Southern Illinois University Edwardsville Study Finds That Most Exposed To SARS-CoV-2 Will Develop Viral Arthropathy Besides Myalgia
A study led by researchers from Southern Illinois University Edwardsville-USA and Hospital Sisters Health System-Illinois-USA has found that a high proportion of the population that has been exposed to the SARS-CoV-2 virus will eventually develop viral arthropathy
Viral arthropathy (viral arthritis) is swelling and irritation (inflammation) of one or more joints particularly hinge joints like the elbow and the knee caused by a viral infection.
Myalgia describes muscle aches and pain, which can involve ligaments, tendons and fascia, the soft tissues that connect muscles, bones and organs
Although viral arthropathy is an increasingly recognized sequela of several viral pathogens including alphaviruses, hepatitis, and various other coronaviruses, its manifestation in COVID-19 infected and post COVID individuals is far more prevalent.
Increasing case reports of viral arthropathy and also myalgia associated with SARS-CoV-2 infection (COVID-19) both during active disease and following resolution of acute COVID-19 symptoms are becoming a common occurrence.
The study team lead by Dr Christopher Herndon from School of Pharmacy, Southern Illinois University Edwardsville sought to describe the prevalence of viral arthropathy and myalgia associated with COVID-19, as well as to identify factors that may predict these symptoms.
A national, cross-sectional survey was conducted using a questionnaire administered online. Subjects self-reporting previous confirmed COVID-19 were recruited using the Amazon Mechanical Turk crowdsourcing platform. Questionnaire items included demographics, frequency and severity of common COVID-19 symptoms, requirement for hospitalization or mechanical ventilation, subject recall of arthropathy or myalgia onset, duration, and severity, as well as WOMAC score. Binary logistic regression was used to identify potential predictive co-variates for the development of either arthropathy or myalgia.
In all, a total of 3222 participants completed the arthropathy/myalgia questionnaire with 1065 responses remaining for analysis following application of exclusion criteria, data integrity review, and omission of respondents with confounding conditions.
The study findings showed that of the 1065 cases, 282 (26.5%) reported arthralgia and 566 (53.2%) reported myalgia at some point during or after COVID-19 with 9.9% and 6.0% reporting onset of arthralgia or myalgia, respectively, after resolution of acute COVID-19 symptoms.
The presence of several commonly reported COVID symptoms or indicators of disease severity was predictive of arthralgia including hospitalization (OR 3.7; 95% CI 2.4 to 5.8), sore throat (OR 2.3; 95% CI 1.5 to 3.5), fatigue (OR 2.9; 95% CI 1.7 to 4.9), and ageusia/anosmia (OR 1.7; 95% CI 1.1 to 2.7).
The study findings showed that new-onset arthropathy and myalgia following COVID-19 resolution may be an increasingly encountered etiology for pain.
The study findings were published in the peer reviewed Journal of Pain Research.
Although the majority of viral arthropathies present with the onset of infection and are usually self-limiting, symptoms may persist with select patients and in cases of specific viral infections such as SARS-CoV-2.
Past coronavirus outbreaks, including Middle East respiratory syndrome coronavirus (MERS) and severe acute respiratory syndrome coronavirus (SARS), were not associated with notable new-onset arthropathy; however, myalgia was a reported symptom during acute illness for both viruses.
The SARS-CoV-2coronavirus is one of seven viruses of the coronavirus family and has been previously implicated as an independent risk factor for the development of rheumatoid arthritis. However, the true incidence new-onset arthropathy or myalgia following infection with SARS-CoV-2 is poorly understood.
It was found that in severe COVID-19, an excessive innate immune response may lead to a cytokine storm.
Interestingly, the pattern of pro-inflammatory cytokines induced in COVID-19 has similarities to those targeted in the treatment of rheumatoid arthritis. The persistence of symptoms, such as fatigue, myalgia, dyspnea, coughing, and headache, has been reported weeks after the infection has resolved.
However, many individuals with symptomatic COVID-19 may continue to experience symptoms chronically after the resolution of their initial infection. This experience, described as “long COVID”, is a period in which certain symptoms may persist weeks or months after the infection has resolved and is still poorly understood.
The study findings showed that patients with a self-reported previous infection of COVID-19 experienced new onset symptoms of joint or muscle pain during after their COVID-19 experience.
Arthralgia has been an increasingly cited component of long-covid syndrome, with an estimated prevalence of 19% (95% CI 7–34).
Dr Herndon told Thailand Medical News
, “Our study is the largest study to date to specifically describe the characteristics and timing of arthralgia and myalgia associated with COVID-19.”
In one past retrospective, observational case series involving COVID patients of which all with positive acute phase reactants, rheumatoid factor, or anti-cyclic citrullinated peptide were excluded from the report, patients reported an average duration of 25.9 (± 12.8) days from the time of onset of fever and subsequent arthritis symptoms. Most frequently reported joint involvement was knees (16 of 23), ankles (15 of 23), and low back (7 of 23). Additionally, 9 of 23 patients experienced pain suggestive of enthesitis.
The pathogenesis of the more common viral arthritides has been well described previously.
Molecular mimicry, a phenomenon in which immune cells react with epitopes both derived from the virus and from self, is one proposed mechanism for an autoimmune etiology of new-onset arthritis. This is opposed to actual synovial intrusion by the virus. Similar pathogenesis has been described relating to the receipt of COVID-19 vaccination as well.
The study findings concluded that arthropathy and myalgia are common symptoms experienced during and following COVID-19. After controlling for self-reported, pre-existing conditions, the study team found approximately one-fifth to one-quarter of patients reported experiencing arthralgia or myalgia, respectively.
More noteworthy was new onset joint pain or myalgia following resolution of COVID-19 symptoms. Additionally, COVID-19 vaccination may also contribute to the onset of these symptoms making causal inferences difficult.
The study team stressed that viral arthropathy due to COVID-19 infection should be considered in a differential diagnosis when encountering patients with new onset polyarthropathy or myalgia.
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