COVID-19 Vaccine-induced Autoimmune Rheumatic Diseases: A Systematic Review of Case Reports.

INTRODUCTION: Autoimmune rheumatic diseases (ARDs) have been reported following various vaccinations, including those against COVID-19. Given widespread global vaccination and the rarity of these events, the causal association between COVID-19 vaccination and ARD onset remains unclear. This systematic review aimed to summarize reported ARD cases occurring after COVID-19 vaccination. METHODS: A systematic search of PubMed, Scopus, Google Scholar, and EMBASE was conducted for publications from 2020 to September 2024. Eligible studies included case reports describing new-onset ARDs occurring within 30 days after COVID-19 vaccination in individuals aged ≥16 years without prior ARDs. Data on demographics, vaccine type, ARD subtype, onset interval, and clinical outcomes were extracted. RESULTS: A total of 181 reports comprising 372 patients met the inclusion criteria. The median time to ARD onset was 7 days. Vasculitis was the most frequently reported ARD (50.8%), followed by connective tissue diseases and inflammatory arthritis. Most cases occurred after mRNA vaccines (66.9%). Among 366 cases with a known vaccine type, Pfizer accounted for 55.7%. Cross-tabulation analysis revealed a significantly higher likelihood of ARD following Pfizer vaccination compared with other vaccines (OR = 3.25). Complete remission was achieved in 87.3% of cases, while two deaths were reported. DISCUSSION: The predominance of vasculitis and the temporal proximity of onset raise the possibility of an immunological association, although causality cannot be confirmed due to underreporting and limited clinical details in case reports. CONCLUSION: Clinicians should consider ARDs in patients presenting with musculoskeletal or multisystem symptoms shortly after COVID-19 vaccination, particularly following mRNA-based vaccines.