Post-Acute COVID-19 Joint Pain and New Onset of Rheumatic Musculoskeletal Diseases: A Systematic Review

Abstract

As the number of reports of post-acute COVID-19 musculoskeletal manifestations is rapidly rising, it is important to summarize the current available literature in order to shed light on this new and not fully understood phenomenon. Therefore, we conducted a systematic review to provide an updated picture of post-acute COVID-19 musculoskeletal manifestations of potential rheumatological interest, with a particular focus on joint pain, new onset of rheumatic musculoskeletal diseases and presence of autoantibodies related to inflammatory arthritis such as rheumatoid factor and anti-citrullinated protein antibodies. We included 54 original papers in our systematic review. The prevalence of arthralgia was found to range from 2% to 65% within a time frame varying from 4 weeks to 12 months after acute SARS-CoV-2 infection. Inflammatory arthritis was also reported with various clinical phenotypes such as symmetrical polyarthritis with RA-like pattern similar to other prototypical viral arthritis, polymyalgia-like symptoms, or acute monoarthritis and oligoarthritis of large joints resembling reactive arthritis. Moreover, high figures of post-COVID-19 patients fulfilling the classification criteria for fibromyalgia were found, ranging from 31% to 40%. Finally, the available literature about prevalence of rheumatoid factor and anti-citrullinated protein antibodies was largely inconsistent. In conclusion, manifestations of rheumatological interest such as joint pain, new-onset inflammatory arthritis and fibromyalgia are frequently reported after COVID-19, highlighting the potential role of SARS-CoV-2 as a trigger for the development of autoimmune conditions and rheumatic musculoskeletal diseases.

COVID-19 Impact on Patients with Immune-Mediated Rheumatic Disease: A Comparative Study of Disease Activity and Psychological Well-Being Over Six Months

“…Inflammatory arthritis has been reported with various clinical phenotypes, including RA-like pattern as other prototypical viral arthritis, as well as polymyalgia-like, or acute monoarthritis and oligoarthritis of large joints resembling reactive arthritis or SpA style (23).…”

Longitudinal rheumatoid factor autoantibody responses after SARS-CoV-2 vaccination or infection

“…A concern with the emergence of SARS-CoV-2 and related mRNA vaccines is the possible development of autoimmune disorders, either as a consequence of molecular mimicry or overactivation of the immune system. Especially the new-onset of (inflammatory) arthritis has been reported frequently, but inconsistently ( 6 ). Our results suggest that true de novo induction of RF reactivity is probably a rare event.…”

“…Due to the recent COVID-19 pandemic, the development of autoimmune responses after infection and vaccination has gathered renewed interest. Especially new-onset inflammatory arthritis is considered a relatively common consequence of COVID-19 ( 6 , 7 ). RF frequencies in previously (seemingly) healthy individuals after SARS-CoV-2 infection are sometimes ( 7 – 10 ) – but not always – found to be increased ( 11 – 13 ).…”

The course of COVID-19 in pediatric patients – specific and non-specific clinical manifestations

“…Regarding a connection between the child population and COVID-19 rheumatological manifestations, the reports are not entirely clear. More study has to be carried in this therapeutic area [123][124][125][126][127][128][129].…”