Do Vaccines Cause Arthralgia or Arthritis?

Updated October 10, 2023



Infections may trigger or contribute to the pathogenesis of arthritis. Thus, vaccines may prevent arthritis by protecting against natural infections. Rubella-containing vaccines (e.g. MMR) can cause mild, acute, transient arthralgia or arthritis, rarely in children but commonly in certain adult women (between 10-25% of adult female vaccinees without preexisting rubella immunity), usually beginning 1-3 weeks after vaccination and then persisting up to 3 weeks. Other vaccines currently routinely recommended to the general population in the U.S.* have not been shown to cause chronic arthralgia or arthritis.

Epidemiological Evidence

Mild, acute, transient arthralgia occurs in approximately 25% of adult women without preexisting rubella immunity after rubella vaccination, and mild, acute, transient arthritis occurs in approximately 10%, usually beginning 1-3 weeks after vaccination and then persisting up to 3 weeks. Both are less common in men and rare in children 1.

The 2012 report by the Institute of Medicine (IOM) 2, now called the National Academy of Medicine (NAM), described four studies in women 3-6 and seven studies in children 7-13 that generally reported an increased risk of transient arthralgia after rubella or MMR vaccination. Also described are two studies assessing chronic arthralgia and arthritis in women 5,6 and two studies assessing arthropathy in men 14,15 after rubella or MMR vaccination; one study assessing the association between HPV vaccine and transient arthralgia 16; one study assessing the association between hepatitis B vaccination and exacerbation of rheumatoid arthritis 17; and two studies assessing the association between diphtheria or tetanus toxoid vaccination and chronic arthritis 15,18; however, these studies did not provide convincing evidence due to a lack of validity and precision. The IOM found no relevant studies of quality in the literature providing evidence of an association between any other vaccines and chronic arthropathy 2.

Most studies published since the 2012 IOM report did not show a statistically significant association between influenza and HPV vaccines and arthralgia 19-22. A 2011 study found a relative risk of arthralgia of 2.0 (95% CI: 1.6-2.5) after receipt of a vero-cell culture-derived trivalent influenza vaccine 23, and another 2011 study found an odds ratio of grade 3 arthralgias of 2.68 (95% CI: 1.29-5.59) after receipt of the AS04-adjuvanted HPV-16/18 vaccine (Cervarix®) among women in Korea 24. No association has been found between vaccination and arthritis 25-29.

Studies in patients with autoimmune inflammatory arthritis showed no change in disease severity or relapse rates after influenza vaccination 30-36. A 2017 South Korean nationwide cohort study found no associations between HPV vaccination and 33 predefined serious adverse events (including arthritis) 37. A 2019 case-crossover study found vaccination associated with double the odds of gout flares among gout patients (95% CI: 1.01-3.89) 38. A 2019 self-controlled case series analysis among people with autoimmune rheumatic diseases in the UK found no association between influenza vaccination and rheumatoid arthritis flares 39. A 2019 systematic review concluded that the current evidence is too heterogeneous and incomplete to infer a causal association between vaccination and incident arthritis or worsening of arthritic conditions 40. A 2020 systematic review and meta-analysis found no association between HPV vaccines and many autoimmune or other rare diseases (including rheumatoid arthritis) 41.

Proposed Biological Mechanism

Environmental factors such as infections may trigger or contribute to the pathogenesis of arthritis; however, the exact mechanisms are still unclear 42-45.

Based on both cases reviewed and knowledge about the natural infection, the IOM concluded that there was some mechanistic evidence in support of a causal relationship between rubella vaccine in women and arthralgia 3,46-48; however, there was less evidence for a relationship between rubella vaccine in women and chronic arthralgia 48-50 or arthritis 47,50. There was little evidence for a relationship between rubella vaccine and arthropathy in men, transient arthralgia in children or chronic arthropathy in children 51,52, for influenza vaccine and onset or exacerbation of arthropathy 53, or for hepatitis B vaccine and onset or exacerbation of arthritis 54,55. The IOM also concluded that there was no mechanistic evidence for an association between all other vaccines and arthralgia, arthritis or arthropathy.

These conclusions do not necessarily consider vaccines recommended only for special populations in the United States such as Yellow Fever vaccine (international travelers) or Smallpox vaccine (military personnel), or vaccines no longer recommended to the public such as the Janssen (J&J) COVID-19 vaccine.


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