key: cord-1005749-2tpttdpf authors: Manzo, Ciro; Castagna, Alberto; Natale, Maria; Ruotolo, Giovanni title: Answer to Cadiou et al « SARS-CoV-2, polymyalgia rheumatica and giant cell arteritis: COVID19 vaccine shot as a trigger? » Joint Bone Spine 2021;88:105282 date: 2021-10-01 journal: Joint Bone Spine DOI: 10.1016/j.jbspin.2021.105284 sha: 65985daab9cbced0e46b3a1b66c009265f112341 doc_id: 1005749 cord_uid: 2tpttdpf nan We are grateful for the attention they have paid to our previous correspondence [2] and, above all, for highlighting the possibility that COVID19 vaccines may trigger PMR and/or GCA. In short, PMR and/or GCA may be triggered both by the virus and COVID19 vaccination. Recently, we reported a 69-year-old woman who complained of PMR the day after the first dose of the tozinameran (BNT162b2) vaccine [3] . No clinical manifestations of GCA was present, and an 18fuoldeoxyglucose positron emission tomography associated with total body computed tomography showed an increased uptake of tracer in peri-artricular and extra-articular synovial structures of shoulder and pelvic girdles without large-vessel involvement. Nasal and oropharyngeal swabs were negative for SARS-CoV-2 both at the time of diagnosis and three days after. When therapy with prednisone 15 mg/day started, she quickly improved. After > 6 months, no different diagnosis was possible. She is still taking prednisone (7.5 College of Rheumatology (EULAR/ACR) collaborative initiative [4] and is fine. The second dose of vaccine was not administrated. To date, we do not observe new-onset or flares of GCA following COVID-19 vaccination. Cadiou and co-authors are right. A specific attention regarding signs of these adverse events may be needed in post approval observational studies evaluating vaccine tolerance. Reports are still anecdotal [5] . No doubt. In the specific case of PMR, it is a common knowledge that many PMR patients are managed by their general practitioners and are often not referred to rheumatologists [6, 7] . Therefore, it is possible that some reports can be missed. Finally, the interactions among COVID-19 vaccines, their adjuvants, and the human system are very complex, and the potential role of these vaccines in triggering PMR (with or without GCA) is yet to be clarified. For instance, the role of Toll-like receptors 7 and 9 [3, 8] , or the possibility that these adverse events may be considered as expression of an autoimmune/inflammatory syndrome induced by adjuvant (ASIA) [9] are intriguing working-hypotheses that deserves further studies with well-defined protocols. Disclosure of interest: the authors declare that they have no competing interest. SARS-CoV-2, polymyalgia rheumatica and giant cell arteritis: COVID19 vaccine shot as a trigger? Can SARS-CoV-2 trigger relapse of polymyalgia rheumatica? Polymyalgia rheumatica as uncommon adverse event following immunization with COVID-19 vaccine : A case report and review of literature Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative Immune-mediated disease flares or new-onset disease in 27 subjects following mRNA/DNA SARS-CoV-2 vaccination The role of the general practitioner and the out-of-hospital public rheumatologist in the diagnosis and follow-up of patients with polymyalgia rheumatica Diagnosis of polymyalgia rheumatica in primary healthy care: favoring and confounding factors -a cohort study Toll-like receptor 4 gene polymorphism in polymyalgia rheumatica and elderly-onset rheumatoid arthritis Autoimmune/inflammatory syndrome induced by adiuvants (ASIA) demonstrates distinct autoimmune and autoinflammatyory disease associations according to the adjiuvant subtype: insights from an analysis of 500 cases