The development of inflammatory arthritis following SARS-CoV-2 infection: a systematic review of the literature

Abstract

Background Given the widespread impact of COVID-19, it is important to explore any atypical presentations and long-term sequelae associated with this viral infection, including the precipitation of inflammatory arthritis. Objective To identify and summarize clinical reports of acute inflammatory arthritis associated with COVID-19. Methods A systematic review of the PubMed (MEDLINE), Google Scholar, and Cochrane Central databases through January 31, 2022 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The inclusion criteria were: human subjects and English language. Data extraction and qualitative synthesis of the demographics, clinical presentations, treatments, and outcomes were performed. Quality assessment was performed using the Joanna-Briggs Institute critical appraisal tools. Results A total of 37 articles collectively describing the cases of 54 patients were included. The mean age was 48.2 years (6-78 years). 53.7% of patients were male and 46.3% were female. The onset of articular symptoms varied considerably, and the majority of cases were described as polyarticular (29). The classification of inflammatory arthritis in the included studies was as follows: reactive (19), post-viral (13), new-onset rheumatoid arthritis (RA) (8), crystal-proven arthropathy flare (4), acute viral (2), new-onset psoriatic arthritis (2), flare of preexisting RA (2), and other (4). Arthritis treatment regimens varied but consisted largely of NSAIDs and corticosteroids with most patients experiencing improvement or resolution of their joint symptoms. Conclusion There is limited low-level evidence suggesting that patients may develop acute arthritis during or after SARS-CoV-2 infection. This review highlights the need for further research to elucidate the relationship between COVID-19 and the development of inflammatory arthritis.

A systematic review of the incidence, management and prognosis of new-onset autoimmune connective tissue diseases after COVID-19

“…Similarly, recent studies have linked SARS-CoV-2 infection to the onset of systemic autoimmune rheumatic diseases (SARD) following SARS-CoV-2 infection [ 9 , 10 ]. An SR by Chaudhry et al elucidated that eight patients developed new rheumatoid arthritis (RA) and several others had flare-ups of their existing RA after being infected with SARS-CoV-2 [ 11 ], aligning with another SR of literature on the vasculitides after COVID-19 infection [ 12 ]. Despite the emergence of new-onset autoimmune connective tissue diseases (ACTDs) following COVID-19 infection, an SR of the literature is lacking.…”

A case of de novo seronegative inflammatory oligoarthritis associated with COVID-19 infection

“…Since the emergence of the pandemic, there have been numerous reports of incident inflammatory arthritis related to SARS-CoV-2 virus infection in adults. Nearly all such cases are characterized by a reactive arthritis syndrome, although de novo rheumatoid arthritis and psoriatic arthritis presenting within 3 to 4 weeks following SARS-CoV-2 infection have also been described [3] .…”

Simultaneous occurrence of knee septic arthritis and coronavirus disease 2019 (COVID-19): A case report

“…Furthermore, a case of shoulder septic arthritis was reported 1 week after Pfizer-BioNTech vaccine [16] , but in present case, the patients did not receive any vaccine. Also there are case reports of inflammatory arthritis (rheumatoid arthritis, systemic lupus erythematosus, reactive arthritis, crystal-proven arthropathy flare, new-onset psoriatic arthritis and flare of preexisting inflammatory arthritis) after COVID19 [2] , [17] , [18] . This report describes the simultaneous existence of knee septic arthritis with Staphylococcus aureus and COVID 19.…”

“…Moreover, the clinical severity of COVID-19 varies from acute respiratory distress syndrome (ARDS) and multiple organ dysfunctions to asymptomatic [1] . There have been reports of reactive arthritis and the onset of inflammatory arthritis (rheumatoid arthritis; psoriatic arthritis and gouty arthritis) after COVID-19 [2] . But there are few reports of septic arthritis during or after COVID-19 [3] .…”