disease profile. We noted a significant increase in the computed tomography (CT) severity score of COVID-19 infection among non-vaccinated individuals (odds ratio = 1.1,95% confidence interval [0.29, 2.29], P &lt; 0.001). Moreover, we also noted a significant increase in the need (P = 0.01) and length of hospitalization (P &lt; 0.001) among COVID-19 non-vaccinated individuals. We also noted vaccination significantly prevented an acute flare-up of auto-immune disease when infected with COVID-19 (P &lt; 0.001). Conclusion: Although vaccination did not affect the incidence of disease among patients with auto-immune disease, it did significantly decrease the CT severity score, hospitalization rate, and length of stay following COVID-19 infection. Moreover, vaccination also prevented acute flare-ups of autoimmune disease following COVID-19 infection.

To examine the frequency of, and risk factors for, disease flare following COVID-19 vaccination in patients with systemic rheumatic disease (SRD). An international study was conducted from 2 April to 16 August 2021, using an online survey of 5619 adults with SRD for adverse events following COVID-19 vaccination, including flares of disease requiring a change in treatment. We examined risk factors identified a priori based on published associations with SRD activity and SARS-CoV-2 severity, including demographics, SRD type, comorbidities, vaccine type, cessation of immunosuppressive medications around vaccination and history of reactions to non-COVID-19 vaccines, using multivariable logistic regression. Flares requiring a change in treatment following COVID-19 vaccination were reported by 4.9% of patients. Compared with rheumatoid arthritis, certain SRD, including systemic lupus erythematosus (OR 1.51, 95% CI 1.03, 2.20), psoriatic arthritis (OR 1.95, 95% CI 1.20, 3.18) and polymyalgia rheumatica (OR 1.94, 95% CI 1.08, 2.48) were associated with higher odds of flare, while idiopathic inflammatory myopathies were associated with lower odds for flare (OR 0.54, 95% CI 0.31-0.96). The Oxford-AstraZeneca vaccine was associated with higher odds of flare relative to the Pfizer-BioNTech vaccine (OR 1.44, 95% CI 1.07, 1.95), as were a prior reaction to a non-COVID-19 vaccine (OR 2.50, 95% CI 1.76, 3.54) and female sex (OR 2.71, 95% CI 1.55, 4.72). SRD flares requiring changes in treatment following COVID-19 vaccination were uncommon in this large international study. Several potential risk factors, as well as differences by disease type, warrant further examination in prospective cohorts.

Do JAK inhibitors affect immune response to COVID-19 vaccination? Data from the MAJIK-SFR Registry.

AB1108 ANALYSIS OF HOMOGENOUS PATTERN IN ANTI-NUCLEAR ANTIBODY-INDIRECT IMMUNOFLUORESCENCE ASSAY

We observed a high frequency of patients with IIM experiencing post-COVID-19 disease flares. A past history of Asthma and those with certain acute COVID-19 symptoms were at higher risk. REFERENCES:

Background:COVID-19 vaccine hesitancy among pregnant and breastfeeding women with autoimmune diseases (AID) is often attributed to the fear of adverse events (AE) and disease flares (DF). No data are available...

Cutaneous lupus erythematosus flare with vitiligo-like depigmentation following the AstraZeneca COVID vaccine

Background:Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of systemic autoimmune diseases with significant multi-domain impact, including muscle, skin, lungs, and the cardiovascular system. Myositis-associated autoantibodies, present in approximately 70%...

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