The Association of Polymyalgia Rheumatica and Giant Cell Arteritis With COVID-19 Vaccination: A Systematic Review.

Abstract

Background: Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are interrelated inflammatory conditions, and evidence suggests that infection and vaccination might act as a trigger for these conditions. This descriptive systematic review summarizes the published case reports and case series on new-onset PMR and GCA following COVID-19 vaccination, highlighting their clinical features, diagnostic findings, and treatment outcomes.

Objectives: To do a systematic analysis of available literature regarding the association between COVID-19 vaccination and the first onset or flare of PMR and/or GCA.

Design: Systematic review of case reports and case series.

Data sources and methods: A systematic literature search was conducted using PubMed/MEDLINE, Cochrane, ScienceDirect, and Google Scholar. Data on patient demographics, clinical features, outcomes, and latency periods were extracted and analyzed. Quality assessment of included studies was performed using the Joanna Briggs Institute Critical Appraisal Tool.

Results: A total of 32 articles, documenting 50 new-onset cases (30 PMR and 20 GCA), were identified for inclusion. The mean age for patients with PMR was 71.06 years, and 72.85 years for GCA. A slight female predominance was observed (60%) for both PMR and GCA. Pfizer-BioNTech (48%) and AstraZeneca (38%) vaccines were most frequently associated with disease onset. The mean latency period from vaccination to symptom onset was 11.03 days for PMR and 5.3 days for GCA, indicating a temporal relationship. Most of these studies originated from North America and Europe mimicking the global scale of vaccination. Most patients responded well to symptomatic treatment with corticosteroids.

Conclusions: There exists a temporal association between COVID-19 mRNA or viral vector-based vaccines and the onset of PMR and GCA. While causality is not proven, this review underscores the need for clinicians to be aware of this potential association to ensure timely diagnosis and treatment, particularly as booster vaccinations continue to be administered. Larger epidemiological studies with long-term follow-up are essential to further explore this association.