Special focus on the association between COVID-19 vaccination and Raynaud’s phenomenon in autoimmune disease

KEYWORDS:

• Association
• COVID-19 vaccination
• Raynaud’s phenomenon
• autoimmune disease patients

Dear editor

We read Lisy’s paper¹ with great interest. In this paper, the author retrospectively analyzed a cohort study about the association between COVID-19 vaccination and Raynaud’s phenomenon(RP). They found that 15 participants reported the initial manifestation of RP among these 19 participants had RP. Additionally, antinuclear antibodies (20%, 3/15), anti-cardiolipin antibodies (7%, 1/15), thyroid disorders (20%, 3/15), smoking (13%, 2/15), concomitant use of beta-blockers (13%, 2/15), or antecedent frostbites (13%, 2/15) were regarded as the predisposing factors for RP in most of the participants (67%, 10/15). Despite definite results, we would like to give some comments, especially focusing on autoimmune disease, which is the common cause of Raynaud’s phenomenon in rheumatology.

First, predisposing factors are the risk factors that make a person more susceptible to developing a disease. Lisy’s study found that the antinuclear antibodies and anti-cardiolipin antibodies were regarded as the predisposing factors in these 15 participants who reported the initial manifestation of RP. However, more and more studies have shown the autoimmunity of people who were unwilling to receive the COVID-19 vaccine because of fears of additional adverse events. And case series of cutaneous vasculitis, reactive arthritis, Guillain-Barré syndrome, or immune-mediated disease flare from mRNA are continuously emerging.² Thus, the detailed autoimmunity status of these RP participants or whether they suffered from autoimmune diseases, is also crucial to establishing a clear connection between the COVID-19 vaccine with RP in these patients with autoimmune disease. Moreover, 1 participant had an anti-cardiolipin antibody, is it an IgM or IgG type antibody for this participant since IgM had the diagnostic role but not an IgG anti-cardiolipin antibody.

Second, we noticed in Lisy’s study,¹ that three out of four participants with preexisting RP before COVID-19 vaccination reported aggravation in frequency and intensity after immunization. The antinuclear antibodies status in these four participants could add significance to this study, although they reported that these participants had not suffered from concurrent autoimmune or connective tissue disease linked to RP.

Third, this study does not contain a control group of unvaccinated autoimmune disease. To evaluate how the COVID-19 vaccine induces RP in this population, a control group could be helpful. Additionally, access to healthcare, certain jobs to RP, and socioeconomic position are examples of potential confounding factors that can affect the results that could be discussed in this study.

Thus, in this letter, we want to highlight and discuss whether a clear association between the development of RP and COVID-19 vaccination exists or whether RP represents a bystander effect in these autoimmune disease. Given more and more people receiving COVID-19 vaccine, physicians may remain alert to additional adverse events, especially in autoimmune disease. Although these comments, we extend our congratulations to Lisy’s study and his colleagues for their outstanding work.

Authors contributions

All authors reviewed this manuscript and agreed to submit this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was not supported by any funding.