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Baker H, Amaral JK, Schoen RT. Management of postinfectious inflammatory arthritis. Curr Opin Rheumatol 2024; 36:155-162. [PMID: 38411201 DOI: 10.1097/bor.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
PURPOSE OF REVIEW Postinfectious inflammatory arthritis can result from various pathogens, including bacteria, viruses, fungi, and parasites. Prompt identification and treatment of acute infection is vital, but some cases progress to chronic arthritis despite successful treatment of infection. Postinfectious inflammatory arthritis varies from mild, self-limited arthralgia to severe, refractory arthritis, necessitating ongoing disease-modifying treatment. This review explores the spectrum of postinfectious inflammatory arthritis to provide insights into effective management. RECENT FINDINGS Research continues regarding the benefit of antimicrobial therapy, beyond treatment of the acute infection, to diminish the severity of postinfectious inflammatory arthritis. Following treatment of acute infection, most cases are self-limited so treatment is symptomatic. However, a difficult-to-predict fraction of cases develop chronic postinfectious inflammatory arthritis that can be challenging to manage. Recently, as more biologic, and targeted synthetic DMARDs have become available, treatment options have expanded. SUMMARY In this article, we use the term 'postinfectious inflammatory arthritis' rather than 'reactive arthritis' because it describes a broader spectrum of diseases and emphasizes the common pathogenesis of a postinfectious inflammatory process. We summarize the conventional therapies and recent management developments for the most frequently encountered postinfectious inflammatory arthritides.
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Affiliation(s)
- Hailey Baker
- Section of Rheumatology, Allergy, and Immunology, Yale School of Medicine
| | - J Kennedy Amaral
- Institute of Diagnostic Medicine of Cariri, Juazeiro do Norte, Ceará, Brazil
| | - Robert T Schoen
- Section of Rheumatology, Allergy, and Immunology, Yale School of Medicine
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Barron-Cervantes NM, Gonzalez-Salido J, Colado-Martinez J, Retana-Estrada E, Bibiano-Escalante HO. Reactive Arthritis as a Consequence of Infection by Clostridium difficile in a Pediatric Patient. Cureus 2024; 16:e54647. [PMID: 38529427 PMCID: PMC10961936 DOI: 10.7759/cureus.54647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/27/2024] Open
Abstract
Reactive arthritis (RA) is the development of a sterile inflammatory arthritis usually associated with a previously known infection, most commonly from the gastrointestinal or urogenital tract. The diagnosis is clinical, based on the presence of acute oligoarticular arthritis of larger joints developing within two to four weeks of the infection. However, in some cases where the infection is not clear, the diagnosis is a challenge, like in the case presented here. We must always rule out past infections as a cause of arthritis by directly asking about the presence of symptomatology associated with it, presented in the past few weeks. It's important to emphasize that human leukocyte antigen B27 (HLA-B27) should not be used as a diagnostic tool, and it always needs to be correlated with the clinical features. There is no confirmed evidence in the literature that is in favor of prescribing antibiotic therapy during an acute presentation of RA as it usually presents after the infection is cured.
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Nasrallah OG, Mohty R, El-Cheikh J, Merashli M. Systemic Mastocytosis: A Mimicker of Reactive Arthritis. Case Rep Rheumatol 2023; 2023:6655005. [PMID: 37584057 PMCID: PMC10425246 DOI: 10.1155/2023/6655005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/14/2023] [Accepted: 07/15/2023] [Indexed: 08/17/2023] Open
Abstract
Objectives Illustration of a case of systemic mastocytosis mimicking reactive arthritis in the absence of an infectious etiology. Methods Review of the patient's medical records. Results We report a case of systemic mastocytosis relapse, presenting with pancytopenia accompanied by knee monoarthritis, cystitis, and bilateral conjunctivitis occurring simultaneously at the same time interval within 2-4 days, mimicking reactive arthritis in the absence of an infectious etiology. Conclusion Our case demonstrated reactive arthritis features (triad of urethritis, conjunctivitis, and arthritis) without an infectious trigger but rather a relapse of mastocytosis. We should think outside the box when faced with such a clinical scenario in the absence of an infectious etiology. Paraneoplastic reactive arthritis is to be considered after excluding an underlying infection.
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Affiliation(s)
- Oussama G. Nasrallah
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Razan Mohty
- Division of Hematology, Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jean El-Cheikh
- Division of Hematology, Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mira Merashli
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Lv P, Liu P, Zhou X, Liu J. A case of reactive arthritis caused by a perianal abscess. SAGE Open Med Case Rep 2023; 11:2050313X231177764. [PMID: 37359279 PMCID: PMC10285606 DOI: 10.1177/2050313x231177764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/07/2023] [Indexed: 06/28/2023] Open
Abstract
Reactive arthritis is an immune-mediated aseptic arthritis resulting from either genitourinary or intestinal tract in a genetically susceptible host. Reactive arthritis is not uncommon, and the most common infectious agents are Chlamydia trachomatis, Salmonella, Yersinia, and Shigella, some new infectious agents include Staphylococcus lugdunensis, Rothia mucilaginosa, and umbilical cord-derived Wharton's jelly, as well as the SARS-CoV-2 virus, which has been more studied in recent years. We found that reactive arthritis caused by infection of perianal abscesses is very rare and few cases have been described in the medical literature. We report a 21-year-old man with polyarticular swelling and pain, and subcutaneous hematoma at his right ankle joint; he was considered reactive arthritis. After treating with non-steroidal anti-inflammatory drugs, sulfasalazine, surgery, and antibiotics, the patient's arthralgia gradually improved and the symptoms largely disappeared at the 1-month follow-up.
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Affiliation(s)
- Pan Lv
- Department of Rheumatology and Immunology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Pingdan Liu
- Department of Rheumatology and Immunology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaoqin Zhou
- Department of Rheumatology and Immunology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jianping Liu
- Department of Rheumatology and Immunology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Migliorini F, Bell A, Vaishya R, Eschweiler J, Hildebrand F, Maffulli N. Reactive arthritis following COVID-19 current evidence, diagnosis, and management strategies. J Orthop Surg Res 2023; 18:205. [PMID: 36922870 PMCID: PMC10017067 DOI: 10.1186/s13018-023-03651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/25/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Immune-mediated conditions associated to Corona Virus Disease-19 (COVID-19) have been reported, including vasculitis, antiphospholipid antibody syndrome, myositis, and lupus. Emerging studies have reported the potential occurrence of reactive arthritis in patients previously infected with COVID-19. This systematic review summarised the current evidence on the occurrence of reactive arthritis in patients previously infected by COVID-19. METHODS This study was conducted according to the 2020 PRISMA guidelines. All the clinical investigations describing the occurrence of reactive arthritis following COVID-19 were accessed. In September 2022, the following databases were accessed: PubMed, Web of Science, Google Scholar, Embase. The generalities of the study were extracted: author, year and journal of publication, country of the main author, study design, sample size, mean age, number of women, main results of the study. The following data on COVID-19 severity and management were retrieved: type of treatment, hospitalization regimes (inpatient or outpatient), admission to the intensive care unit, need of mechanical ventilation, pharmacological management. The following data on reactive arthritis were collected: time elapsed between COVID-19 infection to the onset of reactive arthritis symptoms (days), pharmacological management, type of arthritis (mono- or bilateral, mono- or polyarticular), extra-articular manifestations, presence of tenosynovitis or enthesitis, synovial examination at microscopic polarised light, imaging (radiography, magnetic resonance, sonography), clinical examination, laboratory findings. RESULTS Data from 27 case reports (54 patients) were retrieved, with a mean age of 49.8 ± 14.5 years. 54% (29 of 54 patients) were women. The mean time span between COVID-19 infection and the occurrence of reactive arthritis symptoms was 22.3 ± 10.7 days. Between studies diagnosis and management of reactive arthritis were heterogeneous. Symptoms resolved within few days in all studies considered. At last follow-up, all patients were minimally symptomatic or asymptomatic, and no additional therapy or attentions were required by any patient. CONCLUSION Poor evidence suggests that COVID-19 could target the musculoskeletal system causing reactive arthritis at its post infectious stage. COVID-19 can act as a causative agent or as a trigger for development of reactive arthritis even without presence of antibodies of rheumatological disorders. Treating physicians should have a high index of suspicion while treating post infectious COVID-19 patient with arthralgia. LEVEL OF EVIDENCE Level IV, systematic review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany. .,Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany.
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals Institutes of Orthopaedics, New Delhi, India
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, ST4 7QB, England.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, E1 4DG, England
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Slouma M, Abbes M, Mehmli T, Dhahri R, Metoui L, Gharsallah I, Louzir B. Reactive arthritis occurring after COVID-19 infection: a narrative review. Infection 2023; 51:37-45. [PMID: 35655110 PMCID: PMC9162104 DOI: 10.1007/s15010-022-01858-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/15/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Reactive arthritis is acute aseptic arthritis occurring 1 to 4 weeks after a distant infection in a genetically predisposed individual. It may occur after COVID-19 infection. We summarize, in this article, the current findings of reactive arthritis following COVID-19 infection. METHODS A literature search has been performed from December 2019 to December 2021. We included case reports of reactive arthritis occurring after COVID-19 infection. We collected demographic, clinical, and paraclinical data. RESULTS A total of 22 articles were reviewed. There were 14 men and 11 women with a mean age of 44.96 + 17.47 years. Oligoarticular involvement of the lower limbs was the most frequent clinical presentation. The time between arthritis and COVID infection ranged from 6 to 48 days. The diagnosis was based on clinical and laboratory findings. The pharmacological management was based on non-steroidal anti-inflammatory drugs in 20 cases. Systemic or local steroid therapy was indicated in 13 patients. Sulfasalazine was indicated in two cases. Alleviation of symptoms and recovery were noted in 22 cases. The mean duration of the clinical resolution was 16 + 57 days. CONCLUSION The diagnosis of reactive arthritis should be considered in patients with a new onset of arthritis following COVID-19 infection. Its mechanism is still unclear.
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Affiliation(s)
- Maroua Slouma
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Maissa Abbes
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Takoua Mehmli
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Rim Dhahri
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Leila Metoui
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Imen Gharsallah
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Bassem Louzir
- grid.415617.0Department of Internal Medicine, Military Hospital, Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
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Bekaryssova D, Joshi M, Gupta L, Yessirkepov M, Gupta P, Zimba O, Gasparyan AY, Ahmed S, Kitas GD, Agarwal V. Knowledge and Perceptions of Reactive Arthritis Diagnosis and Management Among Healthcare Workers During the COVID-19 Pandemic: Online Survey. J Korean Med Sci 2022; 37:e355. [PMID: 36573387 PMCID: PMC9792259 DOI: 10.3346/jkms.2022.37.e355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/23/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Reactive arthritis (ReA) is an often neglected disease that received some attention during the coronavirus disease 2019 (COVID-19) pandemic. There is some evidence that infection with severe acute respiratory syndrome coronavirus 2 can lead to "reactive" arthritis. However, this does not follow the classical definition of ReA that limits the organisms leading to this condition. Also, there is no recommendation by any international society on the management of ReA during the current pandemic. Thus, a survey was conducted to gather information about how modern clinicians across the world approach ReA. METHODS An e-survey was carried out based on convenient sampling via social media platforms. Twenty questions were validated on the pathogenesis, clinical presentation, and management of ReA. These also included information on post-COVID-19 arthritis. Duplicate entries were prevented and standard guidelines were followed for reporting internet-based surveys. RESULTS There were 193 respondents from 24 countries. Around one-fifth knew the classical definition of ReA. Nearly half considered the triad of conjunctivitis, urethritis and asymmetric oligoarthritis a "must" for diagnosis of ReA. Other common manifestations reported include enthesitis, dermatitis, dactylitis, uveitis, and oral or genital ulcers. Three-fourths opined that no test was specific for ReA. Drugs for ReA were non-steroidal anti-inflammatory drugs, intra-articular injections, and conventional disease-modifying agents with less than 10% supporting biological use. CONCLUSION The survey brought out the gap in existing concepts of ReA. The current definition needs to be updated. There is an unmet need for consensus recommendations for the management of ReA, including the use of biologicals.
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Affiliation(s)
- Dana Bekaryssova
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Mrudula Joshi
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Prakash Gupta
- Virgen Milagrosa University Foundation College of Medicine, San Carlos City, Pangasinan, Philippines
| | - Olena Zimba
- Department of Internal Medicine #2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, India.
| | - George D Kitas
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Liu Y, He J, Jiang J, Wang Y, Liu T. Reactive Arthritis Triggered by Adalimumab and Leflunomide in a Patient with Ankylosing Spondylitis. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:2601-2605. [DOI: 10.2147/ccid.s390918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022]
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Zeidler H. [History of reactive arthritis. Historical milestones and future]. Z Rheumatol 2022; 81:692-698. [PMID: 36006472 PMCID: PMC9406267 DOI: 10.1007/s00393-022-01253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
The introduction of the term reactive arthritis (ReA) for the joint inflammation observed after infection with Yersinia enterocolitica, in which "a causative pathogen cannot be isolated from the synovial fluid", and the association with the HLA-B27 were the historical milestones for a new classification and assignment to the spondylarthritides (SpA). The division into postinfectious and reactive arthritis proposed in 1976 was put into perspective in the 1990s because of investigations with the newly available molecular biological method of the polymerase chain reaction. Microbial products could be identified from joint samples of patients with ReA. Therefore, it was proposed to abandon the distinction between the two groups of diseases and to prefer the term ReA for both. This created a terminological and nosological issue. On the one hand, there are generally accepted classification and diagnostic criteria for the classical HLA-B27-associated ReA that are assigned to SpA. On the other hand, an increasing number of bacterial pathogens, viruses, amoebas, helminths as well as antiviral and antibacterial vaccinations are described as triggers of arthritis, which have been published under the term ReA. Since the beginning of the SARS-CoV‑2 pandemic, cases of acute post-COVID-19 arthritis have been described, which were also classified as ReA because of comparable clinical features.
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Affiliation(s)
- H Zeidler
- Medizinische Hochschule Hannover, Carl-Neuberg Str. 1, 30625, Hannover, Deutschland.
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Al-Beltagi M, Saeed NK, Bediwy AS. COVID-19 disease and autoimmune disorders: A mutual pathway. World J Methodol 2022; 12:200-223. [PMID: 36159097 PMCID: PMC9350728 DOI: 10.5662/wjm.v12.i4.200] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/17/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a real challenge for humanity with high morbidity and mortality. Despite being primarily a respiratory illness, COVID-19 can affect nearly every human body tissue, causing many diseases. After viral infection, the immune system can recognize the viral antigens presented by the immune cells. This immune response is usually controlled and terminated once the infection is aborted. Nevertheless, in some patients, the immune reaction becomes out of control with the development of autoimmune diseases. Several human tissue antigens showed a strong response with antibodies directed against many severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) proteins, such as SARS-CoV-2 S, N, and autoimmune target proteins. The immunogenic effects of SARS-CoV-2 are due to the sizeable viral RNA molecules with interrupted transcription increasing the pool of epitopes with increased chances of molecular mimicry and interaction with the host immune system, the overlap between some viral and human peptides, the viral induced-tissue damage, and the robust and complex binding between sACE-2 and SARS-CoV-2 S protein. Consequently, COVID-19 and its vaccine may trigger the development of many autoimmune diseases in a predisposed patient. This review discusses the mutual relation between COVID-19 and autoimmune diseases, their interactive effects on each other, the role of the COVID-19 vaccine in triggering autoimmune diseases, the factors affecting the severity of COVID-19 in patients suffering from autoimmune diseases, and the different ways to minimize the risk of COVID-19 in patients with autoimmune diseases.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al-Habib Medical Group, Manama 26671, Manama, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Manama, Bahrain
- Microbiology Section, Department of Pathology, Irish Royal College of Surgeon, Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Disease, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Chest Disease, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al-Habib Medical Group, Manama 26671, Manama, Bahrain
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Ardakani MV, Parviz S, Ghadimi E, Zamani Z, Salehi M, Firoozabadi MA, Mortazavi SMJ. Concomitant septic arthritis of the hip joint and femoral head avascular necrosis in patients with recent COVID-19 infection: a cautionary report. J Orthop Surg Res 2022; 17:302. [PMID: 35668523 PMCID: PMC9168355 DOI: 10.1186/s13018-022-03192-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/25/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose At present, concomitant avascular necrosis (AVN) of femoral head and septic arthritis (SA) as a sequel of COVID-19 infection has yet not been documented. By large-scale use of life-saving corticosteroids (CS) in COVID-19 cases, our aim is to warn of the occurrence of hip joint infection in these patients.
Methods We report a series of five cases in which patients developed septic arthritis concomitant with AVN after being treated for COVID-19 infection. The mean dose of prednisolone used in these cases was 1695.2 mg. The time period of onset of hip symptoms in our cases from the beginning of the COVID-19 infection was 56 days in the first case, 43 days in the second case, 30 days in the third case, 29 days in the fourth case and 50 days in the last case, with an average time of 41.6 days. All patients underwent surgery depending on the extent of articular cartilage damage by direct anterior approach. Results Clinical and laboratory symptoms improved significantly in all patients. The mean visual analogue pain score of the patients decreased from 9.4 (9–10) before surgery to 2.8 (1–4) after 1 week of operation. Conclusion In any patient with the history of COVID-19 infection specially those who have been treated with corticosteroid as one of the medications prescribed during the disease, any joint symptom specially in the hips should draw our attention to the joint infection, and with timely diagnosis and surgery, their hip joint can be saved.
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Affiliation(s)
- Mohammad Vahedian Ardakani
- Joint Reconstruction Research Centre, Tehran University of Medical Sciences, End of Keshavarz Blvd, Tehran, 1419733141, Iran
| | - Sara Parviz
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Department of Radiology, Medical Imaging Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Ghadimi
- Joint Reconstruction Research Centre, Tehran University of Medical Sciences, End of Keshavarz Blvd, Tehran, 1419733141, Iran
| | - Zahra Zamani
- Community Medicine Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Imam Khomeini Hospital Complex, Infectious Diseases Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ayati Firoozabadi
- Joint Reconstruction Research Centre, Tehran University of Medical Sciences, End of Keshavarz Blvd, Tehran, 1419733141, Iran
| | - S M Javad Mortazavi
- Joint Reconstruction Research Centre, Tehran University of Medical Sciences, End of Keshavarz Blvd, Tehran, 1419733141, Iran.
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Jensen AK, Chatzidionysiou K, Torp CK, Sørensen AS, Tenstad HB, Schäfer VS, Kostine M, Jacobsen S, Leipe J, Kragstrup TW. Comparison of immune checkpoint inhibitor-induced arthritis and reactive arthritis to inform therapeutic strategy. Biomed Pharmacother 2022; 148:112687. [PMID: 35228067 DOI: 10.1016/j.biopha.2022.112687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Immune checkpoint inhibitor-induced inflammatory arthritis (ICI-IA) is a relatively new disease entity caused by ICI agents during cancer therapy. Reactive arthritis (ReA) is a well-known disease entity caused by urogenital or gastrointestinal bacterial infection or pneumonia. In this sense, ICI-IA and ReA are both defined by a reaction to a well-specified causal event. As a result, comparing these diseases may help to determine therapeutic strategies. METHODS We compared ICI-IA and ReA with special focus on pharmacological management. Specifically regarding treatment, we conducted a literature search of studies published in the PubMed database. Inclusion criteria were studies on treatment with non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GC), or disease modifying antirheumatic drugs (DMARDs) in ICI-IA or ReA. During systematic selection, 21 studies evaluating ICI-IA and 14 studies evaluating ReA were included. RESULTS In ICI-IA, prospective and retrospective studies have shown effects of non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoid (GC), sulfasalazine (SSZ), methotrexate (MTX), hydroxychloroquine (HCQ) and TNFi. In ReA, retrospective studies evaluated NSAIDs and GC. A randomized controlled trial reported the effect of SSZ, and a retrospective study reported the effect of MTX and SSZ in combination with tumor necrosis factor alpha inhibition (TNFi). For both entities, small case reports show treatment effects of interleukin 6 receptor inhibition (IL-6Ri). DISCUSSION This literature review identified both similarities and differences regarding the pathogenesis and clinical features of ReA and ICI-IA. Studies on treatment reported effectiveness of NSAIDs, GC, MTX, SSZ and TNFi in both diseases. Further, small case reports showed effects of IL-6Ri.
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Affiliation(s)
- Anders Kirkegaard Jensen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Sygehus Lillebælt, Kolding, Denmark
| | - Katerina Chatzidionysiou
- Department of Medicine Solna, Karolinska Institutet, Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Valentin S Schäfer
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Marie Kostine
- Department of Rheumatology, Bordeaux, University, Hospital, France
| | - Søren Jacobsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Copenhagen, Denmark
| | - Jan Leipe
- Division of Rheumatology, Department of Medicine V, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Germany.
| | - Tue Wenzel Kragstrup
- Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
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Jørgensen SL, Mechlenburg I. Effects of Low-Load Blood-Flow Restricted Resistance Training on Functional Capacity and Patient-Reported Outcome in a Young Male Suffering From Reactive Arthritis. Front Sports Act Living 2022; 3:798902. [PMID: 34988436 PMCID: PMC8720780 DOI: 10.3389/fspor.2021.798902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/02/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction: Reactive arthritis (ReA) is a chronic inflammatory disease usually caused by a preceding gastrointestinal or genitourinary bacterial infection. ReA usually occurs in the lower limbs causing joint pain and joint swelling. Physiotherapy-led exercise is recommended to prevent muscle atrophy. The purpose of this case report is to describe the outcome after 12 weeks of low-load blood flow restricted resistance training (BFR-RT) as a rehabilitation method for a young male suffering from ReA. Methods and materials: A 17-year-old male suffered from ReA in the both knee joints and the left hip joint. 36 months after the incident, he suffered from another ReA incident in his right knee. Non-steroid anti-inflammatory drugs and a new arthrocentesis added with corticosteroid injection was unsuccessful in treating the ReA. The patient performed 12 weeks of BFR-RT on the right lower limb with a low amount of supervision after the first week of training. Assessment of unilateral 30-sec chair stand test (u30-sec CST), low-thigh circumference above apex patella, The Knee Injury and Osteoarthritis Outcome Score (KOOS), The Forgotten Knee Joint Score (FJS), and Numeric Ranking Scale for pain (NRS) was performed at baseline and after 3,6,9, and 12 weeks of BFR-RT. Results: The patient completed all planned exercise sessions. u30-sec CST improved with 7 repetitions (reps) on the right limb and 5 reps on the left leg. Low-thigh circumference decreased 1.1 cm on the right leg and 1.0 on the left leg. KOOS symptoms, ADL, quality of life and FJS demonstrated a clinically relevant change on 10, 14 and 23 points. Conclusion: The present case study indicates that even with low amounts of supervision BFR-RT could increase functional performance, reduce knee joint swelling and improve key patient-reported outcome.
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Affiliation(s)
- Stian Langgård Jørgensen
- Department of Occupational and Physical Therapy, Horsens Regional Hospital, Aarhus, Denmark.,H-HIP, Horsens Regional Hospital, Horsens, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Inger Mechlenburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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Wendling D, Verhoeven F, Chouk M, Prati C. Le SARS-CoV-2 peut-il induire une arthrite réactionnelle ? REVUE DU RHUMATISME 2021; 88:326-328. [PMID: 33824573 PMCID: PMC8017909 DOI: 10.1016/j.rhum.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Daniel Wendling
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France
- EA 4266, Pathogens and inflammation, EPILAB, université Bourgogne Franche-Comté, Besançon, France
| | - Frank Verhoeven
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France
- EA 4267, PEPITE, université Bourgogne Franche-Comté, Besançon, France
| | - Mickael Chouk
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France
| | - Clément Prati
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France
- EA 4267, PEPITE, université Bourgogne Franche-Comté, Besançon, France
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Abstract
Introduction COVID-19 has caused unprecedented hardships in the 21st century with more than 150 million infections. Various immunological phenomena have been described during the course of the infection, and this infection has also triggered autoimmunity. Rheumatological illnesses have been described following resolution of the acute infection; hence we sought to conduct a review of the rheumatological complications of COVID-19. Methods We conducted a literature search for articles relating to sequelae of COVID-19 from Jan 2020 to 30th April 2021. Results We found a number of reports of inflammatory arthritis after SARS-CoV-2 infection. SLE and renal disease have been described, and vasculitis also appears to be a common complication. Rhabdomyolysis and myositis has also been reported in a number of patients. We also found some evidence of large vessel vasculitis in ‘long COVID’ patients. Conclusions This review highlights a number of important complications such as inflammatory arthritis, lupus-like disease, myostis and vasculitis following SARS-CoV-2 infection.
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Abstract
A previously healthy 53-year-old man was hospitalised for 12 days due to COVID-19 with shortness of breath. A few days after discharge from hospital, the patient developed fever and severe pain in several joints in the lower extremities. The pain was so severe that the patient was unable to stand on his feet. Synovial fluid from the right-side knee contained a high number of polynuclear cells and a few mononuclear cells. Microscopy, culture and PCR tests for bacterial infection were all negative. Furthermore, the patient tested negative for rheumatoid factor, anti-cyclic citrullinated peptide and human leukocyte antigen (HLA)-B27. Thus, the condition was compatible with reactive arthritis. The condition improved markedly after a few days’ treatment with non-steroid anti-inflammatory drugs and prednisolone.
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Affiliation(s)
- Bo Langhoff Hønge
- Department of Infectious Diseases, Aarhus Universitet, Aarhus, Denmark
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Wendling D, Verhoeven F, Chouk M, Prati C. Can SARS-CoV-2 trigger reactive arthritis? Joint Bone Spine 2020; 88:105086. [PMID: 33127461 PMCID: PMC7590820 DOI: 10.1016/j.jbspin.2020.105086] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Daniel Wendling
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA 4266, Pathogens and inflammation, EPILAB, université Bourgogne Franche-Comté, Besançon, France.
| | - Frank Verhoeven
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA 4267, PEPITE, université Bourgogne Franche-Comté, Besançon, France
| | - Mickael Chouk
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France
| | - Clément Prati
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA 4267, PEPITE, université Bourgogne Franche-Comté, Besançon, France
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