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Mudge HR, Honey JR, Tachoukaft S, Hider SL, Mason KJ, Welsh VK, Burton C. Summarizing Evidence of Associations of COVID-19 With a Future Diagnosis of Inflammatory Rheumatic and Musculoskeletal Diseases: A Rapid Review. Arthritis Care Res (Hoboken) 2024; 76:40-48. [PMID: 37691274 DOI: 10.1002/acr.25227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/11/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Musculoskeletal symptoms are commonly reported following acute COVID-19. It is unclear whether those with musculoskeletal symptoms subsequently develop inflammatory rheumatic musculoskeletal disease (iRMD). This review seeks to identify evidence for an association between acute COVID-19 and subsequent iRMD diagnosis. METHODS A rapid review of the literature using a systematic search of Medline, EMBASE and two COVID-19 databases was undertaken until August 2022. Case studies, case series, cross-sectional, case-control, and cohort studies reporting patients with an incident iRMD following COVID-19 were included. Title and abstract screening were conducted by one reviewer and full text screening by two reviewers. Data extraction and quality appraisal were by one reviewer, with a second verifying. Study-type specific critical appraisal tools were used. RESULTS Results were narratively synthesized. A total of 80 studies were included (69 case reports, 10 case series and 1 cross-sectional study). Commonly reported iRMDs were "reactive arthropathies" (n = 47), "inflammatory arthropathies unspecified" (n = 18), rheumatoid arthritis (n = 12) and systemic lupus erythematosus (n = 11). The cross-sectional study reported 37% of those with COVID-19 developed "post COVID arthritis." Time from diagnosis of COVID-19 to iRMD presentation ranged from 0 to 120 days. Several mechanisms were proposed to explain the association between COVID-19 and iRMD development: autoimmune processes, aberrant inflammatory responses, colonization of joint spaces, direct damage from the severe acute respiratory syndrome coronavirus 2 virus and genetic predisposition. CONCLUSION The level of evidence of the studies included in this review was low and the quality generally poor. Prospective observational studies are required to confirm associations and likely impact of post COVID-19 iRMDs at a population level.
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Affiliation(s)
| | - Jonathan R Honey
- Salisbury NHS Foundation Trust, Wessex Foundation School, Salisbury, UK
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Bekaryssova D, Yessirkepov M, Bekarissova S. Reactive arthritis following COVID-19: clinical case presentation and literature review. Rheumatol Int 2024; 44:191-195. [PMID: 37801125 DOI: 10.1007/s00296-023-05480-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023]
Abstract
Reactive arthritis (ReA) is a clinical condition typically triggered by extra-articular bacterial infections and often associated with the presence of HLA-B27. While ReA has traditionally been associated with gastrointestinal and genitourinary infections, its pathogenesis involves immune and inflammatory responses that lead to joint affections. The emergence of COVID-19, caused by SARS-CoV-2, has prompted studies of plausible associations of the virus with ReA. We present a case of ReA in a patient who survived COVID-19 and presented with joint affections. The patient, a 31-year-old man, presented with lower limb joints pain. SARS-CoV-2 was confirmed by PCR testing during COVID-19-associated pneumonia. Following a thorough examination and exclusion of all ReA-associated infections, a diagnosis of ReA after COVID-19 was confirmed. In addition, this article encompasses a study of similar clinical cases of ReA following COVID-19 reported worldwide.
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Affiliation(s)
- Dana Bekaryssova
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan.
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
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Zarpoosh M, Amirian P. COVID-associated arthritis after severe and non-severe COVID-19: A systematic review. Immun Inflamm Dis 2023; 11:e1035. [PMID: 37904701 PMCID: PMC10566449 DOI: 10.1002/iid3.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/03/2023] [Accepted: 09/22/2023] [Indexed: 11/01/2023] Open
Abstract
AIM Since the coronavirus outbreak became a global health emergency in 2020, various immune-based effects, such as inflammatory arthritis (IA), have been recorded. This study aimed to determine the role of COVID-19 severity on post-COVID arthritis. METHODS We systematically reviewed 95 patients who developed arthritis after severe and non-severe COVID-19 infection by searching the databases, including PubMed, SCOPUS, and EMBASE. We used the term "COVID-associated arthritis" because there was no definite diagnostic method for classifying arthritides after COVID-19 infection, and the diagnosed arthritis types were based on the authors' viewpoints. RESULTS After evaluating the data between the two severe and non-severe COVID-19-infected groups of patients, the results showed that the COVID-19 severity may affect the pattern of joint involvement in IA. In both groups, combination therapy, including oral nonsteroidal anti-inflammatory drugs with different types of corticosteroids, was the most common treatment. In addition, the mean age and comorbidities rate was higher in the severe COVID-19 group. Even though the patients in the severe COVID-19 group developed more serious COVID-19 symptoms, they experienced milder arthritis with better outcomes and more delayed onsets that required less aggressive therapy. CONCLUSION We conclude that there may be an inverse relationship between COVID-19 severity and arthritis severity, possibly due to weaker immunity conditions following immunosuppressant treatments in patients with severe COVID-19.
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Affiliation(s)
- Mahsa Zarpoosh
- Kermanshah University of Medical Science (KUMS)KermanshahIran
| | - Parsa Amirian
- Kermanshah University of Medical Science (KUMS)KermanshahIran
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Hassan AAA, Khalifa AA. Femoral head avascular necrosis in COVID-19 survivors: a systematic review. Rheumatol Int 2023; 43:1583-1595. [PMID: 37338665 PMCID: PMC10348993 DOI: 10.1007/s00296-023-05373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
The current systematic review aimed to document published cases of femoral head avascular necrosis (FHAVN) post-COVID-19, to report the COVID-19 disease characteristics and management patients received, and to evaluate how the FHAVN were diagnosed and treated among various reports. A systematic literature review was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through a comprehensive English literature search on January 2023 through four databases (Embase, PubMed, Cochrane Library, and Scopus), including studies reporting on FHAVN post-COVID-19. Fourteen articles were included, ten (71.4%) were case reports, and four (28.6%) case series reported on 104 patients having a mean age of 42.2 ± 11.7 (14:74) years, in which 182 hip joints were affected. In 13 reports, corticosteroids were used during the COVID-19 management plan for a mean of 24.8 ± 11 (7:42) days, with a mean prednisolone equivalent dose of 1238.5 ± 492.8 (100:3520) mg. A mean of 142.1 ± 107.6 (7:459) days passed between COVID-19 diagnosis and FHAVN detection, and most of the hips were stage II (70.1%), and concomitant septic arthritis was present in eight (4.4%) hips. Most hips (147, 80.8%) were treated non-surgically, of which 143 (78.6%) hips received medical treatment, while 35 (19.2%) hips were surgically managed, 16 (8.8%) core decompression, 13 (7.1%) primary THA, five (2.7%) staged THA and three (1.6%) had first stage THA (debridement and application of antibiotic-loaded cement spacer). The outcomes were acceptable as regards hip function and pain relief. Femoral head avascular necrosis post-COVID-19 infection is a real concern, primarily attributed to corticosteroid usage, besides other factors. Early suspicion and detection are mandatory, as conservative management lines are effective during early stages with acceptable outcomes. However, surgical intervention was required for progressive collapse or patients presented in the late stage.
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Affiliation(s)
| | - Ahmed A. Khalifa
- Orthopedic Department, Qena Faculty of Medicine, South Valley University, Kilo 6 Qena-Safaga Highway, Qena, Egypt
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5
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Daher J, Nammour M, Nammour AG, Tannoury E, Sisco-Wise L. Reactive Arthritis Following Coronavirus 2019 Infection in a Pediatric Patient: A Rare Case Report. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023:S2589-5141(23)00076-2. [PMID: 37363621 PMCID: PMC10165056 DOI: 10.1016/j.jhsg.2023.04.012] [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] [Received: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 06/28/2023] Open
Abstract
Reactive arthritis (ReA) following Coronavirus 2019 (COVID-19) infection has been described mainly in adults, and only two pediatric cases have been reported. We report a third case where ReA was found to be a sequela following COVID-19 infection. A 15-year-old right-handed Caucasian girl presented with severe left-wrist pain. She was experiencing fever, rash, and migratory oligoarthritis, and laboratory work-up showed elevated inflammatory markers and a positive COVID-19 IgG antibody test. Imaging revealed inflammatory arthropathy with wrist synovitis. The patient was diagnosed with ReA following COVID-19 infection and was treated surgically by wrist arthroscopic synovectomy after the failure of conservative management. It has been 1 year after her surgery, and she is doing well. Emerging case reports are linking ReA as a delayed response to COVID-19 infection; therefore, ReA should be included in the list of differential diagnoses in all patients with joint pain following COVID-19 infection.
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Affiliation(s)
- Jimmy Daher
- Department of Orthopedic Surgery, Ochsner Medical Center, New Orleans, LA
| | - Michael Nammour
- Department of Orthopedic Surgery, Ochsner Medical Center, New Orleans, LA
| | - Anna Grace Nammour
- Department of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - Esther Tannoury
- Diagnostic Radiology Department, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Leslie Sisco-Wise
- Department of Orthopedic Surgery, Ochsner Medical Center, New Orleans, LA
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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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Migliorini F, Karlsson J, Maffulli N. Reactive arthritis following COVID-19: cause for concern. Knee Surg Sports Traumatol Arthrosc 2023; 31:2068-2070. [PMID: 36809513 PMCID: PMC9942056 DOI: 10.1007/s00167-023-07332-z] [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: 01/14/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
Low-quality evidence suggests that COVID-19 may trigger reactive arthritis one to four weeks after the infection. Post COVID-19 reactive arthritis resolves within a few days, and no additional treatment is required. Established diagnostic or classification criteria for reactive arthritis are missing, and a deeper understanding of the immune mechanism related to COVID-19 prompt us to further investigate the immunopathogenic mechanisms capable of promoting or contrasting the development of specific rheumatic diseases. Caution should be exerted when managing post-infectious COVID-19 patient with arthralgia.
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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.
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy ,School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, ST4 7QB Stoke On Trent, England ,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, E1 4DG London, England
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8
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Pal A, Roongta R, Mondal S, Sinha D, Sinhamahapatra P, Ghosh A, Chattopadhyay A. Does post-COVID reactive arthritis exist? Experience of a tertiary care centre with a review of the literature. REUMATOLOGIA CLINICA 2023; 19:67-73. [PMID: 35578636 PMCID: PMC9096625 DOI: 10.1016/j.reuma.2022.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/06/2022] [Indexed: 02/07/2023]
Abstract
Background Rheumatological manifestations following COVID-19 are various, including Reactive Arthritis (ReA), which is a form of asymmetric oligoarthritis mainly involving the lower limbs, with or without extra-articular features. The current case series describes the clinical profile and treatment outcome of 23 patients with post-COVID-19 ReA. Methods A retrospective, observational study of patients with post-COVID-19 arthritis over one year was conducted at a tertiary care centre in India. Patients (n = 23) with either a positive polymerase chain reaction test for SARS-CoV2 or an anti-COVID-19 antibody test were included. Available demographic details, musculoskeletal symptoms, inflammatory markers, and treatment given were documented. Results Sixteen out of 23 patients were female. The mean age of the patients was 42.8 years. Nineteen patients had had symptomatic COVID-19 infection in the past. The duration between onset of COVID-19 symptoms and arthritis ranged from 5 to 52 days with a mean of 25.9 days. The knee was the most involved joint (16 out of 23 cases). Seven patients had inflammatory lower back pain and nine had enthesitis. Most patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs) and steroids - either depot injection or a short oral course. Three patients required treatment with hydroxychloroquine and methotrexate which were eventually stopped. No relapse was reported in any of the patients. Conclusion On combining our data with 21 other case reports of ReA, a lower limb predominant, oligoarticular, asymmetric pattern of arthritis was seen with a female preponderance. The mean number of joints involved was 2.8. Axial symptoms and enthesitis were often coexistent. Treatment with NSAIDs and intra-articular steroids was effective. However, whether COVID-19 was the definitive aetiology of the arthritis is yet to be proven.
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Affiliation(s)
- Atanu Pal
- Department of Nephrology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Rashmi Roongta
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Sumantro Mondal
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Debanjali Sinha
- Department of Clinical Immunology and Rheumatology, Institute of Neurosciences, Kolkata, India
| | - Pradyot Sinhamahapatra
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Alakendu Ghosh
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Arghya Chattopadhyay
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India,Corresponding author
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Does post-COVID reactive arthritis exist? Experience of a tertiary care centre with a review of the literature. REUMATOLOGIA CLINICA 2023; 19:67-73. [PMID: 36739121 PMCID: PMC9892928 DOI: 10.1016/j.reumae.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/06/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Rheumatological manifestations following COVID-19 are various, including Reactive Arthritis (ReA), which is a form of asymmetric oligoarthritis mainly involving the lower limbs, with or without extra-articular features. The current case series describes the clinical profile and treatment outcome of 23 patients with post-COVID-19 ReA. METHODS A retrospective, observational study of patients with post-COVID-19 arthritis over one year was conducted at a tertiary care centre in India. Patients (n=23) with either a positive polymerase chain reaction test for SARS-CoV2 or an anti-COVID-19 antibody test were included. Available demographic details, musculoskeletal symptoms, inflammatory markers, and treatment given were documented. RESULTS Sixteen out of 23 patients were female. The mean age of the patients was 42.8 years. Nineteen patients had had symptomatic COVID-19 infection in the past. The duration between onset of COVID-19 symptoms and arthritis ranged from 5 to 52 days with a mean of 25.9 days. The knee was the most involved joint (16 out of 23 cases). Seven patients had inflammatory lower back pain and nine had enthesitis. Most patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs) and steroids - either depot injection or a short oral course. Three patients required treatment with hydroxychloroquine and methotrexate which were eventually stopped. No relapse was reported in any of the patients. CONCLUSION On combining our data with 21 other case reports of ReA, a lower limb predominant, oligoarticular, asymmetric pattern of arthritis was seen with a female preponderance. The mean number of joints involved was 2.8. Axial symptoms and enthesitis were often coexistent. Treatment with NSAIDs and intra-articular steroids was effective. However, whether COVID-19 was the definitive aetiology of the arthritis is yet to be proven.
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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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Chaudhry ZS, Nellessen N, Reis C, Sharip A. The development of inflammatory arthritis following SARS-CoV-2 infection: a systematic review of the literature. Fam Pract 2022; 39:1116-1134. [PMID: 35395090 PMCID: PMC9383795 DOI: 10.1093/fampra/cmac029] [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] [Indexed: 11/12/2022] Open
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.
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Affiliation(s)
- Zaira S Chaudhry
- Loma Linda University Medical Center, Occupational Medicine Center, San Bernardino, CA, USA
| | - Nathan Nellessen
- Loma Linda University Medical Center, Occupational Medicine Center, San Bernardino, CA, USA
| | - Cesar Reis
- Loma Linda University Medical Center, Occupational Medicine Center, San Bernardino, CA, USA
| | - Akbar Sharip
- Loma Linda University Medical Center, Occupational Medicine Center, San Bernardino, CA, USA
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Farisogullari B, Pinto AS, Machado PM. COVID-19-associated arthritis: an emerging new entity? RMD Open 2022; 8:rmdopen-2021-002026. [PMID: 36100294 PMCID: PMC9471208 DOI: 10.1136/rmdopen-2021-002026] [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] [Received: 05/05/2022] [Accepted: 08/20/2022] [Indexed: 11/03/2022] Open
Abstract
The current COVID-19 pandemic raises several clinical challenges. Cases of COVID-19-associated arthritis have been reported, and inconsistently described as either COVID-19 viral arthritis or COVID-19 reactive arthritis. We aimed to review all the reported cases of 'COVID-19-associated arthritis', which we propose, is a better term to define the entire spectrum of new-onset arthritis believed to be associated with SARS-CoV-2 infection. We performed a systematic literature review using MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews to search for articles published up to 13 December 2021. We included cohort studies, case series and case reports describing patients diagnosed with COVID-19 reactive or viral arthritis by a physician, irrespective of fulfilment of classification criteria. To identify relevant studies, medical subject headings and keywords related to 'COVID-19/SARS-CoV-2 infection' and 'reactive arthritis' were used. Our search retrieved 419 articles, of which 31 were included in the review. A total of 33 cases were reported in these 31 articles, the majority being adults (28/33=85%) with peripheral joint involvement (26/33=79%). Most of the patients responded well to treatment and the disease was self-limiting. These 33 case reports describe a possible causal relationship between exposure to SARS-CoV-2 and the onset of arthritis. However, since these cases were reported during a pandemic, other aetiologies cannot be fully excluded. The exact mechanism through which SARS-CoV-2 might trigger arthritis is not fully understood and robust epidemiological data to support a causal relationship are still lacking.
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Affiliation(s)
- Bayram Farisogullari
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Ana S Pinto
- Department of Rheumatology, Unidade Local de Saúde da Guarda EPE, Guarda, Portugal
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK .,National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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13
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Omar IM, Weaver JS, Samet JD, Serhal AM, Mar WA, Taljanovic MS. Musculoskeletal Manifestations of COVID-19: Currently Described Clinical Symptoms and Multimodality Imaging Findings. Radiographics 2022; 42:1415-1432. [PMID: 35867593 PMCID: PMC9341171 DOI: 10.1148/rg.220036] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
COVID-19, the clinical syndrome produced by infection with SARS-CoV-2, can result
in multisystem organ dysfunction, including respiratory failure and
hypercoagulability, which can lead to critical illness and death.
Musculoskeletal (MSK) manifestations of COVID-19 are common but have been
relatively underreported, possibly because of the severity of manifestations in
other organ systems. Additionally, patients who have undergone sedation and who
are critically ill are often unable to alert clinicians of their MSK symptoms.
Furthermore, some therapeutic measures such as medications and vaccinations can
worsen existing MSK symptoms or cause additional symptoms. Symptoms may persist
or occur months after the initial infection, known as post-COVID condition or
long COVID. As the global experience with COVID-19 and the vaccination effort
increases, certain patterns of MSK disease involving the bones, muscles,
peripheral nerves, blood vessels, and joints have emerged, many of which are
likely related to a hyperinflammatory host response, prothrombotic state, or
therapeutic efforts rather than direct viral toxicity. Imaging findings for
various COVID-19–related MSK pathologic conditions across a variety of
modalities are being recognized, which can be helpful for diagnosis, treatment
guidance, and follow-up. The online slide presentation from the RSNA Annual Meeting is
available for this article. ©RSNA, 2022
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Affiliation(s)
- Imran M Omar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Jennifer S Weaver
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Jonathan D Samet
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Ali M Serhal
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Winnie A Mar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
| | - Mihra S Taljanovic
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (I.M.O., A.M.S.); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. (J.S.W., M.S.T.); Department of Medical Imaging, Ann & Robert Lurie Children's Hospital, Chicago, Ill (J.D.S.); Department of Radiology, University of Illinois at Chicago College of Medicine, Chicago, Ill (W.A.M.); and Departments of Medical Imaging and Orthopaedics, University of Arizona College of Medicine, Tucson, Ariz (M.S.T.)
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14
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Dawoud R, Haddad D, Shah V, Patel V, Abbas G, Guduru S, Dakka A, Kaushik V, Cheriyath P. COVID-19 Vaccine-Related Arthritis: A Descriptive Study of Case Reports on a Rare Complication. Cureus 2022; 14:e26702. [PMID: 35959192 PMCID: PMC9359799 DOI: 10.7759/cureus.26702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Large-scale coronavirus disease 2019 (COVID-19) vaccination programs have been rolled out worldwide. Vaccines that are widely used globally include mRNA vaccines, adenoviral vector vaccines, and inactivated whole-virus vaccines. COVID-19 vaccines can lead to varying side effects. Among the most common of these adverse effects are pain at the injection site, fatigue, and headaches. Some side effects, however, are not very well documented, and these include joint-related adverse effects. In this review, we assess the epidemiology and clinical features of post-COVID-19 vaccination joint-related adverse effects based on the analysis of 16 patient case reports. Based on our analysis, we found that females formed the majority of the cases, accounting for 62.5% of patients, while 37.5% of the cases were males. The mean age of presentation among the patients was 54.8 years, with a standard deviation (SD) of 17.49 years. In 37.5% of the cases, patients received the Sinovac vaccine. The proportion of patients who received other vaccines was as follows: the Pfizer vaccine: 31.25%; Sputnik V: 12.5%; Moderna, AstraZeneca, and Covaxin: 6.25% each. The characteristics of joint-related adverse effects following COVID-19 vaccination were analyzed in this study. We identified several key findings related to factors such as age, gender, type of vaccine, clinical features, and diagnosis modality. Our analysis showed that more cases were reported among individuals who received the Sinovac vaccine, as compared to the others. Further research is required to examine the underlying cause of this association.
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15
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AKYÖN ŞH, TURAN GÖKÇE D. Bilateral Gouty Arthritis Developing After Covid-19 Infection: A Case Report. TURKISH JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.46310/tjim.1066207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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16
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Bekaryssova D, Yessirkepov M, Zimba O, Gasparyan AY, Ahmed S. Reactive arthritis before and after the onset of the COVID-19 pandemic. Clin Rheumatol 2022; 41:1641-1652. [PMID: 35247132 PMCID: PMC8898028 DOI: 10.1007/s10067-022-06120-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 12/19/2022]
Abstract
Most accepted definitions of reactive arthritis (ReA) consider it a type of spondyloarthritis (SpA) precipitated by a gut or urogenital infection. A wider definition considers any arthritis that occurs after a mucosal surface infection as ReA. There is limited consensus regarding a working definition, status of HLA-B27, or even classification criteria for ReA. This may also contribute to a lack of systemic studies or clinical trials for ReA, thereby reducing further treatment recommendations to expert opinions only. The emergence of post-COVID-19 ReA has brought the focus back on this enigmatic entity. Post-COVID-19 ReA can present at extremes of age, appears to affect both sexes equally and can have different presentations. Some present with small joint arthritis, others with SpA phenotype-either with peripheral or axial involvement, while a few have only tenosynovitis or dactylitis. The emergence of post-vaccination inflammatory arthritis hints at similar pathophysiology involved. There needs to be a global consensus on whether or not to include all such conditions under the umbrella of ReA. Doing so will enable studies on uniform groups on how infections precipitate arthritis and what predicts chronicity. These have implications beyond ReA and might be extrapolated to other inflammatory arthritides. Key Points | • Classical reactive arthritis (ReA) has a spondyloarthritis phenotype and is preceded by symptomatic gut or urogenital infection | • The demonstration of antigen and nucleic acid sequences of pathogens in synovium has blurred the difference between invasive arthritis and reactive arthritis | • Post-COVID-19 ReA has a transient phenotype and can have different presentations. All reported cases are self-limiting | • The large amount of literature reporting post-COVID-19 ReA calls for introspection if the existing definitions of ReA need to be updated. |
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Affiliation(s)
- Dana Bekaryssova
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - 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, West Midlands, UK
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, 751024, India.
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17
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Osada A, Sakuragi C, Toya C, Mitsuo A. New-onset Polymyalgia Rheumatica Following the Administration of the Pfizer-BioNTech COVID-19 Vaccine. Intern Med 2022; 61:749-753. [PMID: 34897152 PMCID: PMC8943385 DOI: 10.2169/internalmedicine.8651-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We herein report the case of an 80-year-old Japanese woman who presented to our hospital with bilateral pain in the shoulders and hips lasting for a month since 2 days after the second dose of the BNT162b2 COVID-19 vaccine. Her physical findings, laboratory data, and ultrasonographic findings of bilateral biceps tenosynovitis and lateral subacromial bursitis were consistent with a diagnosis of polymyalgia rheumatica (PMR). She was successfully treated with oral prednisolone 15 mg/day. Although a causal relationship could not be definitively confirmed, PMR should be considered as a differential diagnosis in cases of persistent myalgia after administration of the BNT162b2 vaccine.
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Affiliation(s)
- Atsumu Osada
- Division of Rheumatology, National Hospital Organization Disaster Medical Center, Japan
| | - Chinatsu Sakuragi
- Division of Rheumatology, National Hospital Organization Disaster Medical Center, Japan
| | - Chisashi Toya
- Division of Cardiology, National Hospital Organization Disaster Medical Center, Japan
| | - Akiko Mitsuo
- Division of Rheumatology, National Hospital Organization Disaster Medical Center, Japan
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18
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Reactive arthritis (ReA) following the first dose of Covid-19 vaccine; A case report. RHEUMATOLOGY (BULGARIA) 2022:95-98. [DOI: 10.35465/30.1.2022.pp95-98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Introduction: The development of vaccination against COVID-19 infection was a promising step during the battle against this pandemic; however, some vaccines were associated with some complications starting with just flu-like symptoms up to anaphylaxis; of the reported complications is joints pain. Here, we report a case who developed reactive arthritis (ReA) after receiving the first dose of the Pfizer-BioNTech Covid-19 vaccine. Case presentation: A healthy 54 years old male with no previous history of any medical condition was presented with bilateral hand and bilateral knee pain after one week of receiving his first dose of Pfizer-BioNTech Covid-19 vaccine. Clinical examination revealed swelling, tenderness, and erythema over the right index metacarpophalangeal joint and the medial aspect of the right knee. Radiographs of the hand and knee were normal. Laboratory investigations were within normal values except for an elevated ESR (15 mm/hr.) and a positive CRP titer of 48 mg/l. The symptoms entirely resolved after two weeks of non-steroidal anti-inflammatory medications. Conclusions: Although rare, however, ReA could be presented as a complication of Covid-19 vaccination, and physicians should be aware of the possibility of its occurrence.
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19
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Kocyigit BF, Akyol A. Reactive arthritis after COVID-19: a case-based review. Rheumatol Int 2021; 41:2031-2039. [PMID: 34550429 PMCID: PMC8456072 DOI: 10.1007/s00296-021-04998-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the coronavirus disease 19 (COVID-19) pandemic, which is deeply affecting the whole world. In this new case for the scientific world, scientists are investigating the etiopathogenesis of viral infection-induced damage and have started to focus on the short and long-term immune system effects and alterations after SARS-CoV-2 infection. The case is here reported of a 53-year-old female patient with acute monoarthritis after SARS-CoV-2 infection, who responded adequately to 150 mg/day diclofenac treatment, and the available case reports are comprehensively reviewed. With the focus on arthritis after SARS-CoV2 infection, which emerges as a new pathological condition associated with COVID-19, it was aimed to examine the possible immunological mechanisms of post-COVID-19 arthritis based on the current data on SARS-CoV-2 and the known pathogenetic background of viral arthritis.
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Affiliation(s)
- Burhan Fatih Kocyigit
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey.
| | - Ahmet Akyol
- Physiotherapy and Rehabilitation Application and Research Center, Hasan Kalyoncu University, Gaziantep, Turkey
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20
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Post-COVID-19 Arthritis and Sacroiliitis: Natural History with Longitudinal Magnetic Resonance Imaging Study in Two Cases and Review of the Literature. Viruses 2021; 13:v13081558. [PMID: 34452422 PMCID: PMC8402767 DOI: 10.3390/v13081558] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 12/24/2022] Open
Abstract
Severe acute respiratory coronavirus-2 syndrome (SARS-CoV-2) is a well-known pandemic infectious disease caused by an RNA virus belonging to the coronaviridae family. The most important involvement during the acute phase of infection concerns the respiratory tract and may be fatal. However, COVID-19 may become a systemic disease with a wide spectrum of manifestations. Herein, we report the natural history of sacroiliac inflammatory involvement in two females who developed COVID-19 infection with mild flu-like symptoms. After the infection they reported inflammatory back pain, with magnetic resonance imaging (MRI) studies showing typical aspects of sacroiliitis. Symptoms improved with NSAIDs therapy over the following months while MRI remained positive. A literature review was performed on this emerging topic. To our knowledge, this is the first MRI longitudinal study of post-COVID-19 sacroiliitis with almost one year of follow-up. Predisposing factors for the development of articular involvement are unclear but a long-lasting persistence of the virus, demonstrated by nasopharyngeal swab, may enhance the probability of altering the immune system in a favourable background.
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