Frequency of fibromyalgia syndrome and anxiety post-corona virus disease-2019 (COVID-19) in patients attending the rheumatology clinic

Aim of the work To screen for the new development of fibromyalgia syndrome (FMS) and anxiety in rheumatic diseases (RDs) patients and control who recovered from coronavirus disease 2019 (COVID-19). Patients and methods The study included 200 RDs patients and 100 matched controls with no previous history of FMS and who recovered from COVID-19. The patients' RDs included rheumatoid arthritis (RA) (n = 50), systemic lupus erythematosus (SLE) (n = 50), juvenile idiopathic arthritis (JIA) (n = 40) and spondyloarthritis (SpA) (n = 60). The fibromyalgia symptom scale (FS), fibromyalgia impact questionnaire (FIQ) and Hamilton Anxiety rating scale were assessed. Results The mean age of patients was 35.9 ± 8.5 years with female: male 2.6:1. Fibromyalgia and anxiety were significantly higher in cases than control (22.5 % vs 12 % and 27 % vs16 %, p = 0.002, p = 0.03 respectively). Hypertension, obesity, anxiety, severe COVID-19, frequency of SLE and SpA were significantly higher in patients with FMS compared to those without (31.1 % vs 11.6 %, 68.9 % vs 21.9 %, 84.4 % vs 10.3 %, 48.9 % vs 16.8 %, 31.1 % vs 23.2 % and 40 % vs 27.1;p = 0.002, p < 0.001, p < 0.001, p < 0.001, p = 0.014, p = 0.004 respectively).Severity of COVID-19, diabetes and anxiety were significant predictors of FMS(β = 1.1, p = 0.007;β = 3.03, p = 0.001 and β = 4.44, p < 0.001 respectively). Fibromyalgia increases with increase anxiety grade;the percentage of fibromyalgia was 4.7 %, 50 %, 90 % and 100 % among patients with no anxiety, mild, moderate, and severe anxiety respectively (p < 0.001). Conclusion Fibromyalgia is common in RDs patients post-COVID-19. Diabetes, COVID-19 infection severity and anxiety predict the risk of developing post-COVID-19 fibromyalgia. Post-COVID-19 fibromyalgia occurred more in hypertensive, obese, anxious and patients with severe COVID infection.

Noninvasive Imaging for Patients with COVID-19 and Acute Chest Pain

Acute chest pain is a common presentation in patients with COVID-19. Although noninvasive cardiac imaging modalities continue to be important cornerstones of management, the pandemic has brought forth difficult and unprecedented challenges in the provision of timely care while ensuring the safety of patients and providers. Clinical practice has adapted to these challenges, with several recommendations and societal guidelines emerging on the appropriate use of imaging modalities. In this review, we summarize the current evidence base on the use of noninvasive cardiac imaging modalities in COVID-19 patients with acute chest pain, with a focus on acute coronary syndromes.

Characteristics and Risk Factors of Persistent Neuropathic Pain in Recovered COVID-19 Patients.

OBJECTIVES: To assess risk factors for persistent neuropathic pain in subjects recovered from coronavirus disease 2019 (COVID-19) and to study the serum level of neurofilament light chain (NFL) in those patients. DESIGN: Case-control study. SETTING: Persistent post-COVID-19 pain. SUBJECTS: In total, 45 patients with post-COVID-19 pain and another 45 age and sex-matched healthcare workers who recovered from COVID-19 without pain. METHODS: The included participants were subjected to medical history taking, screening for depressive disorders, comprehensive neurological examination, and pain evaluation using the Douleur Neuropathique en 4 questions (DN4). All patients who had a score at least 4/10 on DN4 were included. The serum NFL level was measured for both groups at the time of patients' enrollment. RESULTS: The frequency of depression, moderate and severe COVID-19 cases, disease duration and serum ferritin were significantly higher in the cases with post-COVID-19 pain than controls. Binary logistic regression revealed that depression, azithromycin use, moderate and severe COVID-19 increased the odds of post-COVID-19 pain by 4.462, 5.444, 4.901, and 6.276 times, respectively. Cases with post-COVID-19 pain had significantly higher NFL (11.34 ± 9.7, 95% confidence interval [CI]: 8.42-14.25) than control group (7.64 ± 5.40, 95% CI: 6.02-9.27), (P value = .029). Patients with allodynia had significantly higher NFL (14.96 ± 12.41, 95% CI: 8.58-21.35) compared to those without (9.14 ± 6.99, 95% CI: 6.43-11.85) (P value = .05). DISCUSSION: Depression, azithromycin, and moderate and severe COVID-19 are independent predictors of persistent post-COVID-19 pain. Serum NFL may serve as a potential biomarker for persistent neuropathic pain after COVID-19.

Relative Frequency and Risk Factors of COVID-19 Related Headache in a Sample of Egyptian Population: A Hospital-Based Study.

OBJECTIVES: Headache is considered one of the most frequent neurological manifestations of coronavirus disease 2019 (COVID-19). This work aimed to identify the relative frequency of COVID-19-related headache and to clarify the impact of clinical, laboratory findings of COVID-19 infection on headache occurrence and its response to analgesics. DESIGN: Cross-sectional study. SETTING: Recovered COVID-19 patients. SUBJECTS: In total, 782 patients with a confirmed diagnosis of COVID-19 infection. METHODS: Clinical, laboratory, and imaging data were obtained from the hospital medical records. Regarding patients who developed COVID-19 related headache, a trained neurologist performed an analysis of headache and its response to analgesics. RESULTS: The relative frequency of COVID-19 related headache among our sample was 55.1% with 95% confidence interval (CI) (.516-.586) for the estimated population prevalence. Female gender, malignancy, primary headache, fever, dehydration, lower levels of hemoglobin and platelets and higher levels of neutrophil/lymphocyte ratio (NLR) and CRP were significantly associated with COVID-19 related headache. Multivariate analysis revealed that female gender, fever, dehydration, primary headache, high NLR, and decreased platelet count were independent predictors of headache occurrence. By evaluating headache response to analgesics, old age, diabetes, hypertension, primary headache, severe COVID-19, steroid intake, higher CRP and ferritin and lower hemoglobin levels were associated with poor response to analgesics. Multivariate analysis revealed that primary headache, steroids intake, moderate and severe COVID-19 were independent predictors of non-response to analgesics. DISCUSSION: Headache occurs in 55.1% of patients with COVID-19. Female gender, fever, dehydration, primary headache, high NLR, and decreased platelet count are considered independent predictors of COVID-19 related headache.