Remitting seronegative symmetrical synovitis with pitting oe
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Since the onset of the COVID-19 pandemic, more than 3?million people have lost their lives. The most effective approach against COVID-19 includes the development and administration of safe vaccines. A cross-sectional study among healthcare professionals indicated that BNT162b2 mRNA COVID-19 was associated with vaccination-induced arthritis/arthralgia in 17% of the population studied.

Rarely vaccines can trigger a new-onset rheumatic disease; however, data regarding the SARS-CoV-2 vaccines are lacking. In the present study, we report the first case of remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) induced by BNT162b2 mRNA COVID-19 vaccination in a patient with no history of rheumatic disease. Healthcare providers need to be aware of this condition induced by COVID-19 vaccine and appropriately treat it.

An 80-year-old Caucasian man presented with a 2-week history of acute onset of bilateral hand swelling and pain, which was worse in the left hand and was associated with paresthesia. The symptoms began 2?days following the second dose of the BNT162b2 mRNA COVID-19 vaccine. The patient’s medical history included hypertension, hyperlipidaemia, atrial fibrillation, ischaemic cardiomyopathy, aortic valve stenosis, COPD, sleep apnoea and without any previous history of any rheumatic disorder. Physical examination revealed symmetrical pitting oedema in the dorsum of both hands and synovitis.

Laboratory investigations revealed an elevated erythrocyte sedimentation rate of 55?mm/hour (normal less than 20) and C reactive protein level of 120?mg/L, with negative antinuclear antibodies rheumatoid factor and anticyclic citrullinated peptide antibodies. The full blood count, renal and liver function tests were normal. Hepatitis B and C antibodies, parvovirus B19 were negative. The hand radiographs did not show any evidence of erosion or chondrocalcinosis. Chest radiograph was normal.

The patient took paracetamol without symptom relief. He was prescribed prednisolone 15?mg daily and had a remarkable improvement in his symptoms. In addition, the patient also underwent physical therapy and used topical NSAIDs.

Three months following the onset of his symptoms, a trial to wean off prednisolone was unsuccessful, and the patient stills require prednisolone 5?mg daily. The repeated erythrocyte sedimentation rate was 36?mm/hour and C reactive protein level of 3?mg/L. They also discussed the option to add a disease modifying antirheumatic drug, such as methotrexate, but the patient was reluctant to take the medication.