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1.
Annals of the Rheumatic Diseases ; 81:1691, 2022.
Article in English | EMBASE | ID: covidwho-2009075

ABSTRACT

Background: Recent data suggests that SARS-Cov-2 can alter self-tolerance and trigger autoimmune responses through cross-reactivity with host cells;therefore it can lead to late autoimmune and infammatory manifestations. With regard to rheumatic and musculoskeletal diseases (RMDs), medical literature displays sporadic case reports describing a variety of conditions diagnosed after COVID-19, but it remains still unclear what are the most common problems in patients presenting to rheumatology clinic following COVID-19 disease. Objectives: To describe the pattern of post-COVID-19 RMDs in a consecutive group of patients from rheumatology outpatient clinic. Methods: We have performed an observational descriptive study of a group of adult patients who received a new diagnosis of RMD within a timeframe of 12 weeks after the confirmation of COVID-19. Data was collected based on clinical presentation, paraclinical pattern and radiological examinations. Results: The study included 23 patients who were consulted in rheumatology outpatient clinic and had post COVID-19 new onset joint, periarticular, bone or infammatory syndrome manifestations. The general characteristics of the study group were as follows: mean age 45.5±11.3 (range 21-63) years and female to male ratio of 1.8:1. The majority of subjects consulted for joint symptoms (91.4%), in other cases reason for consultation was persistent low grade fever and fatigue (4.3%) and skin rash with dyspnea (4.3%). The mean duration of symptoms was 9.8±10.5 (range 1-42) weeks, and the time of onset after COVID-19 diagnosis was 4.9±4.1 (range 0-12) weeks. Concerning COVID-19 severity, it was established that in 60.9% it was mild, 17.4 %-moderate and 21.7%-severe. After clinical and paraclinical examination, the following diseases were diagnosed: ReA, lupus like syndromes, avascular necrosis, new onset RA and new onset PsA. In 69.7% of patients were diagnosed with ReA, the clinical pattern being joint or periarticular involvement of the hand, knee and feet. In 13.0% cases patients had multisystemic involvement (myocarditis, pericarditis, skin rash, infammatory arthritis and/or low grade fever) and positive ANA and or dsDNA Ab, these cases were diagnosed as lupus like syndromes and followed a severe form of COVID-19. In 8.7% of patients who presented with non-infammatory hip pain, avascular necrosis was diagnosed, in both cases femoral head being the affected part. No be noted that patients with avascular necrosis had a severe form of COVID-19 disease and joint pain started later after COVID-19 diagnosis (10-12 weeks). In 4.3% of cases each, new onset RA and PsA were identifed. Conclusion: In the present study we have found that COVID-19 can be followed by a variety of RMDs. The most common symptom of patients presenting with RMD was joint pain. The most common disease was post-COVID ReA (69.7%). Avascular necrosis (8.7%) and lupus like syndromes (13.0%) were found in patients who experienced a severe form of COVID-19. More rarely, patients had new onset of rheumatoid arthritis (4.3%) or psoriatic arthritis (4.3%). Our findings suggest that during the COVID-19 recovery period patients might experience onset of RDMs;therefore, in the presence of joint symptoms or other manifestations suggesting an autoimmune disease, patients should be referred to a rheumatologist for careful clinical examination.

2.
Annals of the Rheumatic Diseases ; 81:1688, 2022.
Article in English | EMBASE | ID: covidwho-2009058

ABSTRACT

Background: According to the recent medical literature, COVID-19 disease can lead to a constellation of clinical syndromes lasting well beyond the frst 30 days of infection. The most common post COVID sequalae includes pulmonary, nervous system and neurocognitive, mental, metabolic, cardiovascular, gastrointestinal and several other clinical manifestations. Regarding joint involvement and particularly reactive arthritis (ReA), literature data is limited and describes case reports or series of cases of patients diagnosed with this condition following COVID-19 disease. Objectives: To describe the pattern and the management of post-COVID reactive arthritis. Methods: We have conducted a descriptive study of consecutive adult patients who presented to rheumatology outpatient clinic for joint or peri-articular pain/swelling/stiffness and received a diagnosis of post-COVID 19 reactive arthritis, by excluding other types of rheumatological conditions. The assessed clinical variables were: visual analogue scale (VAS) pain, swollen joint count (SJC), tender joint count (TJC), duration of morning stiffness, presence of enthesitis/tendinitis and axial involvement. Biochemistry and serology was performed: rheumatoid factor, ACPA, ANA, HLA B27, antiChlamydia Trachomatis, Ureaplasma Urealyticum and Mycoplasma Hominis Ab, anti HBs and HBc Ab, and anti HCV. COVID-19 disease prior to diagnosis of ReA was confrmed by PCR test. Results: In the study were included 16 patients with confrmed post COVID-19 ReA. The mean age of the study group was 43.5±10.8 (range 21-60), the female: male ratio was 4:1 and the duration of joint symptoms was 10.4±11.8 (range 1-42) weeks. The severity of COVID-19 disease was mild in 68.7% cases, moderate in 18.7% and severe in only 6.2% of the cases. The duration between COVID-19 diagnosis and ReA varied between cases, with a mean value of 4.3±4.2 (range 1-12) weeks. In 43.7% of the cases patients had peripheral joint involvement (synovitis), in 37.5%-periarticular involvement (enthesitis), 6.25%-isolate axial involvement (sacroiliac joints), 6.25% enthesitis and axial involvement (cervical spine) and 6.25% synovitis and enthesitis. In patients with peripheral joint pattern, the distribution of pain was symmetric (71.4%). The pattern of synovitis was determined by a TJC of 6.25±5.2 (range 1-16) joints and SJC 1.6±2.4 (range 0-7) joints. Both TJC and SJC correlated positively with the duration of morning stiffness (r=0.9 and r=0.6), but did not correlate with the VAS pain scale. In most of the cases synovitis affected the hand (wrist, MCP and PIP) 62.5% and the knee, feet and ankles-50%. Two patients presented with monoarthritis, 1 with oligoarthritis and 5 with polyarthritis, in the majority of cases, involvement being symmetric (75%). Periarticular pattern was determined by enthesi-tis, affecting the elbow and shoulder (50%), costo-sternal enthesitis (25%) and trochanteritis (25%). From the entire study group, 31.2% had elevated serum infammatory markers (ESR and/or CRP). Patients responded well to NSAIDs alone in 68.7% cases, local (intra-articular or peri-articular infltrations) or and systemic corticoids (5 mg Prednisolone equivalent) were administered in 5.3% and 12.5% cases respectively, in 12.5% cases (two patients) Methotrexate was administered. Conclusion: Reactive arthritis represents a post COVID-19 sequelae. The time of onset of ReA varied between 1 and 12 weeks after COVID-19 diagnosis. The clinical pattern of the disease was expressed by joint or periarticular involvement, mainly affecting the hand, feet and knee symmetrically. Cases of axial manifestations were less common. Most of the patients responded well to NSAIDs, only in a few particular cases, low doses of corticoids and/or Methotrexate were recommended.

3.
Osteoporosis International ; 32(SUPPL 1):S273, 2022.
Article in English | EMBASE | ID: covidwho-1748504

ABSTRACT

Objective: Kinet o therapy is proposed as a method of nonpharmacological treatment of knee osteoarthritis (OA) by the EULAR and OARSI recommendations. Since the COVID-19 pandemic was declared by the WHO in March 2020, there have been different restrictions for outpatient rehabilitation clinics in the Republic of Moldova, from banning clinic visits, limited access, or the need for additional precautions for both patient safety and health professionals. This study aimed to assess the restrictions of the kinetotherapy rehabilitation program in patients with osteoarthritis during the pandemic Methods: We performed a qualitative study of patient attitude and the impact of COVID-19 restrictions on their rehabilitation program. The sample (n=28) consisted of patients with osteoarthritis that were admitted to outpatient rehabilitation facilities associated with University Rehabilitation Center. All patients underwent a standard kinetotherapy 10 D program between September 2020-March 2021. The patient's opinions were assessed in semi-structed interview by phone calls, after completing the kinetotherapy program. The qualitative findings of the impact of pandemic restrictions on patients with OA Results: In the study were included 28 patients (9 men and 19 women) The analysis revealed 9 areas concerning challenging reasons in patients with knee OA during the rehabilitation program: certain restrictions across the country determined by infection rate, fear for traveling in public transport or becoming infected during exercise program because they cannot keep a safe distance, high rate of abandon or poor adherence to kinetotherapeutic program due to patient infection or need to respect the self-isolation, preference of individual sessions rather than group sessions increased rate of telerehabilitation, challenges in elderly to use gadgets, post-COVID symptoms caused some limitation for the intensity of the program, increased communication needs of patients Conclusion: Kinetotherapy rehabilitation is an important part of the management of knee osteoarthritis, its realization in pandemic conditions determined several challenges, as brought challenges but also opportunities.

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