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Original article
Available online 13 May 2022
Does post-COVID reactive arthritis exist? Experience of a tertiary care centre with a review of the literature
¿Existe la artritis reactiva post-COVID?: experiencia de un centro de tercer nivel de atención con revisión de la literatura
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Atanu Pala,1, Rashmi Roongtab,1, Sumantro Mondalb, Debanjali Sinhac, Pradyot Sinhamahapatrab, Alakendu Ghoshb, Arghya Chattopadhyayb,
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dr.a.chattopadhyay@gmail.com

Corresponding author.
a Department of Nephrology, Institute of Post Graduate Medical Education and Research, Kolkata, India
b Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
c Department of Clinical Immunology and Rheumatology, Institute of Neurosciences, Kolkata, India
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Table 1. Demographic and clinical characteristics of 14 patients with post COVID ReA.
Table 2. Demographic and clinical characteristics of 21 reported cases of post COVID ReA.
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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.

Keywords:
COVID-19 reactive arthritis
Post COVID-19 arthritis
Post COVID-19 ReA
Resumen
Antecedentes

Las manifestaciones reumatológicas posteriores al COVID-19 son diversas, entre ellas, la artritis reactiva, que es una forma de oligoartritis asimétrica que afecta principalmente a los miembros inferiores, con o sin características extraarticulares. La serie de casos actual describe el perfil clínico y el resultado del tratamiento de 23 pacientes con artritis reactiva posterior a COVID-19.

Métodos

Se realizó un estudio observacional retrospectivo de pacientes con artritis post-COVID-19 durante un año en un centro de atención terciaria en India. Se incluyeron pacientes (n=23) con una prueba de reacción en cadena de la polimerasa positiva para SARS-CoV-2 o una prueba de anticuerpos anti-COVID-19. Se documentaron los detalles demográficos disponibles, los síntomas musculoesqueléticos, los marcadores inflamatorios y el tratamiento administrado.

Resultados

Dieciséis de los 23 pacientes eran mujeres. La edad media de los pacientes fue de 42,8 años. Diecinueve pacientes habían tenido infección sintomática por COVID-19 en el pasado. La duración entre el inicio de los síntomas de COVID-19 y la artritis osciló entre 5 y 52 días, con una media de 25,9 días. La rodilla fue la articulación más comúnmente involucrada (16 de 23 casos). Siete pacientes tenían dolor lumbar inflamatorio y 9 tenían entesitis. La mayoría de los pacientes fueron tratados con medicamentos antiinflamatorios no esteroideos y esteroides, ya fuera una inyección de depósito o un ciclo oral corto. Tres pacientes requirieron tratamiento con hidroxicloroquina y metotrexato, que finalmente se suspendieron. No se reportaron recaídas en ninguno de los pacientes.

Conclusión

Al combinar nuestros datos con otros 21 informes de casos de artritis reactiva, se observó un patrón de artritis oligoarticular asimétrico predominante en las extremidades inferiores con predominio femenino. El número medio de articulaciones afectadas fue de 2,8. A menudo coexistían síntomas axiales y entesitis. El tratamiento con antiinflamatorios no esteroideos y esteroides intraarticulares fue eficaz. Sin embargo, aún no se ha demostrado si el COVID-19 fue la etiología definitiva de la artritis.

Palabras clave:
Artritis reactiva por COVID-19
Artritis post-COVID-19
Artritis reactiva post-COVID-19

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