Progression from palindromic rheumatism to rheumatoid arthritis after COVID-19 vaccination

Infections including COVID-19 infection are associated with immune overactivation and hyperinflammation, and cases of incident inflammatory arthritis after COVID-19 and other respiratory viral infections have been reported. Theoretical concerns of autoimmunity due to molecular mimicry exist with vaccines including vaccines for COVID-19, and rare cases of flares of underlying chronic inflammatory disorders such as systemic lupus erythematosus have been reported after COVID-19 vaccination. Here we present the case of a patient with a 7-year history of well-controlled palindromic rheumatism who developed rheumatoid arthritis 2 weeks after vaccination for COVID-19. This is the first such case to our knowledge, and further studies can elaborate on the risk of autoimmunity due to COVID-19 vaccines if one exists. Given the overall safety and efficacy of COVID-19 vaccines, the proven benefits of vaccinating vulnerable patients with autoimmune disorders outweigh this potential theoretical risk of autoimmune disease flare, and vaccinations in this at-risk population shall be strongly encouraged.