Development of Peripheral Spondyloarthritis after COVID-19 in HLA-B27-Positive Monozygotic Twins: Single Cell Transcriptome Profiling

We describe cases of 23-year-old monozygotic twins both diagnosed with spondyloarthritis (SpA) after COVID-19 infection. The probable linkage between SpA and COVID-19 was elaborated with our cases as well as literature reviews from January 2020 to October 2021. Of note, shared genetic traits by monozygotic twins, particularly HLA-B27 positivity, might have contributed to their susceptibility to COVID-19 induced SpA. Moreover, single cell transcriptome analysis revealed that the transcriptomic profile of SpA after COVID-19 was distinctive from idiopathic radiographic axSpA as shown by differential expression of ribosomal protein S26 (RPS26) and SNHG5 in nearly all subsets of peripheral blood mononuclear cells.