----------1: J Rheumatol 1998 Sep;25(9):1687-93     Comment in:

*    J Rheumatol. 1999 Jul;26(7):1636.

 

 

The development of rheumatoid arthritis after recombinant hepatitis B vaccination.

 

Pope JE, Stevens A, Howson W, Bell DA.

 

Department of Medicine, the University of Western Ontario, London, Canada.

 

OBJECTIVE: Hepatitis B vaccination has been associated with reactive arthritis and rarely rheumatoid arthritis (RA). We defined the clinical, serologic, and immunogenetic background of patients developing RA, soon after recombinant hepatitis B vaccination.

 

METHODS: The clinical, serologic, and HLA antigens of a cluster of firefighters who developed arthritis after prophylactic recombinant hepatitis B vaccination (5 subjects), as well as a second group of sporadic cases of arthritis (6 patients) after hepatitis B vaccination are described.

 

RESULTS: Ten of 11 patients fulfilled revised American College of Rheumatology criteria for RA. All cases had persistent arthritis for more than 6 months; at 48 months followup 2 cases no longer had inflammatory arthritis. Nine patients required disease modifying antirheumatic drugs. Five subjects were HLA-DR4 positive. HLA class II genes expressing the RA shared motif were identified in 9/11 patients genotyped for HLA-DRbeta1 and DQbeta1 alleles (0401, 0101, or 0404). All the firefighters shared the HLA-DRbeta1 allele 0301 and the DQbeta1 allele 0201, with which it is in linkage disequilibrium.

 

CONCLUSION: These polymorphic residues in the binding site of the MHC class II molecules of the affected patients appear capable of binding some peptide sequences of the recombinant vaccine peptides they received and may be responsible for hepatitis B vaccine triggering development of RA in these cases. Recombinant hepatitis B vaccine may trigger the development of RA in MHC class II genetically susceptible individuals.

 

PMID: 9733447 [PubMed - indexed for MEDLINE]

 

 

 

Rheumatology (Oxford) 1999 Oct;38(10):978-83

 

Rheumatic disorders developed after hepatitis B vaccination.

 

Maillefert JF, Sibilia J, Toussirot E, Vignon E, Eschard JP, Lorcerie B, Juvin R, Parchin-Geneste N, Piroth C, Wendling D, Kuntz JL, Tavernier C, Gaudin P.

 

Department of Rheumatology, Dijon University Hospital, France.

 

OBJECTIVE: To obtain an overview of rheumatic disorders occurring after hepatitis B vaccination.

 

METHODS: A questionnaire was sent to rheumatology departments in nine French hospitals. Criteria for entry were rheumatic complaints of 1 week's duration or more, occurrence during the 2 months following hepatitis B vaccination, no previously diagnosed rheumatic disease and no other explanation for the complaints.

 

RESULTS: Twenty-two patients were included. The observed disorders were as

follows: rheumatoid arthritis for six patients; exacerbation of a previously non-diagnosed systemic lupus erythematosus for two; post-vaccinal arthritis for five; polyarthralgia-myalgia for four; suspected or biopsy-proved vasculitis for three; miscellaneous for two.

 

CONCLUSIONS: Hepatitis B vaccine might be followed by various rheumatic conditions and might trigger the onset of underlying inflammatory or autoimmune rheumatic diseases. However, a causal relationship between hepatitis B vaccination and the observed rheumatic manifestations cannot be easily established. Further epidemiological studies are needed to establish whether hepatitis B vaccination is associated or not with an incidence of rheumatic disorders higher than normal.

 

PMID: 10534549 [PubMed - indexed for MEDLINE]

 

 

 

1: Scand J Rheumatol 1995;24(1):50-2

 

Arthritis after hepatitis B vaccination. Report of three cases.

 

Gross K, Combe C, Kruger K, Schattenkirchner M.

Rheumatology Unit, LM University of Munich, Germany.

 

Side effects of hepatitis vaccination are rare. Only a few cases of arthritis after hepatitis vaccination have been published. We report on three cases of vaccination-induced arthritis with different resulting disease. Two cases show the pattern of reactive arthritis. None of them was associated with HLA-B27. In the third case onset of rheumatoid arthritis was triggered by hepatitis vaccination. These three cases show that arthritis after hepatitis B vaccination probably is more common than reported so far, especially in a genetically predisposed subject (two of our patients expressed HLA-DR4).

 

PMID: 7863281 [PubMed - indexed for MEDLINE]

 

 

 

 

Rev Med Interne 1998 Feb;19(2):134-6

 

[Adult-onset Still's disease after hepatitis A and B vaccination?] [Article in French]

 

Grasland A, Le Maitre F, Pouchot J, Hazera P, Bazin C, Vinceneux P. Service de medecine interne V, hopital Louis-Mourier, Colombes.

 

BACKGROUND: Hepatitis A and B vaccination are generally very well tolerated. However, exceptional cases of arthritis and systemic diseases have been reported after hepatitis B vaccination.

 

CASE REPORT: The authors report a case of adult Still's disease apparently triggered by hepatitis A and B vaccination. The patient was a 38-year-old woman who presented with fever, hepatitis, pneumonitis and neurologic symptoms, compatible with the diagnosis of adult Still's disease.

 

DISCUSSION: The authors discuss the rarity of systemic diseases triggered by such vaccination, the link between hepatitis B virus and some vasculitis, and the possibility for viral bacterial infections to trigger adult Still's disease.

 

PMID: 9775130 [PubMed - indexed for MEDLINE]

 

 

 

 

Arthritis Rheum 2000 Sep;43(9):2139-40

 

Sjogren's syndrome occurring after hepatitis B vaccination.

 

Toussirot E, Lohse A, Wendling D, Mougin C.

University Hospital Jean Minjoz, Besancon, France.

 

PMID: 11014366 [PubMed - indexed for MEDLINE]

 

 

 

 

 Br J Rheumatol 1997 Mar;36(3):366-9

 

Patients who develop inflammatory polyarthritis (IP) after immunization are clinically indistinguishable from other patients with IP.

 

Harrison BJ, Thomson W, Pepper L, Ollier WE, Chakravarty K, Barrett EM, Silman AJ, Symmons DP.

 

ARC Epidemiology Research Unit, Manchester.

 

Musculoskeletal symptoms may occur following various types of immunization, and it has also been suggested that, like infection, immunization may act as a trigger for rheumatoid arthritis (RA). A total of 48 of 898 (5.3%) patients with early inflammatory polyarthritis (IP) referred to the Norfolk Arthritis Register reported an immunization in the 6 weeks prior to symptom onset. There were no important clinical or demographic differences between the 48 immunized patients and 185 consecutive patients who did not report prior immunization. In addition, the frequencies of HLA-DRB1*01. *04 and the shared epitope in 33 of the immunized patients were similar to those in the 185 non-immunized patients and to those in 136 healthy controls. Further results from a case-control study suggest that the rate of immunization is higher amongst cases (5.5%) than age- and sex-matched controls (2.8%). In a small number of susceptible individuals, immunization may thus act as a trigger for RA.

 

PMID: 9133970 [PubMed - indexed for MEDLINE]