ABSTRACT
A previously healthy 53-year-old man was hospitalised for 12 days due to COVID-19 with shortness of breath. A few days after discharge from hospital, the patient developed fever and severe pain in several joints in the lower extremities. The pain was so severe that the patient was unable to stand on his feet. Synovial fluid from the right-side knee contained a high number of polynuclear cells and a few mononuclear cells. Microscopy, culture and PCR tests for bacterial infection were all negative. Furthermore, the patient tested negative for rheumatoid factor, anti-cyclic citrullinated peptide and human leukocyte antigen (HLA)-B27. Thus, the condition was compatible with reactive arthritis. The condition improved markedly after a few days' treatment with non-steroid anti-inflammatory drugs and prednisolone.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Arthritis, Reactive , Arthritis , COVID-19 , Prednisolone/administration & dosage , Synovial Fluid , Anti-Inflammatory Agents/administration & dosage , Arthralgia/diagnosis , Arthralgia/etiology , Arthritis/drug therapy , Arthritis/etiology , Arthritis/physiopathology , Arthritis, Reactive/diagnosis , Arthritis, Reactive/drug therapy , Arthritis, Reactive/physiopathology , Arthritis, Reactive/virology , Arthritis, Rheumatoid/diagnosis , Autoantibodies/analysis , COVID-19/complications , COVID-19/physiopathology , COVID-19/therapy , Diagnosis, Differential , Humans , Knee Joint/diagnostic imaging , Lower Extremity/pathology , Male , Middle Aged , Radiography/methods , Synovial Fluid/cytology , Synovial Fluid/immunology , Treatment OutcomeABSTRACT
BACKGROUND: Prolonged social isolation as a result of the COVID-19 global pandemic has been a source of considerable psychological distress for many people. This can manifest in many ways and if left undetected can impact negatively on general health. It is essential to understand the impact of these conditions on inflammatory arthritis (IA) patients, especially axial spondyloarthropathy (axSpA). AIM: To capture the level of psychological distress for patients with IA following prolonged social isolation. METHODS: A survey was sent out to patients with a confirmed diagnosis of IA. This captured changes in sleep, mood, disease activity, employment and general health since the beginning of the social isolation period. A PHQ-4 (Patient Health Questionnaire) was included to determine level of psychological distress. RESULTS: Females with IA reported significantly higher rates of decline in general health (40% vs 16%, p = 0.01), mood disturbance (43.4% vs 26%, p = 0.03) and increased disease activity (50% vs 16%, p = 0.01) compared to males. Evaluating the mean PHQ-4 scores, no significant difference was noted between genders (4.80 vs 3.44, p = 0.10). However, females demonstrated a non-significant trend toward increased rates of moderate to severe psychological distress (40% vs 30%, p = 0.13). Subanalysis of patients with axSpA found high rates of moderate to severe distress in both genders. CONCLUSIONS: Females with IA reported significantly higher rates of decline in general health, mood disturbance and increased disease activity during the period of social isolation. This was reflected in a trend towards greater levels of psychological distress.