Post SARS-CoV-2 infection reactive arthritis: a brief report of two pediatric cases

Sinaei, Reza; Pezeshki, Sara; Parvaresh, Saeedeh; Sinaei, Roya; Shiari, Reza; Yeganeh, Mehrnoush Hassas; Bazargn, Nasrin; Gharaei, Nava

doi:10.1186/s12969-021-00555-9

Cited by 23 publications

(30 citation statements)

References 15 publications

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“…ACPA and ANA: negative HLA-B27: negative NSAIDs Opioid analgesic. Steroid Recovered within 3 weeks Honge et al[ 20 ] 53/male Severe/dexamethasone 16/Negative Right knee and ankles CRP: 327 mg/L RF, ACPA, AAN: negative HLA-B27: negative NSAIDs Prednisolone (25 mg daily) Recovered Shokraee et al [ 21 ] 58/female Severe/Interferon β1 Dexamethasone Ceftriaxone 15 /NS Right hip CRP: 6.5 mg/L ESR: 45 mm N.S N.S NSAIDs Prednisolone (80 mg) Recovered within 5 days Coath et al[ 22 ] 53/male Mild/None N.S Sacroiliac costovertebral and costotransverse joints CRP: 13 mg/L NS HLA-B27: positive NSAIDs Methylprednisolone 120 mg Recovered Danssaert et al [ 23 ] 37/female Moderate/NS 12/Negative Wrist,MCP,IP joints/Extensor tendinosis CRP and ESR within normal limits RF: negative ANA: speckled N.S NSAIDs topical Gabapentin Opioid Improvement without recovery Sinaei et al [ 24 ] 8/male Mild/NS 7/NP Left hip ESR: 3 mm CRP: 3.5 mg/L RF and ANA: negative N.S NSAIDs ...…”

Section: Resultsmentioning

confidence: 99%

“…It did not reveal erosions in [ 15 , 17 , 18 , 20 , 25 , 36 ]. Articular ultrasound (US), done in three cases, revealed synovitis in all patients [ 21 , 24 , 26 ].…”

Section: Resultsmentioning

confidence: 99%

“…Seven patients underwent magnetic resonance imaging (MRI). It showed bone marrow oedema of the sacroiliac joints in four cases, sacroiliac joint effusion in two patients [ 21 , 24 , 34 – 36 ], and wrist joint synovitis with mild tenosynovitis of the flexor tendons in one patient [ 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…Radiographs of involved joints are commonly unremarkable [ 15 – 18 , 20 , 25 ]. Joint ultrasound and MRI may show articular effusion, synovial thickness, and soft tissue edema [ 24 , 26 , 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

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Reactive arthritis occurring after COVID-19 infection: a narrative review

et al. 2022

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Purpose Reactive arthritis is acute aseptic arthritis occurring 1 to 4 weeks after a distant infection in a genetically predisposed individual. It may occur after COVID-19 infection. We summarize, in this article, the current findings of reactive arthritis following COVID-19 infection. Methods A literature search has been performed from December 2019 to December 2021. We included case reports of reactive arthritis occurring after COVID-19 infection. We collected demographic, clinical, and paraclinical data. Results A total of 22 articles were reviewed. There were 14 men and 11 women with a mean age of 44.96 + 17.47 years. Oligoarticular involvement of the lower limbs was the most frequent clinical presentation. The time between arthritis and COVID infection ranged from 6 to 48 days. The diagnosis was based on clinical and laboratory findings. The pharmacological management was based on non-steroidal anti-inflammatory drugs in 20 cases. Systemic or local steroid therapy was indicated in 13 patients. Sulfasalazine was indicated in two cases. Alleviation of symptoms and recovery were noted in 22 cases. The mean duration of the clinical resolution was 16 + 57 days. Conclusion The diagnosis of reactive arthritis should be considered in patients with a new onset of arthritis following COVID-19 infection. Its mechanism is still unclear.

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Section: Resultsmentioning

confidence: 99%

“…It did not reveal erosions in [ 15 , 17 , 18 , 20 , 25 , 36 ]. Articular ultrasound (US), done in three cases, revealed synovitis in all patients [ 21 , 24 , 26 ].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Reactive arthritis occurring after COVID-19 infection: a narrative review

et al. 2022

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“…This is in contrast to the classical ReA that is most common between 15 and 40 years of age. Again, at least three cases of post-COVID-19 ReA have also been reported in the paediatric age group [ 41 , 45 ]. Unlike classical ReA, gender distribution appears equal between males and females.…”

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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Summarizing Evidence of Associations of COVID‐19 With a Future Diagnosis of Inflammatory Rheumatic and Musculoskeletal Diseases: A Rapid Review

Mudge,

Honey,

Tachoukaft

et al. 2023

Arthritis Care & Research

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Musculoskeletal symptoms are commonly reported following acute coronavirus disease 2019 (COVID‐19). It is unclear whether those with musculoskeletal symptoms subsequently develop inflammatory rheumatic musculoskeletal disease (iRMD). This review seeks to identify evidence for an association between acute COVID‐19 and subsequent iRMD diagnosis. A rapid review of the literature using a systematic search of Medline, EMBASE and two COVID‐19 databases was undertaken until August 2022. Case studies, case series, cross‐sectional, case‐control, and cohort studies reporting patients with an incident iRMD following COVID‐19 were included. Title and abstract screening were conducted by one reviewer, and full text screening by two reviewers. Data extraction and quality appraisal were by one reviewer, with a second verifying. Study‐type specific critical appraisal tools were used. Results were narratively synthesised. 80 studies were included (69 case reports, 10 case series and 1 cross‐sectional study). Commonly reported iRMDs were ‘reactive arthropathies’ (studies=47), ‘inflammatory arthropathies unspecified’ (studies=18), rheumatoid arthritis (studies=12) and lupus erythematosus (studies=11). The cross‐sectional study reported 37% of those with COVID‐19 developed ‘post‐covid arthritis.’ Time from diagnosis of COVID‐19 to iRMD presentation ranged from 0‐120 days. Several mechanisms were proposed to explain the association between COVID‐19 and iRMD development: auto‐immune processes, aberrant inflammatory responses, colonisation of joint spaces, direct damage from the SARS‐CoV2 virus and genetic predisposition. The level of evidence of the studies included in this review was low, and the quality generally poor. Prospective observational studies are required to confirm associations and likely impact of post COVID‐19 iRMDs at a population level.

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Post SARS-CoV-2 infection reactive arthritis: a brief report of two pediatric cases

Cited by 23 publications

References 15 publications

Reactive arthritis occurring after COVID-19 infection: a narrative review

Reactive arthritis occurring after COVID-19 infection: a narrative review

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

Summarizing Evidence of Associations of COVID‐19 With a Future Diagnosis of Inflammatory Rheumatic and Musculoskeletal Diseases: A Rapid Review

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