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1.
BMJ Case Rep ; 15(7)2022 Jul 21.
Article in English | MEDLINE | ID: covidwho-1962131

ABSTRACT

We report a patient with seronegative rheumatoid arthritis diagnosed with Whipple's disease following treatment of tumour necrosis factor inhibitor (TNFI) therapy. Whipple's disease should be considered in patients with seronegative rheumatoid arthritis and other unexplained multisystem illness. The TNFI therapy and immunosuppressive therapies can unmask latent Whipple's disease.


Subject(s)
Arthritis, Rheumatoid , Whipple Disease , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Humans , Tumor Necrosis Factor Inhibitors/therapeutic use , Whipple Disease/diagnosis , Whipple Disease/drug therapy
2.
Clin Exp Rheumatol ; 40(7): 1247-1257, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1935079

ABSTRACT

New evidence for the treatment of rheumatoid arthritis (RA) has emerged during the last year. Specifically, updated guidelines on pharmacological and non-pharmacological management of RA have emphasised the necessity of global patient's care, and have shifted the role of some older drugs, such as glucocorticoids and methotrexate. In addition, the long-term safety of Janus kinase inhibitors was investigated and reinforced. With respect to the coronavirus-19 pandemic, reassuring data on the efficacy and safety of vaccinations in the RA population were acquired, as well as on the potential role of telemedicine in RA management. Machine learning prediction models and biomarkers development have emerged as promising innovations in the area of precision/personalised medicine, appearing to encourage future expansion.In this narrative review, the authors aim to give their specific point of view on the most relevant and potentially impacting novelties published during 2021 and early 2022 in the context of RA management.


Subject(s)
Antirheumatic Agents , Arthritis, Rheumatoid , Janus Kinase Inhibitors , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Glucocorticoids/therapeutic use , Humans , Janus Kinase Inhibitors/adverse effects , Methotrexate/therapeutic use
3.
RMD Open ; 8(2)2022 Jul.
Article in English | MEDLINE | ID: covidwho-1932793

ABSTRACT

In the last decade, much research has focused on the development of rheumatoid arthritis (RA) and the symptomatic phase preceding the onset of clinical arthritis. Observational studies on imaging have revealed that subclinical joint inflammation in patients with arthralgia at risk for RA precedes and predicts the onset of clinically apparent arthritis. Moreover, the results of two placebo-controlled randomised proof-of-concept trials in patients with arthralgia and MRI-detected subclinical inflammation studies will soon be available. The initial results are encouraging and suggest a beneficial effect of DMARD treatment on subclinical inflammation. Since this may increase the necessity to detect subclinical joint inflammation in persons with arthralgia that are at risk for RA, we will here review what has been learnt about subclinical inflammation in at-risk individuals by means of imaging. We will focus on MRI as this method has the best sensitivity and reproducibility. We evaluate the prognostic value of MRI-detected subclinical inflammation and assess the lessons learnt from MRIs about the tissues that are inflamed early on and are associated with the clinical phenotype in arthralgia at risk for RA, for example, subclinical tenosynovitis underlying pain and impaired hand function. Finally, because long scan times and the need for intravenous-contrast agent contribute to high costs and limited feasibility of current MRI protocols, we discuss progress that is being made in the field of MRI and that can result in a future-proof way of imaging that is useful for assessment of joint inflammation on a large scale, also in a society with social distancing due to COVID-19 restrictions.


Subject(s)
Arthritis, Rheumatoid , COVID-19 , Arthralgia/diagnosis , Arthralgia/etiology , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/diagnostic imaging , Disease Progression , Humans , Inflammation/diagnosis , Magnetic Resonance Imaging/methods , Reproducibility of Results
5.
Z Rheumatol ; 81(6): 472-481, 2022 Aug.
Article in German | MEDLINE | ID: covidwho-1787811

ABSTRACT

To review and be prepared for upcoming reforms, data from the InEK (Institut für das Entgeltsystem im Krankenhaus, institute for remuneration in hospitals) data browser and the structured quality reports for inpatient rheumatologic treatment were evaluated. Rheumatologic treatment is very diversified, both in terms of diagnoses and structures. Different specializations can be identified. Rheumatologic complex treatment (RCT) is just one of these and is performed on average in just over 10% of cases. In 2020, cases for selected rheumatological diagnoses decreased by more than 20% compared to 2019. For RCT, the decline was even more pronounced with more than 30%. Evidence of higher disease severity could not be found in the available data. It remains to be seen whether the pre-Corona caseload will be regained in the coming years. In all, 146 organizational departments with more than 20 principal diagnoses of rheumatoid arthritis (RA) were identified in 2019. Forty-seven (32%) of these coded RCT more than ten times, and 29 (20%) more than one hundred times. All 23 departments with more than 300 principle diagnoses of RA are members of the Association of Rheumatological Acute Care Hospitals (Verband rheumatologischer Akutkliniken, VRA), 15 of which participated in the KOBRA quality project and carry the VRA seal of approval. Of the 116 internal medicine departments, only 55 (47%) use a specific specialty code for a rheumatology department according to Article 301 SGB V (social insurance code). Information on specialist staffing was partly contradictory. How many cases with inflammatory rheumatic diseases are treated in specialized departments cannot be answered with the available data. Nevertheless, the available data can be used for specialist, structural, and organizational developments in acute inpatient rheumatology.


Subject(s)
Arthritis, Rheumatoid , Rheumatology , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Germany , Hospitalization , Humans , Inpatients , Specialization
6.
RMD Open ; 8(1)2022 03.
Article in English | MEDLINE | ID: covidwho-1769950

ABSTRACT

BACKGROUND: The current standard of care in rheumatoid arthritis (RA) requires regular assessment of disease activity (DA). All standard RA DA measurement instruments require joint counts to be undertaken by a healthcare professional with/without a blood test. Few healthcare providers have the capacity to assess patients as frequently as stipulated by guidelines. Patient Reported Outcome Measures (PROMs) could be an efficient and informative way to assess RA DA, which is highlighted by the SARS-COV-2 pandemic, as most consultations are remote rather than face-to-face. We aimed to assess all PROMs for RA DA against the internationally recognised COSMIN guidelines to provide evidence-based recommendations to select the most suitable PROMs. METHODS: Review registered on PROSPERO as CRD42020176176. The search strategy was based on a previous similar systematic review and expanded to include all articles up to January 2019. All identified articles were rated by two independent assessors following the COSMIN guidelines. RESULTS: 668 abstracts were identified, with 10 articles included. A further 21 were identified from a previous review. Ten PROMs were identified. There was insufficient evidence to place any of the identified PROMs into recommendation for use category A due to lack of evidence for content validity, as stipulated by the COSMIN guidelines. CONCLUSION: Lack of evidence of content validity limits suitable PROM selection, therefore none can be recommended for use. It is acknowledged that all included PROMs were developed before the COSMIN guidelines were published. Future research on PROMs for RA DA must provide evidence of content validity.


Subject(s)
Arthritis, Rheumatoid , COVID-19 , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/therapy , Humans , Patient Reported Outcome Measures , Quality of Life , SARS-CoV-2 , Surveys and Questionnaires
7.
J Clin Rheumatol ; 28(4): 206-211, 2022 Jun 01.
Article in English | MEDLINE | ID: covidwho-1758966

ABSTRACT

BACKGROUND/OBJECTIVE: Although telemedicine use has been under discussion for decades, this topic has gained unprecedented importance during the COVID-19 pandemic. The Rheumatoid Arthritis Disease Activity Index (RADAI) is a user-friendly tool, fully self-administered, to assess rheumatoid arthritis (RA) disease activity. The aim of this study was to compare the performance of RADAI with other disease activity indices, functional status, and inflammatory markers in a large cohort of RA patients. METHODS: We assessed the concurrent validity of RADAI against Clinical Disease Activity Index (CDAI), Disease Activity Score in 28 Joints-C-reactive protein, Disease Activity Score in 28 Joints-erythrocyte sedimentation rate, Simplified Disease Activity Index, and physician assessment of disease activity and the correlation of RADAI with Health Assessment Questionnaire-Disability Index and inflammatory markers at the REAL Study baseline. We also evaluated the correlation of the change in RADAI and the change in CDAI over a 6-month follow-up. RESULTS: From the 1115 patients included in the REAL Study, 1113 had RADAI scores in the first assessment. At baseline, correlations between RADAI and other disease activity indices were strong, ranging from 0.64 (comparison with physician assessment) to 0.79 (comparison with CDAI). Correlation between the change in RADAI score over the 6 months of follow-up and the change in CDAI score over the same period was moderate/strong for the overall group and within the stratified analyses. CONCLUSION: The strong correlation of RADAI with other well-established tools for disease activity measurement reassures its use with RA patients' follow-up, especially in this new era of telemedicine.


Subject(s)
Arthritis, Rheumatoid , COVID-19 , Arthritis, Rheumatoid/diagnosis , Blood Sedimentation , Humans , Pandemics , Severity of Illness Index
8.
Arthritis Care Res (Hoboken) ; 74(4): 572-578, 2022 04.
Article in English | MEDLINE | ID: covidwho-1669343

ABSTRACT

OBJECTIVE: A treat-to-target (TTT) approach improves outcomes in rheumatoid arthritis (RA). In prior work, we found that a learning collaborative (LC) program improved implementation of TTT. We conducted a shorter virtual LC to assess the feasibility and effectiveness of this model for quality improvement and to assess TTT during virtual visits. METHODS: We tested a 6-month virtual LC in ambulatory care. The LC was conducted during the 2020-2021 COVID-19 pandemic when many patient visits were conducted virtually. All LC meetings used videoconferencing and a website to share data. The LC comprised a 6-hour kickoff session and 6 monthly webinars. The LC discussed TTT in RA, its rationale, and rapid cycle improvement as a method for implementing TTT. Practices provided de-identified patient visit data. Monthly webinars reinforced topics and demonstrated data on TTT adherence. This was measured as the percentage of TTT processes completed. We compared TTT adherence between in-person visits versus virtual visits. RESULTS: Eighteen sites participated in the LC, representing 45 rheumatology clinicians. Sites inputted data on 1,826 patient visits, 78% of which were conducted in-person and 22% of which were held in a virtual setting. Adherence with TTT improved from a mean of 51% at baseline to 84% at month 6 (P for trend < 0.001). Each aspect of TTT also improved. Adherence with TTT during virtual visits was lower (65%) than during in-person visits (79%) (P < 0.0001). CONCLUSION: Implementation of TTT for RA can be improved through a relatively low-cost virtual LC. This improvement in TTT implementation was observed despite the COVID-19 pandemic, but we did observe differences in TTT adherence between in-person visits and virtual visits.


Subject(s)
Arthritis, Rheumatoid , COVID-19 , Education, Distance , Rheumatology , Telemedicine , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/epidemiology , Humans , Pandemics
10.
Arthritis Care Res (Hoboken) ; 74(5): 733-740, 2022 May.
Article in English | MEDLINE | ID: covidwho-1565158

ABSTRACT

OBJECTIVE: We aimed to assess trends in anxiety and interruptions in disease-modifying antirheumatic drug (DMARD) use among patients with rheumatic diseases during the COVID-19 pandemic and to evaluate whether DMARD interruptions were associated with disease flares. METHODS: ArthritisPower, the Vasculitis Patient-Powered Research Network, and other patient organizations invited members to join a 52-week longitudinal study, with baseline surveys completed March 29 to June 30, 2020, with follow-up through May 2021. Logistic regression incorporating generalized estimating equations evaluated associations between interruptions in DMARD use and self-reported disease flares at the next survey, adjusting for demographic characteristics, medications, disease, and calendar time. RESULTS: Among 2,424 patients completing a median of 5 follow-up surveys, the mean age was 57 years, 87% were female, and the most common conditions were rheumatoid arthritis, vasculitis, and psoriatic arthritis. Average Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety T scores decreased from April 2020 (58.7) to May 2021 (53.7) (P < 0.001 for trend). Interruptions in DMARD use decreased from April (11.2%) to December 2020 (7.5%) (P < 0.001) but increased through May 2021 (14.0%) (P < 0.001). Interruptions in DMARD use were associated with a significant increase in severe flares (rated ≥6 of 10) at the next survey (12.9% versus 8.0% [odds ratio (OR) 1.71 (95% confidence interval [95% CI 1.23, 2.36]) although not any flare (OR 1.18 [95% CI 0.89, 1.58])]. CONCLUSION: Anxiety and interruptions in DMARD use initially decreased over time, but DMARD interruptions increased during 2021, possibly related to an increase in COVID-19 cases or vaccine availability. Interruptions in DMARD use were associated with increased rates of severe disease flares, highlighting the importance of avoiding unnecessary DMARD interruptions.


Subject(s)
Antirheumatic Agents , Arthritis, Rheumatoid , COVID-19 , Vasculitis , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/epidemiology , COVID-19/epidemiology , Female , Humans , Longitudinal Studies , Male , Middle Aged , Pandemics , Symptom Flare Up , Vasculitis/drug therapy
11.
Arthritis Care Res (Hoboken) ; 74(5): 741-747, 2022 May.
Article in English | MEDLINE | ID: covidwho-1556247

ABSTRACT

OBJECTIVE: Patients with rheumatoid arthritis (RA) are at an increased risk of acquiring infections owing to immunologic dysfunction and use of potent immunomodulatory medications; however, few data are available on their risk of COVID-19. We estimated the rate of COVID-19 among RA participants and compared it with that of the general population. METHODS: Using the Health Improvement Network, we identified RA patients before February 2020 and followed them to September 2020. We calculated the rate of COVID-19 among participants with RA and compared it with that of the general population using a Cox proportional hazards model, adjusting for potential confounders using overlap weighting of exposure score. We repeated the same analysis among participants with osteoarthritis, a nonautoimmune rheumatic disease, as a negative control exposure. RESULTS: We identified 225 cases of suspected and confirmed COVID-19 among 17,268 RA patients, and 14,234 cases among 1,616,600 participants in the general population (1.4 versus 0.9/1,000 person-months), with the adjusted hazard ratio (HRadj ) being 1.19 (95% confidence interval [95% CI] 1.04-1.36). Confirmed COVID-19 cases developed in 46 RA participants and in 2,249 in the general population (0.3 versus 0.1/1,000 person-months), with the HRadj being 1.42 (95% CI 1.01-1.95). No statistically significant difference was observed for suspected and confirmed (HR 1.00 [95% CI 0.93-1.07]) or confirmed (HR 1.08 [95% CI 0.92-1.27]) COVID-19 rates between participants with osteoarthritis and the general population. CONCLUSION: RA, but not osteoarthritis, was associated with an increased risk of COVID-19. Our findings provide timely evidence to support recommendations that booster vaccines and priority access to anti-SARS-CoV-2 monoclonal antibody treatments should be encouraged for RA patients.


Subject(s)
Arthritis, Rheumatoid , COVID-19 , Osteoarthritis , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/epidemiology , COVID-19/epidemiology , Cohort Studies , Humans , Osteoarthritis/complications , Osteoarthritis/diagnosis , Osteoarthritis/epidemiology , Proportional Hazards Models
13.
Int J Rheum Dis ; 24(9): 1106-1111, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1349922

ABSTRACT

Rheumatoid arthritis (RA) is a major health burden in Asia Pacific affecting the quality of life of patients and consuming healthcare resources. According to recent estimates from the World Health Organization-International League Against Rheumatism-Community Oriented Program for Control of Rheumatic Diseases, prevalence is around 0.3%-0.5%. Management guidelines have helped to improve treatment across this diverse region. To gain better insight into current real-world management applications in view of these guidelines, virtual meetings were conducted in mid-2020 to explore perspectives of rheumatologists and patients, as well as discuss the impact of coronavirus disease 2019 on RA management. Patients and rheumatologists from Hong Kong, Malaysia, Singapore, the Philippines, Thailand, India, Pakistan, and Taiwan were included, representing a diverse mix of healthcare systems, wealth, ethnicity and culture. Despite many countries having prospered in recent years, similar challenges in RA diagnosis and treatment were identified. The daily impact and patient experience of RA were also similar across countries, marked by "silent" pain and disability, and universal misunderstanding of the disease. Late diagnosis and treatment, and barriers to access to appropriate treatment, remain problematic. The experience shared by Taiwan offers a glimmer of hope, however, wherein patient advocacy groups have succeeded in being included in policy-making decisions and securing access to advanced treatment. Real-world solutions that pay heed to the unique local needs and diversity of Asia Pacific are required to improve RA management, which will take time. In the interim, help can be sought from the trained, non-rheumatologist community to reduce some of the disease burden.


Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , COVID-19 , Pain Management/trends , Practice Patterns, Physicians'/trends , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/epidemiology , Asia/epidemiology , Humans , Treatment Outcome
14.
Arthritis Care Res (Hoboken) ; 73(9): 1322-1331, 2021 09.
Article in English | MEDLINE | ID: covidwho-1344956

ABSTRACT

OBJECTIVE: To understand medication, lifestyle, and clinical care changes of persons with rheumatoid arthritis (RA) during the first months (March 2020 through May 2020) of the COVID-19 pandemic in the US. METHODS: Data were collected from adults with RA participating in FORWARD, The National Databank for Rheumatic Diseases observational registry, who answered COVID-19 web-based surveys in May 2020 and previously provided baseline characteristics and medication use prior to the US COVID-19 pandemic. We compared medication changes by disease-modifying antirheumatic drug (DMARD) exposure in logistic models that were adjusted for age, sex, comorbidities including pulmonary and cardiovascular diseases, education level, health insurance status, RA disease activity, fatigue, and polysymptomatic distress. RESULTS: Of 734 respondents, 221 (30%) reported medication changes. Among respondents who experienced a medication change, i.e., "medication changers/changers," glucocorticoids (GCs) were more commonly used compared to respondents who did not experience a medication change ("non-changers") (33% versus 18%). Non-hydroxychloroquine conventional DMARDs were less commonly used in changers compared to non-changers pre-COVID-19 (49% versus 62%), and changers reported more economic hardship during the COVID-19 pandemic compared to non-changers (23% versus 15%). While JAK inhibitor use was associated with the likelihood of a medication change, with an odds ratio (OR) of 1.9 (95% confidence interval [95% CI] 1.0, 3.4), only pre-COVID GC use remained a strong predictor for medication change in multivariable models (OR 3.0 [95% CI 1.9, 4.9]). Change in care was observed to have a significant association with pulmonary disease (OR 2.9 [95% CI 1.3, 6.5]), worse RA disease activity (OR 1.1 [95% CI 1.0, 1.1]), and GC use (OR 1.6 [95% CI 1.0, 2.5]). While the incidence of medication changes was the same before and after the American College of Rheumatology (ACR) guidance for the management of rheumatic disease in adult patients during the COVID-19 pandemic were first published in April 2020, self-imposed changes in medication were approximately twice as likely before publication of the guidelines, and physician-guided changes were more likely after publication. CONCLUSION: Persons with RA in the US made substantial medication changes during the first three months of the COVID-19 pandemic, and changes among persons with RA after publication of the ACR guidance in April 2020 were made with increased physician guidance.


Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , COVID-19 , Drug Substitution/trends , Practice Patterns, Physicians'/trends , Risk Reduction Behavior , Aged , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/epidemiology , Female , Glucocorticoids/therapeutic use , Guideline Adherence/trends , Health Care Surveys , Humans , Janus Kinase Inhibitors/therapeutic use , Male , Middle Aged , Practice Guidelines as Topic , Registries , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , United States/epidemiology
15.
Praxis (Bern 1994) ; 110(7): 375-376, 2021.
Article in German | MEDLINE | ID: covidwho-1272828

ABSTRACT

CME Rheumatology 23/Answers: Rheumatoid Arthritis Following COVID-19/SARS-CoV-2 Infection Abstract. Individuals with rheumatic diseases, especially those on immuno-modulating treatment, have an increased risk of infection. On the other hand, it is known that viral infections may be a cause for acute arthralgias and of arthritis. We present in the following a case of ACPA-positive and RF-positive rheumatoid arthritis after an acute COVID-19/SARS-CoV-2 infection and discuss the possible association with the infection.


Subject(s)
Arthritis, Rheumatoid , COVID-19 , Rheumatic Diseases , Rheumatology , Arthritis, Rheumatoid/diagnosis , Humans , SARS-CoV-2
17.
Fundam Clin Pharmacol ; 36(1): 199-209, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1223484

ABSTRACT

BACKGROUND: To determine whether the use of disease-modifying antirheumatic drugs (DMARDs) is linked to the risk of COVID-19 among patients with inflammatory rheumatic diseases (IRDs). METHODS: We performed a disproportionality analysis of the World Health Organization pharmacovigilance database between January 1, 2020, and June 10, 2020. The frequency of COVID-19 reports for all DMARD classes identified was compared with that for all other reports for all other drugs and quoted as the reporting odds ratio (ROR) (95% confidence interval [CI]). RESULTS: Among 980,446 individual case-safety reports voluntarily recorded in the database, 398 identified COVID-19 in DMARD-treated patients with IRDs. There were 177 (44.5%) patients with rheumatoid arthritis (RA), 120 (30.1%) with ankylosing spondylitis (AS), 93 (23.4%) with psoriatic arthritis (PsA), and 8 (2.0%) with juvenile idiopathic arthritis. Most of the cases of COVID-19 occurred in patients taking anti-TNF agents (84.2%), resulting in a significant disproportionality signal (ROR [95% CI]: 8.31 [7.48-9.23]) - particularly in patients with RA, AS or PsA. A significant inverse disproportionality was found for the anti-IL-6 agent tocilizumab (ROR [95% CI]: 0.12 [0.02-0.88]) and JAK inhibitors (ROR [95% CI]: 0.33 [0.19-0.58]) in patients with RA - suggesting that these two drug classes are safer in the context of RA. CONCLUSION: Our results are in line with the literature on a potentially better safety profile for anti-IL-6 agents and JAK inhibitors. The WHO pharmacovigilance data suggest that COVID-19 is significantly more frequent in patients with IRDs treated with TNF inhibitors.


Subject(s)
Antirheumatic Agents , Arthritis, Rheumatoid , COVID-19 , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/epidemiology , Humans , Pharmacovigilance , SARS-CoV-2 , Tumor Necrosis Factor Inhibitors , World Health Organization
18.
Praxis (Bern 1994) ; 110(6): 293-297, 2021 Apr.
Article in German | MEDLINE | ID: covidwho-1205419

ABSTRACT

CME Rheumatology 23: Rheumatoid Arthritis Following COVID-19/SARS-CoV-2 Infection Abstract. Individuals with rheumatic diseases, especially those on immuno-modulating treatment, have an increased risk of infection. On the other hand, it is known that viral infections may be a cause for acute arthralgias and of arthritis. We present in the following a case of ACPA-positive and RF-positive rheumatoid arthritis after an acute COVID-19/SARS-CoV-2 infection and discuss the possible association with the infection.


Subject(s)
Arthritis, Rheumatoid , COVID-19 , Rheumatic Diseases , Rheumatology , Arthritis, Rheumatoid/diagnosis , Humans , SARS-CoV-2
20.
BMJ Case Rep ; 14(3)2021 Mar 02.
Article in English | MEDLINE | ID: covidwho-1115110

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 Outcome
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