Coronavirus disease 2019 (COVID-19) vaccination has been instrumental in controlling global morbidity and mortality. However, in rare circumstances, vaccines have been reported to trigger flares in autoimmune rheumatic conditions such as rheumatoid arthritis (RA). Here, we present a case report of a 36-year-old Indian male, previously in clinical remission from seropositive RA on stable combination disease-modifying antirheumatic drugs, who developed a significant disease flare with pronounced cutaneous and articular manifestations within 48 hours of receiving the first dose of the Covishield (ChAdOx1 nCoV-19) vaccine. Clinical findings included symmetrical pitting oedema, erythematous plaques with extensive exfoliation, as well as acute Mon arthropathy of the knee. Laboratory and joint fluid analysis confirmed an inflammatory flare rather than infection. The patient responded well to corticosteroid therapy with continuation of baseline immunosuppression. Notably, skin and joint symptoms resolved within one month. At one-year follow-up, the patient remained stable and was tolerating subsequent COVID-19 booster vaccinations without incident. This report is novel for describing detailed cutaneous manifestations following Covishield vaccination in an RA patient, as the current literature most commonly reports flares with messenger RNA (mRNA) platforms, and cutaneous involvement remains insufficiently described after viral vector vaccines. The case underscores that, while transient RA flares may rarely occur post-vaccination, they are generally manageable and do not contraindicate further immunisation.
Gupta et al. (Mon,) studied this question.