Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Department of Medical Imaging, Division of Nuclear Medicine, University of Debrecen, Debrecen, Hungary.
Muscle Nerve. 2023 May;67(5):371-377. doi: 10.1002/mus.27811. Epub 2023 Mar 15.
INTRODUCTION/AIMS: Vaccination against coronavirus disease 2019 (COVID-19) is relatively safe in patients with idiopathic inflammatory myopathies (IIM); however, myositis flares following vaccination have been poorly studied. We aimed to evaluate the frequency, features, and outcomes of disease relapses in patients with IIM following COVID-19 vaccination.
A cohort of 176 IIM patients were interviewed after the third wave of the COVID-19 pandemic and followed prospectively. Relapses were determined using the disease state criteria and the outcome of the flares with myositis response criteria, calculating the total improvement score (TIS).
A total of 146 (82.9%) patients received a vaccination, 17/146 (11.6%) patients had a relapse within 3 mo, and 13/146 (8.9%) patients within 1 mo. The relapse rate of unvaccinated patients was 3.3%. Three months after the post-vaccination relapses, 70.6% of the patients (12/17) achieved an improvement of disease activity (average TIS score: 30 ± 15.81; seven minor, five moderate, and zero major improvements). Six months after flares improvement was detected in 15/17(88.2%) of relapsed patients (average TIS score: 43.1 ± 19.53; 3 minimal, 8 moderate, and 4 major). Forward stepwise logistic regression analysis revealed that the active state of myositis at the time of injection (p < .0001; odds ratio, 33; confidence interval, 9-120) was significantly associated with the occurrence of a relapse.
A minority of the vaccinated IIM patients had a confirmed disease flare after COVID-19 vaccination and the majority of the relapses improved after individualized treatment. An active disease state at the time of vaccination probably contributes to the increased risk of a post vaccination myositis flare.
介绍/目的：接种 2019 年冠状病毒病（COVID-19）疫苗在特发性炎性肌病（IIM）患者中相对安全；然而，疫苗接种后肌炎发作的情况研究甚少。我们旨在评估 COVID-19 疫苗接种后 IIM 患者疾病复发的频率、特征和结局。
在 COVID-19 大流行的第三波后，对 176 名 IIM 患者进行了访谈，并进行了前瞻性随访。使用疾病状态标准和肌炎反应标准评估肌炎发作的结局，计算总改善评分（TIS）来确定复发。
共 146 名（82.9%）患者接受了疫苗接种，146 名中有 17 名（11.6%）在 3 个月内出现复发，146 名中有 13 名（8.9%）在 1 个月内出现复发。未接种疫苗的患者复发率为 3.3%。疫苗接种后 3 个月，17 名（70.6%）患者的疾病活动度得到改善（平均 TIS 评分：30±15.81；7 名轻度，5 名中度，0 名重度）。在 17 名出现肌炎发作的患者中，6 个月时发现 15 名（88.2%）患者的病情得到改善（平均 TIS 评分：43.1±19.53；3 名轻度，8 名中度，4 名重度）。向前逐步逻辑回归分析显示，注射时肌炎处于活动状态（p<0.0001；优势比，33；置信区间，9-120）与复发的发生显著相关。
少数接种 COVID-19 疫苗的 IIM 患者在接种疫苗后出现确诊的肌炎发作，大多数发作在个体化治疗后得到改善。接种时的疾病活动状态可能会增加疫苗接种后肌炎发作的风险。
