Title:Rheumatologic Manifestations of Post SARS-CoV-2 Infection: A Case Series
Volume: 18
Issue: 4
Author(s): Samy Metyas*, Christina Chen, Tun Aung, Andrew Ballester and Sovanndy Cheav
Affiliation:
- Covina Arthritis Clinic, 500 W San Bernardino Rd, STE A, Covina, CA 91722, USA
Keywords:
Post-COVID, rheumatological manifestation, disease flare, post-Covid syndrome, rheumatoid arthritis, COVID 19, reactive arthritis.
Abstract:
Background: It has been over a year since the first documented case of the COVID-19
virus was recorded. Since then, our understanding of this virus has continually evolved, however, its
wide-ranging effects are still unfolding. Similar to previously studied viral infections, severe acute
respiratory syndrome-associated coronavirus-2 (SARS-CoV-2) has been shown to lead to a degree
of autoimmunity in patients who are recovering from its effects. Due to its effects on the innate immune
system, such as the toll-like receptors and complement system, a varying degree of proinflammatory
markers can become widespread in those who continue to recover from the virus.
This case series offers a unique perspective on how COVID-19 has had dramatic effects on those
already suffering from inflammatory rheumatic conditions, such as rheumatoid arthritis, systemic
lupus erythematosus, or fibromyalgia. As the ever-lasting effects of COVID-19 are still unfolding,
this case series is one of few to discuss the development and changes of patients with rheumatic
conditions. This study hopes to encourage larger studies to be conducted on the effects of COVID-
19 on autoimmune conditions.
Case Presentation: Seven patients were identified with new manifestations of rheumatic conditions,
which included 3 cases of rheumatoid arthritis, 2 cases of polymyalgia rheumatica, 1 case of reactive
arthritis, and 1 case of cutaneous lupus. Post-COVID syndrome was also diagnosed in 7 other
patients.
Patients with rheumatoid arthritis presented with symptoms 4-5 weeks after being diagnosed with
COVID-19. Symptoms of polyarticular joint pain, swelling, and morning stiffness were reported in
this group. These patients were treated with disease-modifying anti-rheumatic drugs and experienced
an improvement in symptoms on follow-up.
Two cases of polymyalgia rheumatica were identified in patients that were previously diagnosed
with COVID-19 six weeks prior. One patient had no significant past medical history and the other
patient had a history of rheumatoid arthritis, which was well controlled. These patients experienced
weakness and tenderness in the proximal joints with elevated levels of ESR and CRP. They were
treated with prednisone and showed improvement.
Reactive arthritis was diagnosed in 1 patient who presented with swelling in both hands and wrists
2 days after being diagnosed with COVID-19. This patient began to experience symptoms of reactive
arthritis 2 days after resolution of initial COVID-19 symptoms and this persisted for 3 months.
The patient was managed with methylprednisolone injections and NSAIDs, which improved her
symptoms.
Post-COVID syndrome was identified in 7 patients. All patients were female and had a history of
well-controlled fibromyalgia. Patients generally experienced fatigue, headaches, and memory fog,
which had variable onset from a few days and up to 4 weeks after being diagnosed with COVID-19.
One patient had a complete recovery of her symptoms at follow-up 3 months after the initial presentation.
The other 6 patients continued to report symptoms of post-COVID syndrome at follow-up.
Patients were managed with lifestyle modifications and their previous fibromyalgia treatment.
Conclusion: While cases of COVID-19 continue to rise, complications of this disease are still being
discovered. Those who initially recover from COVID-19 may experience new-onset rheumatic conditions,
worsening of previously diagnosed rheumatic conditions, or post-COVID syndrome. As we
continue to learn more about the effects of COVID-19, the awareness of these manifestations will
play a key role in the appropriate management of these patients.
