Tag: arthralgia

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.

Source: Evcik D. Musculoskeletal involvement: COVID-19 and post COVID 19. Turk J Phys Med Rehabil. 2023 Feb 28;69(1):1-7. doi: 10.5606/tftrd.2023.12521. PMID: 37201006; PMCID: PMC10186015.

Miscellaneous neuromuscular symptoms and signs in long Covid

Abstract:

We have completed the 3rd year of the Covid-19 pandemic. In the early stages of the disease, we were faced with a wide variety of symptoms and signs, including the neuromuscular system, as well as life-threatening cardiopulmonary, neurovascular and immune complications.

In our study, we questioned fatigue, myalgia, arthralgia, dyspnea, headache, dizziness, neck pain, back pain, low back pain, knee-hip-foot joint pain, vascular claudication (lower extremity pain/cramp), neuropathic pain, morning stiffness, joint swelling, pernio, imbalance in walking in patients (N=111; 65 female, 29 male) aged 20-59 years, who applied to our outpatient clinic in the last 1 year and had Covid-19.

The mean time after Covid-19 was 5.8 ±2.1 months. The duration of Covid-19 treatment was a minimum of 5 days and a maximum of 12 days (median=5 days). Weight loss in 14.4% (median=3.5 kg), anorexia 17.1%, myalgia 41.4% (visual analog scale, VAS=5.1±1.9 cm), arthralgia 24.3% (VAS=5.1±2 cm), fatigue 63.1%, joint swelling 1.8%, pernio sign 0.9%, morning stiffness 7.2% (median=15 min, min 5-maximum 60 min), headache 39.6%, neuropathic pain 15.3%, effort dyspnea 38.7%, 30 second chair stand test= 14.9 ±3.6, vascular claudication symptom 11.7%, neck pain 27.0%, low back pain 30.6%, back pain 36%, hip-knee-foot pain 18.0%, gait imbalance 1.8%, dizziness 18.9% were observed. While fatigue (p=0.05), headache (p=0.04), and dyspnea (p=0.021) complaints were higher in males; VAS (arthralgia) was found higher in females (p=0.026).

In the post-Covid-19 period, we see many neuromuscular symptoms and signs, especially fatigue, myalgia, headache and back pain. In addition, lower extremity vascular claudication and neuropathic pain related with chronic pain should not be overlooked in these patients.

Source: Koca TT, Erzurumluoglu O, Kocyigit BF. Miscellaneous neuromuscular symptoms and signs in long Covid. Med Science. 2023;12(1):238-43. https://www.medicinescience.org/article/3381 (Full text)

Predictors of Long COVID in Patients without Comorbidities: Data from the Polish Long-COVID Cardiovascular (PoLoCOV-CVD) Study

Abstract:

Background: The SARS-CoV-2 pandemic has become an enormous worldwide challenge over the last two years. However, little is still known about the risk of Long COVID (LC) in patients without comorbidities. Thus, we aimed to assess the predictors of LC in patients without comorbidities.

Methods: Patients’ information, the course of the disease with symptoms, and post-COVID-19 complaints were collected within 4-12 weeks after COVID-19 recovery. Next, the patients were followed for at least 3 months. ECG, 24-h ECG monitoring, 24-h blood pressure (BP) monitoring, echocardiography, and selected biochemical tests were performed. LC was recognized based on the WHO definition.

Results: We identified 701 consecutive patients, 488 of whom completed a 3-month follow-up (63% women). Comparisons were made between the LC group (n = 218) and patients without any symptoms after SARS-CoV-2 recovery (non-LC group) (n = 270). Patients with a severe course of acute-phase COVID-19 developed LC complications more often (34% vs. 19%, p < 0.0001). The persistent symptoms were observed in 45% of LC patients. The LC group also had significantly more symptoms during the acute phase of COVID-19, and they suffered significantly more often from dyspnoea (48 vs. 33%), fatigue (72 vs. 63%), chest pain (50 vs. 36%), leg muscle pain (41 vs. 32%), headache (66 vs. 52%), arthralgia (44 vs. 25%), and chills (34 vs. 25%). In LC patients, significant differences regarding sex and body mass index were observed-woman: 69% vs. 56% (p = 0.003), and BMI: 28 [24-31] vs. 26 kg/m2 [23-30] (p < 0.001), respectively. The number of symptoms in the acute phase was significantly greater in the LC group than in the control group (5 [2-8] vs. 2 [1-5], p = 0.0001). The LC group also had a higher 24-h heart rate (77 [72-83] vs. 75 [70-81], p = 0.021) at admission to the outpatient clinic. Multivariate regression analysis showed that LC patients had a higher BMI (odds ratio (OR): 1.06, 95% confidence intervals [CI]: 1.02-1.10, p = 0.007), almost twice as often had a severe course of COVID-19 (OR: 1.74, CI: 1.07-2.81, p = 0.025), and presented with joint pain in the acute phase (OR: 1.90, CI: 1.23-2.95, p = 0.004).

Conclusions: A severe course of COVID-19, BMI, and arthralgia are independently associated with the risk of Long COVID in healthy individuals.

Source: Chudzik M, Lewek J, Kapusta J, Banach M, Jankowski P, Bielecka-Dabrowa A. Predictors of Long COVID in Patients without Comorbidities: Data from the Polish Long-COVID Cardiovascular (PoLoCOV-CVD) Study. J Clin Med. 2022 Aug 25;11(17):4980. doi: 10.3390/jcm11174980. PMID: 36078910. https://www.mdpi.com/2077-0383/11/17/4980/htm (Full text)

Antibody to parvovirus B19 nonstructural protein is associated with chronic arthralgia in patients with chronic fatigue syndrome/myalgic encephalomyelitis

Abstract:

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a neuro-immune disease of uncertain pathogenesis. Human parvovirus B19 infection has been shown to occur just prior to development of the onset of CFS/ME in several cases, although B19 seroprevalence studies do not show any significant differences between CFS/ME and controls.

In this study, we analysed parvovirus B19 markers in CFS/ME patients (n=200), diagnosed according to Fukuda CDC criteria, and normal blood donors (n=200). Serum from each subject was tested for anti-B19 VP2 IgM and IgG (by Biotrin ELISA), anti-B19 NS1 IgM and IgG (by immunofluorescence), and B19 DNA (by real-time PCR).

CFS/ME patients and normal blood donors had a similar B19 seroprevalence (75 % versus 78 %, respectively). Eighty-three CFS patients (41.5 %) as compared with fourteen (7 %) normal blood donors tested positive for anti-B19 NS1 IgG (chi(2)=64.8; P<0.0001; odds ratio=9.42, CI 5.11-17.38). Of these 83 patients, 61 complained of chronic joint pain, while 22 did not.

Parvovirus B19 DNA was detected in serum of 11 CFS patients and none of the controls by Taqman real-time PCR (chi(2)=9.35, P<0.002). Positivity for anti-B19 NS1 IgG was associated with higher expression levels of the human CFS-associated genes NHLH1 and GABPA. As NS1 antibodies are thought to indicate chronic or severe courses of B19 infection, these findings suggest that although the seroprevalence of B19 in CFS patients is similar to controls, the immune control of the virus in these patients may not be efficient.

 

Source: Kerr JR, Gough J, Richards SC, Main J, Enlander D, McCreary M, Komaroff AL, Chia JK. Antibody to parvovirus B19 nonstructural protein is associated with chronic arthralgia in patients with chronic fatigue syndrome/myalgic encephalomyelitis. J Gen Virol. 2010 Apr;91(Pt 4):893-7. doi: 10.1099/vir.0.017590-0. Epub 2009 Dec 9. https://www.ncbi.nlm.nih.gov/pubmed/20007355

 

Chronic fatigue syndrome and arthralgia following parvovirus B19 infection

Abstract:

OBJECTIVE: To determine the incidence of arthralgia and fatigue complicating B19 infection, along with associated B19 markers and autoantibodies.

METHODS: We studied patients with acute B19 infection (n = 51), patients followed from the time of acute B19 infection (mean 22.5 mo) (n = 39), and healthy controls (n = 50). Clinical details were collected using a questionnaire and blood was tested for B19 markers and autoantibodies.

RESULTS: Acute B19 arthralgia occurred in 31 patients and was associated with female sex (p = 0.007) and age > 20 years (p = 0.02). Acute B19 fatigue occurred in 8 patients and was not significantly associated with any marker. At followup, symptoms consisted of arthralgia (n = 5), arthralgia and fatigue (n = 6), fatigue (n = 7), lymphadenopathy (n = 1), and purpura due to thrombocytopenia (n = 2). Chronic B19 arthralgia was associated with persistent B19 viremia (p = 0.029). Comparison of the B19 followup group with the controls revealed a significantly increased prevalence of arthralgia (p = 0.0002), fatigue (p < 0.0001), and all other markers. Chronic B19 arthralgia was associated with both acute B19 arthralgia (p = 0.0168) and positive ANA at acute infection (p = 0.0043). Chronic B19 fatigue was associated with acute B19 fatigue (p = 0.011). Five patients fulfilled the Centers for Disease Control criteria for a diagnosis of chronic fatigue syndrome (CFS) and one of these was negative for serum anti-B19 IgG at followup by both Western blot and immunofluorescence. However, there was no characteristic pattern of B19 markers/autoantibodies in patients with B19 associated chronic fatigue.

CONCLUSION: CFS may follow acute parvovirus B19 infection; however, attribution of a case of CFS to B19 infection may be extremely difficult in the absence of serological confirmation of acute infection at fatigue onset.

 

Source: Kerr JR, Bracewell J, Laing I, Mattey DL, Bernstein RM, Bruce IN, Tyrrell DA. Chronic fatigue syndrome and arthralgia following parvovirus B19 infection. J Rheumatol. 2002 Mar;29(3):595-602. http://www.ncbi.nlm.nih.gov/pubmed/11911112

 

Chronic fatigue, arthralgia, and malaise

A 25 year old female veterinary nurse presented with a six year history of general malaise and severe fatigue. Associated with this she described frequent (monthly) episodes of polyarthralgia affecting all joints but with a predilection for the small joints of the hands and the wrists. When present this was accompanied by mild morning stiffness. In addition she experienced colicky abdominal pain, sometimes with diarrhoea, occasionally with blood mixed with her faeces. Other complaints consisted of low back pain, sore gritty eyes, and an inability to perform any physical exercise at the time of these symptoms. Her symptoms had been remarkably consistent, with no recent change to their pattern.

Six years ago she had been on a working holiday at a veterinary practice situated in New York state, USA. After eating a dish made with “blue fish” she had immediately developed severe nausea, vomiting, and malaise. Although all her acute symptoms resolved, her other symptoms started on return to the United Kingdom. She was investigated twice, at different hospitals, before being referred to this department. It had been found that her symptoms were helped by treatment with 30 mg prednisolone daily for the severe episodes and a maintenance dose of 5 mg daily. Severe episodes were occurring three to four times a year. Non-steroidal anti-inflammatory drugs, sulphasalazine, and other treatments of inflammatory bowel disease had not helped her symptoms. On all occasions the examination and investigations had been reported as normal including markers of inflammation, connective tissue disease, and radiological and histological gastrointestinal studies. No blood had been seen in her faeces. No diagnosis was made other than a seronegative arthralgia.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1010225/pdf/annrheumd00353-0014.pdf

 

Source: Gompels MM, Spickett GP. Chronic fatigue, arthralgia, and malaise. Ann Rheum Dis. 1996 Aug;55(8):502-3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1010225/

 

Parvovirus B19 infection–persistence and genetic variation

Abstract:

53 patients with acute B19 infection were studied; symptoms at acute infection were rash and arthralgia (n = 26), rash (n = 7), arthralgia (n = 16), aplastic crisis (n = 3), and intrauterine fetal death (n = 1). These patients were followed for 26-85 months (mean 57 months) and re-assessed for persistent symptoms, anti-B19 antibodies, and B19 DNA. At follow-up, 7 individuals were positive for serum B19 DNA, compared with none of the controls (2-tailed p value = 0.016). All 7 of those persistently infected were women, 3 of whom had symptoms; 1 had a chronic haemolytic anaemia (initial presentation was aplastic crisis); 1 had persistent arthralgia in both knees (initial presentation was bilateral knee arthralgia); and 1 had arthralgia in one knee and chronic fatigue syndrome (initial presentation was bilateral arthralgia in knees and shoulders). For the 7 persistently infected patients, serum from the time of diagnosis of acute B19 infection was available for 4, all of which contained B19 DNA. With single-stranded conformational polymorphism (SSCP) assay of these 11 PCR products, identical SSCP types were demonstrated in 5 of 7 follow-up isolates. In 2 of the 4 cases for which both acute and follow-up PCR product was available, the SSCP type of the follow-up product was different from that of the acute product. Two B19 virus types were demonstrated in one patient (with persistent arthralgia and chronic fatigue syndrome) at follow-up assessment.

 

Source: Kerr JR, Curran MD, Moore JE, Murphy PG. Parvovirus B19 infection–persistence and genetic variation. Scand J Infect Dis. 1995;27(6):551-7. http://www.ncbi.nlm.nih.gov/pubmed/8685632

 

Low grade pyrexia: is it chronic fatigue syndrome?

Abstract:

Eighty seven consecutive patients presenting with prolonged low grade pyrexia (99 degrees-101 +/- F) during 1984-93 were followed up for a mean duration of 2.9 years. Mean age was 37.55 years (SD + 10.16) and 66 (75.8%) were females. Onset of pyrexia was acute in 57 patients and was associated with chilly sensation (42), Fatigue (69), Arthralgias (61), myalgias (55) and several other non specific symptoms. Clinical examination showed paucity of physical signs with 7 patients showing tender lymphadenopathy, 7 showing splenomegaly, 5 hepatomegaly, and 1 phylctenular conjunctivitis. Psychiatric examination was within normal limits. Extensive investigations for any viral or other infection, autoimmune disorder or malignancy were unrewarding. Patients were followed up for an average of 2.9 (2 to 5 years). Thirteen patients had become asymptomatic within one year of onset of symptoms, 38 by two years and 45 by the end of three years. This syndrome may be a variant of chronic fatigue syndrome.

Comment in: Low grade pyrexia: is chronic fatigue syndrome a safe and justified diagnosis? [J Assoc Physicians India. 1995]

 

Source: Anand AC, Kumar R, Rao MK, Dham SK. Low grade pyrexia: is it chronic fatigue syndrome? J Assoc Physicians India. 1994 Aug;42(8):606-8. http://www.ncbi.nlm.nih.gov/pubmed/7868552

 

Clinical presentation of chronic fatigue syndrome

Abstract:

Chronic fatigue syndrome (CFS) is a chronic illness of uncertain aetiology characterized by at least six months of debilitating fatigue and associated symptoms. The symptoms of the syndrome are all non-specific and some (but not all) are also seen in psychiatric illness. The symptomatology suggesting an organic component to the illness includes its abrupt onset with an ‘infectious-like’ illness, intermittent unexplained fevers, arthralgias and ‘gelling’ (stiffness), sore throats, cough, photophobia, night sweats, and post-exertional malaise with systemic symptoms. The illness can last for years and is associated with marked impairment of functional health status.

 

Source: Komaroff AL. Clinical presentation of chronic fatigue syndrome. Ciba Found Symp. 1993;173:43-54; discussion 54-61. http://www.ncbi.nlm.nih.gov/pubmed/8491106