# Exploring the COVID-19 Vaccine: New Onset and Exacerbations in Rheumatic Diseases

## TL;DR

This paper reviews how the COVID-19 vaccine can sometimes cause new rheumatic diseases or worsen existing ones, and how these conditions are treated.

## Contribution

The study synthesizes findings from 21 studies to explore the clinical and immunological aspects of rheumatic diseases post-COVID-19 vaccination.

## Key findings

- New-onset and exacerbated rheumatic diseases have been reported following the COVID-19 vaccine.
- Molecular mimicry and immune dysregulation are proposed mechanisms for these rheumatological outcomes.
- Glucocorticoids and immunosuppressive agents are effective in treating post-vaccination rheumatic conditions.

## Abstract

The COVID-19 vaccine has been substantial in mitigating the risk of SARS-CoV-2 infection, transmission, and adverse outcomes on a global scale. While the vaccine has been crucial in reducing COVID-19 risks, rheumatological manifestations are rare. These include new-onset conditions and exacerbations of pre-existing disease, which raise important clinical questions. This narrative literature review aims to synthesize findings from 21 studies on the rheumatological outcomes of COVID-19 vaccination, focusing on clinical presentations, risk factors, pathogenesis, laboratory findings, and treatment outcomes. The patients may present with various symptoms, and there can be certain determinants that may predispose the patients to developing these symptoms. The pathogenesis is postulated to be complex, with proposed mechanisms including molecular mimicry and immune dysregulation to explain the onset of rheumatic disease. Both new-onset rheumatological disease and exacerbated rheumatological conditions post-vaccination typically respond well to first-line treatment with glucocorticoids and immunosuppressive agents. Understanding these findings will help clinicians diagnose, manage, and treat post-vaccination rheumatological conditions more effectively.