A rare subset of Coronavirus Disease-2019 (COVID-19) positive patients has musculoskeletal manifestations including arthritis, arthralgia, myalgia and non specific body aches. Moreover, postviral Reactive Arthritis (ReA) has been reported following COVID-19 infection. This article reports the characteristic joint manifestations of Severe Acute Respiratory Syndrome-Corona Virus-2 (SARSCoV-2) infection in 6 out of 211 consecutive patients with laboratory-confirmed diagnosis of COVID-19 and treated at dedicated hospital. One 49-year-old female patient developed arthritis while having active COVID-19 infection, one 54-year-old male had post-COVID-19 ReA, and one 48-year-old female was found to have undifferentiated arthritis. One 58-year-old female patient was initially thought to have ReA the diagnosis was reconsidered later when her symptoms resolved without any disease modifying agents. Two patients 37-year-old male and 63-year-old female, developed arthralgia following COVID-19 infection. Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and steroids were found to be beneficial in the series of patients. The key point to be noted is that not all arthritis or arthralgia following COVID-19 is ReA.

Background: Fibromyalgia is characterized by chronic widespread pain, which has been linked to neuroinflammation. Hematological indices, i.e., neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) have been shown to be effective markers in neurological diseases like depression. Aims: To study the association between fibromyalgia severity and the hematological indices (NLR, PLR, and MPV). Subjects and Methods: This was a hospital-based cross-sectional study of fibromyalgia patients satisfying the 2016 modification of the 2010/11 ACR criteria. Demographic and clinical characteristics were recorded along with fibromyalgia outcomes and hematological indices. Statistical analysis was done using descriptive statistics, ROC analysis using the Youden index, and Pearson and Spearman correlations. Results: A total of 266 patients were recruited. The (mean ± S.D) NLR, MPV, and PLR were 1.92 ± 1.26, 8.94 ± 1.25, and 119.48 ± 76.91, respectively. Patients with severe visual analog scale (VAS) pain scores had lower MPV (8.8 ± 1.3) than those with mild/moderate pain (9.2 ± 1.1, p = 0.016). MPV showed a mild negative correlation with the Fibromyalgia Impact Questionnaire-Revised (FIQR) score (R2 -0.31 p 0.004). MPV threshold of 8.95 was discriminated severely from mild/moderate VAS-pain score with a sensitivity of 52.3 % and specificity of 66.7%. Conclusions: MPV can possibly be considered as a biomarker for predicting pain severity in fibromyalgia. Given its inexpensive nature, MPV can be used as a cost-effective method to assess fibromyalgia severity in rural India.

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