Relación clínica entre la artritis reactiva y la infección por SARS-CoV-2: una revisión exploratoria

Resumen Introducción: La artritis reactiva (ReA) es una monoartritis u oligoartritis que compromete principalmente las extremidades, y se puede relacionar con infecciones bacterianas o virales. En la actualidad, la covid-19 se ha relacionado con el desarrollo de artropatías debido a su componente inflamatorio. Objetivos: Llevar a cabo una revisión exploratoria de la literatura que describa las características clínicas de la ReA en pacientes sobrevivientes a la infección por SARS-CoV-2. Materiales y métodos: Revisión sistemática exploratoria basada en las guías para comunicar revisiones sistemáticas adaptadas para las revisiones exploratorias Prisma-P y pasos propuestos Arksey y ajustados por Levan. Se incluyeron estudios de tipo experimental y observacional publicados en PubMed y Scopus, en inglés y español, que respondieran las preguntas de investigación planteadas. Resultados: Se incluyeron 25 documentos que describen las principales manifestaciones clínicas de la ReA en 27 pacientes con antecedente de infección por SARS-Cov-2. El tiempo desde el inicio de los síntomas o diagnóstico microbiológico de la covid-19 hasta el desarrollo de manifestaciones articulares o extraarticulares compatibles con ReA osciló entre 7 y 120 días. Las manifestaciones articulares clínicas descritas fueron las artralgias y el edema de predominio en articulaciones de las rodillas, tobillos, codos, interfalángicas, metatarsofalángica y metacarpofalángica. Conclusiones: Las artralgias en las extremidades son el principal síntoma de la ReA en pacientes con antecedente de covid-19. Sus síntomas se pueden presentar en un periodo de días a semanas, desde el inicio de los síntomas clínicos o el diagnóstico microbiológico de la infección por SARS-CoV-2. Introduction: Reactive arthritis (ReA) is a monoarthritis or oligoarthritis that mainly affects the extremities, it can be related to bacterial or viral infections. Currently, COVID-19 has been linked to the development of arthropathies due to its inflammatory component. Objectives: A scoping review of the literature that describes the clinical characteristics of ReA in survivors of SARS-CoV-2 infection. Materials and methods: A systematic review based on the guidelines for reporting systematic reviews adapted for Prisma-P exploratory reviews and steps proposed by Arksey and adjusted by Levan. Experimental and observational studies published in PubMed and Scopus, English and Spanish, which answered the research questions posed, were included. Results: 25 documents were included describing the main clinical manifestations of ReA in 27 patients with a history of SARS-Cov-2 infection. The time from the onset of symptoms or microbiological diagnosis of COVID-19 to the development of articular and/or extra-articular manifestations compatible with ReA ranged from 7 days to 120 days. The clinical joint manifestations described were arthralgia and oedema, predominantly in knee, ankle, elbow, interphalangeal, metatarsophalangeal, and metacarpophalangeal joints. Conclusions: Arthralgias in the extremities are the main symptom of ReA in patients with a history of COVID-19, whose symptoms can present in a period of days to weeks from the onset of clinical symptoms or microbiological diagnosis of SARS-CoV-2 infection.

A Case Report of COVID-19-Related Dactylitis Combined with Chilblain-Like Acral Lesions

This case report describes the occurrence of symmetrical dactylitis of toes combined with chilblain-like acral lesions in a 32-year-old female patient 19 days after a mild coronavirus infection. The article addresses existing problems of managing patients after COVID-19 in daily clinical practice. Scientific evidence is pointing to a growing number of cases of articular and skin involvement associated with COVID-19. However, it remains unclear what approaches to use in the treatment of such patients.

Acute arthritis following SARS-CoV-2 infection: About two cases.

Joint involvement in COVID-19 may occur at different stages of the disease and maybe represented by non-specific arthralgia or by acute arthritis. We report two cases of COVID-19 infection that were complicated by postviral reactive arthritis. Case 1: A 47-year-old male was presented 20 days after a COVID-19 infection with acute right knee arthritis. On biologic data, erythrocyte sedimentation rate and C-reactive protein were normal, and immunologic data were negative. A joint puncture was performed showing a turbid fluid. Testing for microcrystals was negative, as well as the synovial fluid culture. An infectious investigation was conducted, which was negative. The patient's complaints improved significantly, with analgesics and non-steroidal anti-inflammatory drugs (NSAID). Case 2: A 33-year-old female presented with acute left knee arthritis evolving for 48 h, free of fever, after a COVID-19 infection treated 15 days ago. On examination, besides knee arthritis, the osteoarticular examination was normal. A biological inflammatory syndrome was noted in laboratory tests. A yellow fluid with multiple PNN was detected in the joint fluid aspiration, with a negative culture. The patient was treated by analgesics and NSAID. The follow-up was highlighted by the arthritis resolution. Conclusion: Both of our cases are consistent with what has already been reported in the literature confirming the development of PostCOVID arthritis and strengthen the impending necessity of wider studies to identify rheumatologic manifestations in the short- and long-terms after surviving COVID-19.

New Onset Autoimmune Disease More Common after Covid-19

Background: Viral infections including SARS-CoV-2 may trigger autoimmune disease through T-cell-mediated autoimmune response through molecular mimicry-cross-reactive T-cell recognition or bystander T-cell activation. Autoantibodies have been detected in patients with COVID-19 and some human proteins have homologous regions with SARS-CoV-2 peptides that could function as autoantigens. While there are scattered reports of various autoimmune diseases diagnosed after COVID-19, the risk is not known. Method(s): TriNetX (a global federated health research network providing access to electronic medical records across 72 large healthcare organizations) was utilized to define a cohort of adults 18 years or older seen on or after January 1, 2020 with at least one follow-up visit after an index date. Exposure was defined as COVID-19 diagnosis by ICD10 code or positive laboratory test. Controls did not have COVID-19 (by the same criteria) and were propensity score-matched to patients who had COVID-19 by age and female sex. Index date was the date of COVID-19 diagnosis or first provider visit for any reason during the study period for controls. Outcomes (see table) were assessed starting one month after index date (to exclude prior undiagnosed autoimmune disease) until one year after. Patients with a specific outcome prior to the index date or within one month after the index date were excluded from the analysis for that outcome. Incidence by COVID-19 exposure status and risk ratios for each outcome were assessed. Result(s): 4,016,472 patients were included (2,008,236 in both groups). Overall, mean (SD) age was 49.2 (17.9) and 57.7% were female. Patients who had COVID-19 were more likely to be white (63 vs 56.9%;p< 0.001). Rheumatoid arthritis, psoriasis and type 1 diabetes mellitus had the highest incidence after COVID-19 (0.24, 0.22 and 0.19%, respectively). While the incidence of most of the autoimmune diseases assessed were low in both groups, the risk ratios for all but one condition (Grave's) showed statistically significant higher risk in patients after COVID-19 than in those without COVID-19 (see table). Risk ratios were highest for polyarteritis nodosa (4.43, 3.27-6.01), reactive arthritis (3.56, 2.05-6.2) and ANCA-associated vasculitis (3.36, 2.6-4.34). Conclusion(s): Autoimmune diseases were more likely to be diagnosed within the first year after COVID-19 than in age-, sex-matched controls. Future work will assess the validity of autoantibodies in predicting autoimmune disease after COVID-19. (Table Presented).

To the 100th Anniversary of the Birth of Academician V.A. Nasonova. Infections and Rheumatic Diseases: From the Past to the Future

In rheumatology, the problem of infectious pathology is quite acute. This is primarily due to the participation of various infectious agents in the development of immuno-inflammatory rheumatic diseases (IIRD), in which microorganisms play a trigger role, triggering the immunopathological mechanisms of inflammation. Vivid examples of such diseases are acute rheumatic fever and reactive arthritis. The infectious etiology of Lyme disease has been proven. An equally difficult task is the fight against comorbid infection (CI), which often complicates the course of many IIRD due to a violation of the immune status caused by both the background disease and the use of immunosuppressive drugs. The predominance of respiratory tract lesions in the structure of CI in patients with IIRD makes it necessary to use influenza and pneumococcal vaccines in them, since the risk of deaths from these infections among these patients is quite high. During the development of the COVID-19 pandemic, which has become a challenge to all mankind, a large number of new fundamental and medical problems have been revealed concerning the relationship between viral infection and many widespread chronic non-communicable diseases, among which IIRDs occupy an important position. As one of the methods of combating the current COVID-19 pandemic, great hopes are pinned on the widespread use of vaccination. The possibility of using monoclonal antibodies for pre-exposure prophylaxis of COVID-19, including in patients with IIRD, is discussed.Copyright © 2023 Ima-Press Publishing House. All rights reserved.

Reactive Arthritis Following Coronavirus 2019 Infection in a Pediatric Patient: A Rare Case Report.

Reactive arthritis (ReA) following Coronavirus 2019 (COVID-19) infection has been described mainly in adults, and only two pediatric cases have been reported. We report a third case where ReA was found to be a sequela following COVID-19 infection. A 15-year-old right-handed Caucasian girl presented with severe left-wrist pain. She was experiencing fever, rash, and migratory oligoarthritis, and laboratory work-up showed elevated inflammatory markers and a positive COVID-19 IgG antibody test. Imaging revealed inflammatory arthropathy with wrist synovitis. The patient was diagnosed with ReA following COVID-19 infection and was treated surgically by wrist arthroscopic synovectomy after the failure of conservative management. It has been 1 year after her surgery, and she is doing well. Emerging case reports are linking ReA as a delayed response to COVID-19 infection; therefore, ReA should be included in the list of differential diagnoses in all patients with joint pain following COVID-19 infection.

Post-COVID-19 reactive arthritis: Myth or reality?

Since December 2019, a new virus of the coronaviridae, called Coronavirus 2019 (COVID-19), has appeared in the Wuhan province of China. It has been declared a pandemic by the World Health Organization (WHO). The clinical manifestations of COVID-19 reported in the literature are diverse and very heterogeneous. Among these manifestations, reactive arthritis (ReA) remains ambiguous, because of the difficulty of linking these arthritides to COVID-19. ReA is a condition caused by bacteria. The clinical pattern of ReA commonly consists of an inflammation of fewer than five joints, which often includes the lower extremities, joints, eyes, skin, and urethra. It is triggered by an infection in another part of the body;generally the intestines, genitals, or urinary tract. Arthritis may be "additive" or "migratory" (new joints become inflamed after the initially inflamed site has already improved). The time required to develop ReA after infection must not exceed 6 weeks. It occurs most often in men between the ages of 18 and 40. Some patients carry the HLA-B27 gene. Some authors reported cases of ReA caused by COVID-19. They argued that the timing of disease onset was consistent with COVID-19 infection and that no other clear sources of infection were identified. The presence of arthritis, digestive or genital associated manifestations, and the absence of other evident etiologies (after clinical and laboratory exams) were also advanced as arguments for the diagnosis of ReA. The treatment of ReA depends on its stage. Acute inflammation can be treated with nonsteroidal anti-inflammatory drugs. The late stage of reactive arthritis is considered chronic and generally treated with a diseasemodifying antirheumatic drug such as sulfasalazine or methotrexate. In more severe cases, biologic disease-modifying antirheumatic drugs may be used. © 2023 Nova Science Publishers, Inc.

Reactive Arthritis

Reactive arthritis develops as a sequela of a remote infection, usually of the gastrointestinal or genitourinary tract. The presence of acute arthritis and absence of specific diagnostic test markers can lead to misdiagnosis. Prompt recognition and proper management prevent reactive arthritis from progressing to a chronic destructive arthritis. The nurse practitioner's familiarity with reactive arthritis, signs and symptoms, diagnostic criteria, and treatment regimen promote early intervention for achieving the best outcomes, including remission.

Reactive arthritis after COVID19 vaccination: 17 cases.

OBJECTIVES: The aim of the study is to report a series of 17 cases of ankle bi-arthritis that occurred shortly after Covid-19 RNA vaccination, and to discuss the potential role of these vaccines in the pathogenesis of this rheumatological manifestation. METHODS: All patients were examined in the same department and received a full work-up to investigate the usual causes of ankle bi-arthritis. No rheumatic inflammatory disease occurred after 9 months follow -up. A post vaccination serological follow-up in search of anti-Spike antibodies was request for all patients. RESULTS: All patients recovered with low dose of prednisolone within <2 months, except one who could not be weaned off corticosteroids. The level of antibodies found was very high in all patients. CONCLUSION: The ankle bi-arthritis occurrence chronology, the follow-up, and the similar clinical presentation might suggest a pathogenic role of RNA vaccination.

New-Onset Arthritis Following COVID-19 Vaccination: A Systematic Review of Case Reports.

Coronavirus disease 2019 (COVID-19) vaccine has effectively suppressed the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and alleviated its symptoms, but there are also many adverse events. Joint diseases caused by COVID-19 vaccine have been reported in many studies. Some are well-controlled arthritis patients who developed arthritis after COVID-19 vaccination, while others are new-onset joint pain and swelling problems after COVID-19 vaccination. The purpose of this systematic review is to examine the literature reports in existing databases and analyze the incidence of new-onset arthritis after COVID-19 vaccination. We included 31 eligible articles and described 45 patients, ranging in age from 17 to over 90, with more females than males. The majority (84.4%) of patients received the adenovirus vector vaccine (ChAdOx1) and the mRNA-based vaccine (BNT126b2 and mRNA-1273). Most (64.4%) patients developed joint-related symptoms after the first dose of vaccine, and 66.7% developed symptoms within the first week of vaccination. The joint symptoms involved were mainly joint swelling, joint pain, limited range of motion, and so on. A total of 71.1% of the patients involved multiple joints, both large and small; 28.9% of patients involved only a single joint. Some (33.3%) patients were confirmed by imaging, and the most common diagnoses were bursitis and synovitis. Two nonspecific inflammatory markers, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), were monitored in almost all cases, and all patients showed varying degrees of increase in these two markers. Most of the patients received the treatment of glucocorticoid drugs or nonsteroidal anti-inflammatory drugs (NSAIDs). Clinical symptoms markedly improved in most patients, with 26.7% making a full recovery and no relapse after a few months of follow-up. To determine whether there is a causal relationship between COVID-19 vaccination and the triggering of arthritis, large-scale and well-controlled research studies are needed in the future to verify this relationship and to further study its pathogenesis in detail. Clinicians should raise awareness of this complication with a view to early diagnosis and appropriate treatment.

The Association Between COVID-19 and Reactive Arthritis: A Systematic Review of Case Reports and Case Series.

INTRODUCTION: Reactive arthritis (ReA) is a joint inflammation that follows an infection at a distant site, often in the gastrointestinal or urogenital tract. Since the emergence of COVID-19 in January 2020, several case reports have suggested a relation between reactive arthritis and severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), due to the novelty of the disease, most findings were reported in the form of case reports or case series, and a comprehensive overview is still lacking. METHODS: We searched PubMed/Medline and Embase to identify studies addressing the association between ReA and COVID-19. The following terms were used: ["Reactive Arthritis" OR "Post-Infectious Arthritis" OR "Post Infectious Arthritis"] AND ["COVID-19" OR "SARS-CoV-2" OR "2019-nCoV"]. RESULTS: A total number of 35 reports published up to February 16th, 2022, were included in this study. A wide range of ages was affected (mean 41.0, min 4 max 78), with a higher prevalence of males (61.0%) from 16 countries. The number and location of the affected joints were different in included patients, with a higher prevalence of polyarthritis in 41.5% of all cases. Cutaneous manifestations and visual impairments were found as the most common associated symptoms. Most patients (95.1%) recovered, with a mean recovery time of 24 days. Moreover, arthritis induced by COVID-19 seems to relieve faster than ReA, followed by other infections. CONCLUSION: ReA can be a possible sequel of COVID-19 infection. Since musculoskeletal pain is a frequent symptom of COVID-19, ReA with rapid onset can easily be misdiagnosed. Therefore, clinicians should consider ReA a vital differential diagnosis in patients with post-COVID-19 joint swelling. Additional studies are required for further analysis and to corroborate these findings.

Reactive arthritis following COVID-19: cause for concern.

Low-quality evidence suggests that COVID-19 may trigger reactive arthritis one to four weeks after the infection. Post COVID-19 reactive arthritis resolves within a few days, and no additional treatment is required. Established diagnostic or classification criteria for reactive arthritis are missing, and a deeper understanding of the immune mechanism related to COVID-19 prompt us to further investigate the immunopathogenic mechanisms capable of promoting or contrasting the development of specific rheumatic diseases. Caution should be exerted when managing post-infectious COVID-19 patient with arthralgia.

Reactive arthritis following COVID-19 current evidence, diagnosis, and management strategies.

BACKGROUND: Immune-mediated conditions associated to Corona Virus Disease-19 (COVID-19) have been reported, including vasculitis, antiphospholipid antibody syndrome, myositis, and lupus. Emerging studies have reported the potential occurrence of reactive arthritis in patients previously infected with COVID-19. This systematic review summarised the current evidence on the occurrence of reactive arthritis in patients previously infected by COVID-19. METHODS: This study was conducted according to the 2020 PRISMA guidelines. All the clinical investigations describing the occurrence of reactive arthritis following COVID-19 were accessed. In September 2022, the following databases were accessed: PubMed, Web of Science, Google Scholar, Embase. The generalities of the study were extracted: author, year and journal of publication, country of the main author, study design, sample size, mean age, number of women, main results of the study. The following data on COVID-19 severity and management were retrieved: type of treatment, hospitalization regimes (inpatient or outpatient), admission to the intensive care unit, need of mechanical ventilation, pharmacological management. The following data on reactive arthritis were collected: time elapsed between COVID-19 infection to the onset of reactive arthritis symptoms (days), pharmacological management, type of arthritis (mono- or bilateral, mono- or polyarticular), extra-articular manifestations, presence of tenosynovitis or enthesitis, synovial examination at microscopic polarised light, imaging (radiography, magnetic resonance, sonography), clinical examination, laboratory findings. RESULTS: Data from 27 case reports (54 patients) were retrieved, with a mean age of 49.8 ± 14.5 years. 54% (29 of 54 patients) were women. The mean time span between COVID-19 infection and the occurrence of reactive arthritis symptoms was 22.3 ± 10.7 days. Between studies diagnosis and management of reactive arthritis were heterogeneous. Symptoms resolved within few days in all studies considered. At last follow-up, all patients were minimally symptomatic or asymptomatic, and no additional therapy or attentions were required by any patient. CONCLUSION: Poor evidence suggests that COVID-19 could target the musculoskeletal system causing reactive arthritis at its post infectious stage. COVID-19 can act as a causative agent or as a trigger for development of reactive arthritis even without presence of antibodies of rheumatological disorders. Treating physicians should have a high index of suspicion while treating post infectious COVID-19 patient with arthralgia. LEVEL OF EVIDENCE: Level IV, systematic review.

A Case Report of Reactive Arthritis After COVID-19 AstraZeneca Vaccination.

In early 2021, multiple vaccinations for the coronavirus disease 2019 (COVID-19) in various immunological formulations were administered successfully to humans worldwide. Although numerous encountered side effects were expected, there were some effects that were unexpected. We report a case of a patient who experienced a rare occurrence of reactive arthritis in the right knee joint that manifested insidiously as pain, heat, and swelling on the second day following vaccination with the Oxford-AstraZeneca COVID-19 vaccine. The patient underwent a series of investigations, confirming the suspected diagnosis and ruling out other possible diseases. The case was refractory to oral non-steroidal anti-inflammatory drugs. Thus, the treatment was shifted to intra-articular steroids. Although the treatment plan improved the symptoms of the patient noticeably, it did not resolve them. A rare possible side effect following COVID-19 vaccination is reactive arthritis, which often occurs in young and healthy individuals with no significant comorbidities.

Seronegative oligo-arthritis following covid-19 infection: A case report

Objective: To present a case of seronegative oligo-arthritis following COVID-19 infection. Background(s): COVID-19 infection caused by SARS-CoV- 2 may induce autoimmune phenomena. Although musculoskeletal symptoms are usual in COVID-19 infections, clinical arthritis with signs of inflammation are relatively uncommon. Our case highlights the occurrence of reactive arthritis following a COVID-19 infection. Case: A 37 year old woman developed sore throat, rashes, erythema and painful swelling of the 3rd distal interphalangeal joint of the hand and 1st metatarsophalangeal joint of the right foot following COVID-19 exposure. Nasopharyngeal swab test for SARS-CoV- 2 infection was positive. She had completed COVID-19 (inactivated Sinovac) vaccine 2 months earlier. There was a history of undifferentiated inflammatory arthritis 2 years earlier which had resolved with few months of methotrexate and non-steroidal anti-inflammatory drugs (NSAIDs). Work-up disclosed normal complete blood count and erythrocyte sedimentation rate (ESR), slightly elevated C-reactive protein;rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) were negative. She took NSAID for arthritis and anti-histamine for rashes and completed home-based quarantine. Symptoms resolved over the subsequent 2 to 3 weeks without sequelae. Conclusion(s): This case illustrates an autoimmune reaction to COVID-19 infection in the form of reactive arthritis (ReA). Although the clinical presentation, pathomechanisms, and management are likely similar to those described for ReA, we explore additional insights into other mechanisms and manifestations unique to post COVID-19 infections, and the increased susceptibility of this patient with prior history of undifferentiated inflammatory arthritis.

Reactive arthritis after Gam-COVID-Vac vaccination: A case report.

Although the safety and efficacy of vaccinations have been evaluated through clinical trials, medical experts and authorities are very interested in the reporting and investigation of adverse events following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunisation in the general public. This article reports about a 41-year-old man without a history of underlying diseases, complaining of continuous morning stiffness and acute discomfort in his left elbow joint, 20 days after taking the first dosage of Sputnik V. The case was extensively studied, and a possible diagnosis of reactive arthritis was made.

Reactive arthritis after vaccination against SARS-CoV-2: A case series and a mini-review.

The rapid development of COVID-19 vaccines became essential for addressing the global pandemic. Reactive arthritis after vaccination has been a rare phenomenon. Here, we present a case series of three patients with joint inflammation possibly attributed to COVID-19 immunization (mRNA and live adenovirus vectored vaccine). Symptoms were alleviated using non-steroid anti-inflammatory drugs and glucocorticoids. After follow-up, the patients have not been diagnosed with any other rheumatic disease. Reactive arthritis after the COVID-19 vaccine is an unusual adverse effect and poses a negligible risk in comparison to the benefits of immunization, but it should be considered in differential diagnostics by a practicing rheumatologist who cares for patients with new-onset arthritis without apparent cause at the time of pandemic.

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

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.

Does post-COVID reactive arthritis exist? Experience of a tertiary care centre with a review of the literature.

Background: Rheumatological manifestations following COVID-19 are various, including Reactive Arthritis (ReA), which is a form of asymmetric oligoarthritis mainly involving the lower limbs, with or without extra-articular features. The current case series describes the clinical profile and treatment outcome of 23 patients with post-COVID-19 ReA. Methods: A retrospective, observational study of patients with post-COVID-19 arthritis over one year was conducted at a tertiary care centre in India. Patients (n = 23) with either a positive polymerase chain reaction test for SARS-CoV2 or an anti-COVID-19 antibody test were included. Available demographic details, musculoskeletal symptoms, inflammatory markers, and treatment given were documented. Results: Sixteen out of 23 patients were female. The mean age of the patients was 42.8 years. Nineteen patients had had symptomatic COVID-19 infection in the past. The duration between onset of COVID-19 symptoms and arthritis ranged from 5 to 52 days with a mean of 25.9 days. The knee was the most involved joint (16 out of 23 cases). Seven patients had inflammatory lower back pain and nine had enthesitis. Most patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs) and steroids - either depot injection or a short oral course. Three patients required treatment with hydroxychloroquine and methotrexate which were eventually stopped. No relapse was reported in any of the patients. Conclusion: On combining our data with 21 other case reports of ReA, a lower limb predominant, oligoarticular, asymmetric pattern of arthritis was seen with a female preponderance. The mean number of joints involved was 2.8. Axial symptoms and enthesitis were often coexistent. Treatment with NSAIDs and intra-articular steroids was effective. However, whether COVID-19 was the definitive aetiology of the arthritis is yet to be proven.

Antecedentes: Las manifestaciones reumatológicas posteriores al COVID-19 son diversas, entre ellas, la artritis reactiva, que es una forma de oligoartritis asimétrica que afecta principalmente a los miembros inferiores, con o sin características extraarticulares. La serie de casos actual describe el perfil clínico y el resultado del tratamiento de 23 pacientes con artritis reactiva posterior a COVID-19. Métodos: Se realizó un estudio observacional retrospectivo de pacientes con artritis post-COVID-19 durante un año en un centro de atención terciaria en India. Se incluyeron pacientes (n = 23) con una prueba de reacción en cadena de la polimerasa positiva para SARS-CoV-2 o una prueba de anticuerpos anti-COVID-19. Se documentaron los detalles demográficos disponibles, los síntomas musculoesqueléticos, los marcadores inflamatorios y el tratamiento administrado. Resultados: Dieciséis de los 23 pacientes eran mujeres. La edad media de los pacientes fue de 42,8 años. Diecinueve pacientes habían tenido infección sintomática por COVID-19 en el pasado. La duración entre el inicio de los síntomas de COVID-19 y la artritis osciló entre 5 y 52 días, con una media de 25,9 días. La rodilla fue la articulación más comúnmente involucrada (16 de 23 casos). Siete pacientes tenían dolor lumbar inflamatorio y 9 tenían entesitis. La mayoría de los pacientes fueron tratados con medicamentos antiinflamatorios no esteroideos y esteroides, ya fuera una inyección de depósito o un ciclo oral corto. Tres pacientes requirieron tratamiento con hidroxicloroquina y metotrexato, que finalmente se suspendieron. No se reportaron recaídas en ninguno de los pacientes. Conclusión: Al combinar nuestros datos con otros 21 informes de casos de artritis reactiva, se observó un patrón de artritis oligoarticular asimétrico predominante en las extremidades inferiores con predominio femenino. El número medio de articulaciones afectadas fue de 2,8. A menudo coexistían síntomas axiales y entesitis. El tratamiento con antiinflamatorios no esteroideos y esteroides intraarticulares fue eficaz. Sin embargo, aún no se ha demostrado si el COVID-19 fue la etiología definitiva de la artritis.