Adult-onset Still’s disease (AOSD)-like syndrome has rarely been reported as a complication of COVID-19 vaccination. This study reports a 31-year-old female patient who presented with fever, myalgia, arthralgia, pleuropericarditis, leukocytosis, and transaminitis following ChAdOx1 vaccination, and met Yamaguchi’s criteria. A PubMed literature search, performed up until March 2022, identified 10 such cases. A total of 11 cases, including the one in this report, developed AOSD-like syndrome after administration of the viral vector (ChAdOx1) vaccine (six patients) and mRNA vaccine (five patients: BNT162b2 in four and mRNA-1273 in one). There were four male and seven female patients, with their median (Q1, Q3) age and the onset of symptoms after vaccination being 36 years (29, 45) and 10 days (6, 13), respectively. Fever (100%), arthralgia/arthritis (90.9%), skin rashes (81.8%), and sore throat (81.8%) were the main clinical findings. Pericarditis (45.5%), myocarditis/cardiac dysfunction (36.4%), pleuritis (54.6%), and pulmonary infiltrations (36.4%) were also common. One patient developed macrophage activation syndrome. One patient responded well to non-steroidal anti-inflammatory drugs, and the other six showed a good response to high-dose corticosteroids alone. Of the remaining four patients, who showed partial responses to high dose corticosteroids, showed good responses to biological agents. AOSD-like syndrome following COVID-19 vaccination shared many similar clinical features and treatment outcomes to those of idiopathic AOSD (but with a higher prevalence of cardiopulmonary involvement in the former). Physicians should be aware of this extremely rare complication to achieve early diagnosis and provide proper management.

Objectives: To compare disease activity and flares among different doses and types of COVID-19 vaccines in systemic lupus erythematosus (SLE) patients. Methods: SLE patients in a lupus cohort, who received at least one dose of a COVID-19 vaccine (inactivated virus, adenovirus-vectored, or mRNA vaccines) between March and October 2022 joined this study. The data regarding disease activity and flares after each dose were reviewed and compared. Results: Two hundred and one SLE patients (524 total doses) were included in this study, with 201, 199, and 124 of them receiving 1, 2, and 3 doses of a vaccine, respectively, which comprised 183, 128, and 213 doses of inactivated virus, adenovirus-vectored, and mRNA vaccines, respectively. Regardless of vaccine dose or type, there were no significant changes in SLE disease activity pre- or post-vaccination. Flares were significantly more common after the 2nd and 3rd doses than after the 1st one (20.10% and 17.74% vs. 8.96%, p = 0.001, and p = 0.010, respectively), and after inactivated virus, adenovirus-vectored and mRNA vaccinations in 11.48%, 14.84%, and 17.84% of the patients (p = ns), respectively. However, the incidence rate of flares/100 patient-months was not different. The majority of flares were severe, with renal flares being the most frequent. Renal and mucocutaneous involvement and high SLE disease activity prior to the 1st vaccine dose were independent factors that predicted flares. Conclusions: Flares after COVID-19 vaccination were not uncommon. Most of the flares were severe, mainly due to renal flares. SLE patients should have stable low disease activity prior to receiving COVID-19 vaccine in order to avoid flares.

Objective: To assess knowledge of reproductive health (pregnancy and contraception) in systemic lupus erythematosus (SLE) patients with no history of pregnancy. Methods: This cross-sectional study included SLE patients (aged 18–50 years, menstruating, and never pregnant) who attended Chiang Mai University Hospital between November 2021 and July 2023. They completed a reproductive health knowledge assessment and provided information on their contraceptive use. Results: Of 204 SLE patients (mean age 30.91 years, 73.76% single, 27.45% with active nephritis, 62.75% on immunosuppressive drugs), 83.82% and 57.53% had adequate knowledge of pregnancy and contraception in SLE patients, respectively. Among 101 patients with sexual experience, 91 (43.96%), currently active, provided their contraceptive practice. Male condoms and withdrawal methods were commonly used. None of the patients used intrauterine devices. Compared to the past, the current use of male condoms and withdrawal has significantly decreased (76.92% to 62.64%, p = .007, and 47.25% to 37.36%, p = .020, respectively), and effective contraceptive methods (oral contraceptive pills and medroxyprogesterone acetate injections) also have significantly declined (19.78% to 2.20%, p < .001, and 8.79% to 4.40%, p = .046, respectively). In contrast, the proportion of entirely no contraceptive used slightly but significantly increased (2.20% to 7.69%, p = .025). There was no difference in contraceptive methods used, frequency of sexual activity, and SLE disease activity between patients who did and did not live with their partners. Conclusions: Knowledge of reproductive health, particularly contraceptive use in SLE patients, remains suboptimum. Formal reproductive health counseling should be carried out in all SLE patients for better contraception planning.