Musculoskeletal involvement: COVID-19 and post COVID 19

Abstract

The worldwide pandemic of coronavirus disease 2019 (COVID-19) was known to predominantly affect the lungs, but it was realized that COVID-19 had a large variety of clinical involvement. Cardiovascular, gastrointestinal, neurological, and musculoskeletal systems are involved by direct or indirect mechanisms with various manifestations. The musculoskeletal involvement can manifest during COVID-19 infection, due to medications used for the treatment of COVID-19, and in the post/long COVID-19 syndrome. The major symptoms are fatigue, myalgia/arthralgia, back pain, low back pain, and chest pain. During the last two years, musculoskeletal involvement increased, but no clear consensus was obtained about the pathogenesis. However, there is valuable data that supports the hypothesis of angiotensinconverting enzyme 2, inflammation, hypoxia, and muscle catabolism. Additionally, medications that were used for treatment also have musculoskeletal adverse effects, such as corticosteroid-induced myopathy and osteoporosis. Therefore, while deciding the drugs, priorities and benefits should be taken into consideration. Symptoms that begin three months from the onset of the COVID-19 infection, continue for at least two months, and cannot be explained by another diagnosis is accepted as post/long COVID-19 syndrome. Prior symptoms may persist and fluctuate, or new symptoms may manifest. In addition, there must be at least one symptom of infection. Most common musculoskeletal symptoms are myalgia, arthralgia, fatigue, back pain, muscle weakness, sarcopenia, impaired exercise capacity, and physical performance. In addition, the female sex, obesity, elderly patients, hospitalization, prolonged immobility, having mechanical ventilation, not having vaccination, and comorbid disorders can be accepted as clinical predictors for post/long COVID-19 syndrome. Musculoskeletal pain is also a major problem and tends to be in chronic form. There is no consensus on the mechanism, but inflammation and angiotensin-converting enzyme 2 seem to play an important role. Localized and generalized pain may occur after COVID-19, and general pain is at least as common as localized pain. An accurate diagnosis allows physicians to initiate pain management and proper rehabilitation programs.

Musculoskeletal symptoms in COVID-19 and physiotherapy role: Literature review and case study

“…19 Pain of the musculoskeletal system (joint and muscle pain) is a chronic and significant symptom of COVID-19 that may be generalised or localized. 5,20 It is more likely to occur in female patients. 6 Musculoskeletal pain frequently affects the spine or the back, which may be associated with spodyloarthropathy, muscle pain, inflammation, and/or fatigue.…”

“…All of these musculoskeletal symptoms can persist and contribute to long-term or post-COVID-19 disease in the presence of a number of risk factors, including chronic diseases, females increased body weight, old age, a long period of immobility and hospital stay, mechanical ventilator use, not having a vaccination, lower lymphocyte and higher d-dimer levels, and early back pain. 5,21…”

RRM2: a crosstalk gene for COVID-19 and intervertebral disc degeneration revealed by integrated WGCNA and machine learning

“…The Coronavirus Disease Global Pandemic 2019 (COVID- 19) was initially thought to be primarily a pulmonary disease, but it has become clear that COVID-19 has diverse clinical manifestations [7].Studies have reported musculoskeletal symptoms arising during COVID-19 infection, including fatigue, myalgia/arthralgia, back pain, low back pain, and chest pain [8,9]. A study retrospectively examined 210 COVID-19 patients, assessing their symptoms.…”

Morphology and Function of Red Blood Cells in COVID-19 Patients: Current Overview 2023

“…A cytokine storm (interferon-α, and -γ, interleukins, tumor necrosis factor α, and tumor growth factor β), which can lead to a systemic inflammatory reaction, was thought to be the cause [4,5]. Clinical manifestations of such inflammatory responses include gastrointestinal, cardiovascular, neurological, dermatological, hematological, and musculoskeletal disorders [6,7]. Common symptoms of these disorders are microcirculatory disturbances including microthromboses, which have been described in various organs [8][9][10][11][12][13].…”