COVID-19-associated arthritis: an emerging new entity?

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.

A systematic review of the incidence, management and prognosis of new-onset autoimmune connective tissue diseases after COVID-19

“…Machado et al recently proposed a new entity of “COVID-19-associated arthritis” in a similar review of inflammatory arthritis following COVID-19 infection. It may be that such nomenclature is required for those developing ACTD following SARS-COv-2 infection [ 39 ]. Further studies to elucidate the pathogenesis and aetiology of new-onset ACTD in these cases will aid the characterisation and understanding of these diseases.…”

Rheuma nach COVID-19-Infektion oder Impfung

“…In einer Zusammenfassung von 26 Patienten mit COVID-assoziierter Arthritis, die 1 Woche oder später nach COVID-Infektion aufgetreten ist, wurde auch der HLA-Status beschrieben, soweit er vorhanden war. Von 26 angeführten Patienten waren 3 positiv für HLA-B27, 12 negativ und bei 11 Patienten war der HLA-Status nicht bekannt [ 17 ]. Ähnliche Ergebnisse werden auch in einer zusammenfassenden Arbeit über 20 Patienten angeführt, von denen bei 10 Patienten der HLA-B27-Status bekannt war, 2 Patienten waren positiv, 8 negativ [ 10 ].…”

“…Dazu zählen Symptome einer Arthritis, Myositis, autoinflammatorische Symptome, Beschwerden passend zu Kollagenosen oder chronischen entzündlich-rheumatischen Erkrankungen, die nicht assoziiert sind mit Autoantikörpern, wie zum Beispiel Psoriasis mit Psoriasisarthritis oder andere Spondylarthropathien [6,7]. [17]. Ähnliche Ergebnisse werden auch in einer zusammenfassenden Arbeit über 20 Patienten angeführt, von denen bei 10 Patienten der HLA-B27-Status bekannt war, 2 Patienten waren positiv, 8 negativ [10].…”

COVID‐associated arthritis after severe and non‐severe COVID‐19: A systematic review

“…However, one of the hypothetical mechanisms mediating the activation of the inflammatory process is molecular mimicry, which is supposed to be responsible for evoking autoimmune responses in susceptible individuals. 4,18 Many reviews have been conducted to collect COVID-related arthritis before, 3,7,8,23,26,32 but there are some differences between this comprehensive review and them. As mentioned, we collected all IA types following COVID-19, but others only gathered Re-A or viral arthritis.…”

“…It may only be presented with peri-articular manifestations such as tenosynovitis, tendinitis, enthesitis, dactylitis, and bursitis or in conjunction with arthritis. 7,8 Viral infections such as the SARS-CoV-2 virus can solely trigger musculoskeletal manifestations with a nonimmune pathway by directly invading joint tissues and cells; this event is called viral arthritis. Diagnosing and confirming viral arthritis can be challenging because, up to this date, there are no accepted diagnostic criteria to distinguish viral arthritis from post-viral Re-A.…”