Аңдатпа
Dear Editor, We read with great interest one of the latest case report in your journal on arthritis after vaccination against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. The case study relates to an increasingly alarming issue of the development of rheumatic diseases in Coronavirus disease 2019 (COVID-19)-vaccinated subjects. According to the World Health Organization, more than 760 million subjects worldwide have survived COVID-19 and more than 13 billion have been vaccinated against this infection [2]. Viruses and vaccines trigger autoimmune reactions and may lead to certain rheumatic diseases, especially in genetically predisposed individuals [3]. It is likely that COVID-19 repetitively affects the same unvaccinated and vaccinated subjects, increasing the risk of autoimmune complications further. With an unprecedented vaccine campaign amidst the COVID-19 pandemic, the scale of the expected complications may reach a catastrophic level [4]. At the time of writing this piece, PubMed searches retrieved 575 documents related to arthritis and COVID-19 vaccination, including the one in Modern Rheumatology Case Reports [1]. At the beginning of the COVID-19 vaccination campaign, we reported a case of acute arthritis [5] developing after the Sputnik V vaccine (Gam-COVID-Vac), which was also used in the index case [1]. Interestingly, our and the index case have described the elbow joint affection [1, 5]. As at the begging of the COVID-19 vaccination campaign, there are still uncertainties surrounding the origin and definitions of arthritis after the vaccination [2]. Generally speaking, joint affections which are temporally associated with COVID-19 vaccinations can be better defined as post-vaccination arthritides but not reactive arthritides. Likewise, arthritides developing after COVID-19 can be correctly defined as COVID-19 associated or post-viral arthritides [6, 7]. Both forms, post-viral and post-vaccination arthritides, are self-limiting clinical conditions evolving within one month and, as a rule, do not require specific treatment. Short-term and small-dose therapies with non-steroidal anti-inflammatory drugs and glucocorticoids can be administered based on empirical experience. Reactive arthritis is a clinical subtype of spondyloarthritis triggered by bacterial affections, primarily intestinal and urogenital infections [8]. Regrettably, the term reactive arthritis is still commonly and mistakenly applied to post-viral and post-COVID clinical syndromes. We believe that further discussion is urgently needed to reach a consensus on terminology, diagnosing and managing autoimmune conditions developing after COVID-19, COVID-19 vaccinations, and both (mixed). A previous Delphi Consensus [9] has not led to a tangible change, and we raised that point earlier [7, 10]. The index article [1] is thus a step forward towards initiating a global discussion that may clarify the current uncertainties with the terms and definitions.