Joint Manifestations Following COVID-19 Infection- A Case Series of Six Patients

Abstract

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.

COVID‐associated arthritis after severe and non‐severe COVID‐19: A systematic review

“…The interval between COVID‐19 symptoms and the onset of arthritis differs from zero days (simultaneous with COVID‐19) to 3 months. The onset of arthritis in 2 cases occurred less than 1 week (≤1 week) after COVID infection, 54 and 16 happened after 1 week 16–23,30,41,43,51,53,55 …”

“…Prescribed forms of steroids were not noted in 2 cases 54 . HCQ as a kind of DMARDs was administered in 1 case 51 . All prescribed drugs are listed in Table 3, and 1 patient's arthritis subsided without treatment 17 .…”

“…17 Although 15 patients gained complete or significant remission after treatment or follow-up, 2 patients acquired partial symptom improvement 41,54 ; remission status was not mentioned in 1 case. 51 Patients' characteristics in both severe and non-severe groups are summarized in Table 3 and Figure 3. The association between age, sex, type of arthritis, the pattern of joint involvement, location of involved joints, extraarticular manifestation, lab tests, the onset of arthritis, treatment, outcome, and designated severe and nonsevere groups were assessed using χ 2 tests (Table 3).…”

Summarizing Evidence of Associations of COVID‐19 With a Future Diagnosis of Inflammatory Rheumatic and Musculoskeletal Diseases: A Rapid Review

“…The exact terminology varied between studies and, for the purposes of this review, reported iRMDs have been grouped according to the ICD-11 categories: RA, polymyalgia rheumatica and giant cell arteritis, adult-onset Still disease, juvenile idiopathic arthritis, inflammatory spondylarthritis, SLE, systemic sclerosis, idiopathic inflammatory myopathy, vasculitis, psoriatic arthritis, direct infection of joint, and inflammatory arthropathies unspecified. In the case reports and case series, the most commonly reported iRMDs were "reactive arthropathies" (n = 47), 14, followed by "inflammatory arthropathies unspecified" (n = 18), 15,23,24,38,[44][45][46][47][48][49][50][51][52] RA (n = 12), [53][54][55][56][57][58][59][60][61][62] and SLE (n = 11). 6,59,[63][64][65][66][67][68][69][70][71] The single observational (cross-sectional) study by Taha et 37 out of 100 people observed (37%) developed "post COVID arthritis."…”

“…There were 26 studies that proposed mechanisms related to the initiation of an autoimmune process. 6,10,15,[22][23][24]31,33,38,39,45,48,49,55,56,58,65,67,[69][70][71][73][74][75][76][77] Several studies proposed multiple possible autoimmune mechanisms. 10,24,31,39,45,48,55,73,77 Proposed mechanisms included molecular mimicry, 10,15,23,24,31,33,39,45,48,58,65,69,[73][74][75][76]…”