A case of SARS‐CoV‐2‐associated arthritis with detection of viral RNA in synovial fluid

Kuschner, Zachary; Ortega, A.; Mukherji, P. S.

doi:10.1002/emp2.12452

Cited by 12 publications

(24 citation statements)

References 17 publications

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“…Then we excluded 11 patients: 4 with a gout attack, 1 with established RA, 1 with isolated dactylitis, 1 patient who had already been investigated for arthritis before COVID-19 and 4 patients with back pain and sacroiliitis by MRI but with an age at onset > 45 years. Therefore, our review related to arthritis was based on 28 studies [ 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 ] ( Supplementary file ). All included studies were published as full-text journal articles.…”

Section: Resultsmentioning

confidence: 99%

New Onset of Autoimmune Diseases Following COVID-19 Diagnosis

Gracia‐Ramos

Martín‐Nares

Hernández-Molina

2021

Cells

195

158

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There is growing evidence that coronavirus disease 2019 (COVID-19) can lead to a dysregulation of the immune system with the development of autoimmune phenomena. The consequence of this immune dysregulation ranges from the production of autoantibodies to the onset of rheumatic autoimmune disease. In this context, we conducted a systematic review to analyze the current data regarding the new-onset systemic and rheumatic autoimmune diseases in COVID-19 patients. A literature search in PubMed and Scopus databases from December 2019 to September 2021 identified 99 patients that fulfilled the specific diagnostic/classification criteria and/or nomenclature for each rheumatic autoimmune disease. The main diseases reported were vasculitis and arthritis. Idiopathic inflammatory myopathies, systemic lupus erythematosus, and sarcoidosis were also reported in a limited number of patients, as well as isolated cases of systemic sclerosis and adult-onset Still’s disease. These findings highlight the potential spectrum of systemic and rheumatic autoimmune diseases that could be precipitated by SARS-CoV-2 infection. Complementary studies are needed to discern the link between the SARS-CoV-2 and new onset-rheumatic diseases so that this knowledge can be used in early diagnosis and the most suitable management.

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Section: Resultsmentioning

confidence: 99%

New Onset of Autoimmune Diseases Following COVID-19 Diagnosis

Gracia‐Ramos

Martín‐Nares

Hernández-Molina

2021

Cells

195

158

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“…Recent studies also showed no presence of SARS-CoV-2 in the joint of COVID-19 cadavers after analyzing the synovial fluid, synovial membrane, and bone via real-time polymerase chain reaction [ 31 ]. In contrast, one study of a non-hospitalized medium ill patient found traces of nucleic acids of SARS-CoV-2 in the joint [ 32 ]. In general, this points to a non-immediate role of SARS-CoV-2 in the onset of musculoskeletal changes after a SARS-CoV-2 infection.…”

Section: Covid-19 and Musculoskeletal Dysfunctionmentioning

confidence: 99%

“…Recent studies showed that only sporadically nucleic acids of SARS-CoV-2 could be found in the joint [ 31 , 32 ]. Therefore, it seems unlikely that SARS-CoV-2 will directly affect the joint tissue.…”

Section: Early Ageing Alterations In Endothelial and Adipose Tissue Of Covid-19 Patientsmentioning

confidence: 99%

COVID-19 in Joint Ageing and Osteoarthritis: Current Status and Perspectives

Lauwers

Yuan

et al. 2022

IJMS

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COVID-19 is a trending topic worldwide due to its immense impact on society. Recent trends have shifted from acute effects towards the long-term morbidity of COVID-19. In this review, we hypothesize that SARS-CoV-2 contributes to age-related perturbations in endothelial and adipose tissue, which are known to characterize the early aging process. This would explain the long-lasting symptoms of SARS-CoV-2 as the result of an accelerated aging process. Connective tissues such as adipose tissue and musculoskeletal tissue are the primary sites of aging. Therefore, current literature was analyzed focusing on the musculoskeletal symptoms in COVID-19 patients. Hypovitaminosis D, increased fragility, and calcium deficiency point towards bone aging, while joint and muscle pain are typical for joint and muscle aging, respectively. These characteristics could be classified as early osteoarthritis-like phenotype. Exploration of the impact of SARS-CoV-2 and osteoarthritis on endothelial and adipose tissue, as well as neuronal function, showed similar perturbations. At a molecular level, this could be attributed to the angiotensin-converting enzyme 2 expression, renin-angiotensin system dysfunction, and inflammation. Finally, the influence of the nicotinic cholinergic system is being evaluated as a new treatment strategy. This is combined with the current knowledge of musculoskeletal aging to pave the road towards the treatment of long-term COVID-19.

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“…The alternative is that it may be late-onset viral arthritis with actual invasion of the synovial space with the virus [ 78 ]. We could identify one study that reported the detection of SARS-CoV-2 RNA in a patient with wrist arthritis that had appeared 15 days after diarrhoea and upper respiratory tract symptoms [ 79 ]. However, other cases have not found such evidence [ 80 ].…”

Section: Current Definitions and Limitationsmentioning

confidence: 99%

Reactive arthritis before and after the onset of the COVID-19 pandemic

et al. 2022

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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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A case of SARS‐CoV‐2‐associated arthritis with detection of viral RNA in synovial fluid

Cited by 12 publications

References 17 publications

New Onset of Autoimmune Diseases Following COVID-19 Diagnosis

New Onset of Autoimmune Diseases Following COVID-19 Diagnosis

COVID-19 in Joint Ageing and Osteoarthritis: Current Status and Perspectives

Reactive arthritis before and after the onset of the COVID-19 pandemic

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