Ten cases with ASIA syndrome after BNT162b2 vaccination: Is it a distinct rheumatoid arthritis phenotype?

Abstract Purpose Vaccines are an identified cause of autoimmune/inflammatory syndrome which is termed as autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome). In this research, we aimed to investigate the remarkable features of patients, whom we termed as ASIA syndrome, developing rheumatoid arthritis (RA) after BNT162b2 vaccination Methods Patients who were asymptomatic before BNT162b2 vaccination and developed chronic arthritis into three months after vaccination enrolled to the study. Demographic, laboratory, clinical, and treatment characteristics were reviewed retrospectively. Results We found 10 patients developing RA following BNT162b2 vaccination. The median age was 54.5 and six was of them were female. The median time between vaccination and onset of symptoms was seven days; seven patients had acute arthritis, and four had intermittent arthritis at the onset of the disease. Only three patients had a disease onset at small joints of the hands. All patients had radiological erosive changes on hand X-rays. Conclusion We reported a case series of ASIA syndrome for the first time who developed RA with erosive radiological features after the BNT162b2 vaccine. Acutely onset at atypical joints, intermittent course, and rapidly destructive changes on hand radiographs, were the spectacular features of our cases than classical RA. Vaccine-induced form may be an another subtype of RA but studies with larger sample sizes are needed.