key: cord-0926366-k3qsidhv authors: Cadiou, Simon; Perdriger, Aleth; Ardois, Samuel; Albert, Jean-David; Berthoud, Olivia; Lescoat, Alain; Guggenbuhl, Pascal; Robin, François title: SARS-CoV-2, polymyalgia rheumatica and giant cell arteritis: COVID19 vaccine shot as a trigger? Comment on :Can SARS-CoV-2 trigger relapse of polymyalgia rheumatica?” by Manzo et al. Joint Bone Spine 2021;88:105150 date: 2021-09-29 journal: Joint Bone Spine DOI: 10.1016/j.jbspin.2021.105282 sha: 27b9ccca5ed2b0aaeaa98653fe85b8f2a190e335 doc_id: 926366 cord_uid: k3qsidhv nan (1) Univ Rennes, Department of Rheumatology, Rennes University Hospital, France. (2) Univ Rennes, Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, France. We read with high interest the article by Manzo et al. [1] about SARS-CoV-2 triggering polymyalgia rheumatica (PMR). SARS-CoV-2 triggering giant cell arteritis (GCA) have also been described [2] . Interleukin 6 (IL-6) is a key pathway in the pathogenesis of SARS-CoV-2 disease [3] , PMR and [4] and IL-6 blockage has been used in all three diseases [3, 4] . COVID-19 vaccine is crucial for patients, especially with chronic rheumatic diseases (CRD). There is only a few data on vaccine tolerance in these population, but recent reports showed reassuring [5] [6] [7] results with at least 85% of patient without flares after the first dose. However, data are scarce regarding COVID-19 vaccine and PMR or GCA. Here we report three cases of PMR and GCA developed soon after COVID-19 vaccine (fig 1) . The first patient was a 71-year-old man with grade 1 obesity, atrial fibrillation, bypass surgery and aortic bioprosthesis. Fourteen days after his first shot, he developed a mild pain in his left shoulder. One month later, he got his second shot. Pain was persistent, but CRP was normal. Slowly, pain worsened with involvement of both shoulders and morning stiffness lasting at least 2 hours. He also developed thigh, neck and lumbar pain. CRP increased at 55 mg/L. Shoulders ultrasound showed subdeltoid bursitis and biceps tenosynovitis. Thoracoabdominal-pelvic computed tomography (TAP-CT) with injection did not show any carcinologic process or large vessel arteritis. Considering his clinical and biological presentation, the patient met the EULAR 2012 classification criteria of PMR (6 points) [8] . Prednisone was started at 15 mg/day, increased at 20 mg/day after 7 days (54% of improvement of PMR-AS) with good efficiency. To our knowledge, these cases are the first cases of PMR or GCA diseases shortly developed after Covid 19 vaccination. A specific attention regarding signs of these CRD may be needed in post approval observational studies evaluating vaccine tolerance. The potential role of COVID19 vaccine in relapse of pre-existing PMR and ACG is yet to be determined. Consent for publication of clinical details was obtained from patients. The authors declare that they have no competing interest. Can SARS-CoV-2 trigger relapse of polymyalgia rheumatica? SARS-CoV-2 infection triggering a giant cell arteritis IL-6 inhibition in the treatment of COVID-19: A meta-analysis and meta-regression Tocilizumab vs placebo for the treatment of giant cell arteritis with polymyalgia rheumatica symptoms, cranial symptoms or both in a randomized trial Systemic rheumatic disease flares after SARS-CoV-2 vaccination among rheumatology outpatients in New York City Disease activity and humoral response in patients with inflammatory rheumatic diseases after two doses of the Pfizer mRNA vaccine against SARS-CoV-2 Safety of the ChAdOx1 nCoV-19 and the BBV152 vaccines in 724 patients with rheumatic diseases: a post-vaccination cross-sectional survey 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative