COVID-19 Vaccination Increases Risk of Arthritis Flare: Two Case Reports

COVID-19 Vaccination Increases Risk of Arthritis Flare: Two Case Reports

The first case is a 68-year-old woman with rheumatoid arthritis who experienced a flare after she received a BioNTech/Pfizer vaccination in October 2021. She stopped tofacitinib a week prior to the vaccination and developed pain in the left knee a week after the vaccination. The synovial fluid aspirated through the knee exhibited the pattern of inflammatory synovial fluid. Her symptoms were relieved after repeated joint aspiration and intra-articular corticosteroid injections. The second case is a 45-year-old man without underlying diseases who presented with left knee pain on the day after his third dose of the Medigen COVID-19 vaccine in January 2022. The synovial fluid aspirated through the knee exhibited the pattern of inflammatory synovial fluid. His symptoms were relieved after repeated joint aspiration and oral non-steroidal anti-inflammatory drugs. We discuss the possible mechanism underlying the arthritis flare and answer the following questions: (1) whether to stop antirheumatic drugs before vaccination; (2) when to resume medication after vaccination.