Abstract Body

To date, around 60% of the world population has been protected by vaccines against SARS-CoV-2, signifcantly reducing the devastating efect of the pandemic and restoring social economic activity through mass vaccination. Multiple studies have demonstrated the efectiveness and safety of vaccines against COVID-19 in healthy populations, in people with risk factors, in people with or without SARS-CoV-2 infection, and in immunocompromised people. According to the criteria for post-vaccine adverse events established by the World Health Organization, a minority of individuals may develop adverse events, including autoimmune syndromes. The exact mechanisms for the development of these autoimmune syndromes are under study, and to date, a cause-efect relationship has not been established. Many of these autoimmune syndromes meet sufcient criteria for the diagnosis of Adjuvant-Induced Autoimmune Syndrome (ASIA syndrome). The descriptions of these autoimmune syndromes open new perspectives to the knowledge of the complex relationship between the host, its immune system, with the new vaccines and the development of new-onset autoimmune syndromes. Fortunately, most of these autoimmune syndromes are easily controlled with steroids and other immunomodulatory medications and are short-lived. Rheumatologists must be alert to the development of these autoimmune syndromes, and investigate the relationship between autoimmune/infammatory symptoms and vaccination time, and assess their therapeutic response.

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ABSTRACT

The term "cytokine storm" was first proposed in 1993 by Ferrara et al. In 1991, Chatenaud described a systemic clinical picture called "Cytokine Release Syndrome", very similar to "Cytokine Storm Syndrome", so these terms can be used synonymously.

During the COVID-19 pandemic, high-risk individuals (>65 years, with comorbidities) may develop cytokine storms as a consequence of multi-organ involvement seen during the acute and post COVID-19 phases.

On the other hand, the term immune neuroendocrine system was first proposed by Besedovsky H et al. Evidence obtained during COVID-19 infection, demonstrated that SARS-CoV-2 infections can affect the immune neuroendocrine system, both in its invasion stage of different organs and tissues and in the recovery stage. This damage is caused by a viral infection and/or cytokine storm. The main stress response systems are 1. The hypothalamic-pituitary-adrenal axis (HPA). 2. The hypothalamic-pituitary-thyroid axis (HPT). 3.The hypothalamic-pituitary-gonadal axis (HPG). 4. Prolactin/growth hormone system, and 5. The autonomic nervous system. The immuno-neuroendocrine interaction is activated by stress factors such as infections, autoimmune diseases or trauma. This review analyzes the devastating effect of SARS-CoV-2 infection and the cytokine storm on the Immune neuroendocrine system. This evidence may lead to new therapeutic proposals.

Background and Aims

To establish the frequency of new onset rheumatological syndromes associated to COVID-19 vaccination.

Methods

Systematic search for original research articles published between January 2021 and February 2022 was made. PRISMA guidelines were used. Electronic searches for cohort studies, case reports or case series were performed in Medline, EMBASE, Cochrane, Scopus, EBSCO, WoS and LILACS using the following key terms in all possible combinations: “Rheumatic diseases”, “Systemic Vasculitis”, “Myositis”, “Polymyositis”, “Lupus Erythematosus, Systemic”, “Antiphospholipid Syndrome”, “Still’s Disease, Adult-Onset”, “Rheumatoid arthritis”, “ANCA-associated vasculitis”, “Spondyloarthritis”, “Reactive arthritis”, “Sjögren's syndrome”, “Systemic sclerosis”, “Covid-19 vaccine” and “SARS-CoV2 vaccine”. Reference lists of all retrieved articles were manually reviewed.

Results

264 publications were reviewed.150 articles were evaluated and 45 reports with 62 patients (ACG 6, IgA vasculitis 5, SLE 8, ANCA vasculitis 22, adult-onset Still's disease 9, reactive arthritis 2, rheumatoid arthritis 1, Sjögren's syndrome 3, systemic sclerosis 2, Takayasu's arteritis 2, cryoglobulinemic vasculitis 1, Kawasaki disease 1) were included. 58.1% were women with a median age of 54 years (iQR 36.75-76/o), 51% developed rheumatic disease after the first dose and 49% after the second dose, with a median of 10 days (IQR 5.2-14 days). Patients were treated with variable steroids doses and in some cases inmunosupresive therapy , 54% achieved remissión or complete response (mean 6-12 weeks) and 22.4% partial response.

Conclusions

Despite the increasing number of documented cases, the incidence remains low compared to the benefits of vaccination. Rheumatologic syndromes associated to COVID-19 vaccination appeared to have a good short term prognosis. Long-term follow-up is required.