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2.
Nat Med ; 28(1): 20-23, 2022 01.
Article in English | MEDLINE | ID: covidwho-1636011
3.
PLoS One ; 16(12): e0260743, 2021.
Article in English | MEDLINE | ID: covidwho-1559789

ABSTRACT

BACKGROUND: Outpatient rehabilitation was temporarily suspended because of coronavirus disease (COVID-19), and there was a risk that patients' activities of daily living (ADLs) would decrease and physical functions unmaintained. Therefore, we investigated the ADLs and motor functions of chronic stroke patients whose outpatient rehabilitation was temporarily interrupted. METHODS: In this observational study, the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and Barthel Index (BI) scores of 49 stroke hemiplegic patients at 6 and 3 months before rehabilitation interruptions were retrospectively determined and were prospectively investigated on resumption of outpatient rehabilitation. Presence or absence of symptoms and difficulties caused by the interruption period (IP) was investigated using a binomial method. Deltas were analyzed using a generalized linear model (GLM) according to the survey period. Age, sex, severity of FMA-UE immediately post-resumption and post-onset period were used as covariates. For survey items showing significant model fit, the 95% confidence interval of minimum detectable change (MDC95) was calculated, and the amount of change was compared. Questionnaire responses were tested via proportion ratio. Statistical significance was set at 5%. RESULTS: The FMA-UE part A and total scores were significantly model fit depending on periods. The estimated FMA-UE total score decreased by 1.64 (z = -2.38, p = 0.02) during the 3-month IP. No fits were observed by GLM in other parts of the FMA-UE, ARAT, or BI. The calculated MDC95 was 3.58 for FMA-UE part A and 4.50 for FMA-UE overall. Answers to questions regarding sleep disturbance and physical pain were significantly biased toward "no" in the psychosomatic function items (p<0.05). There was no bias in the distribution of answers to questions regarding joint stiffness, muscle weakness, muscle stiffness, and difficulty in moving arms and hands. All 16 questions regarding activities and participation items were significantly biased toward answers "no" (p<0.05). CONCLUSIONS: The FMA-UE part A and total scores were affected. Patients complained of subjective symptoms related to upper limb paralysis after the IP. Since ADLs of patients were maintained, the therapist can recommend that patients not receiving outpatient treatments be evaluated in relation to the shoulder, elbow, and forearm and instructed on self-training to maintain motor function.


Subject(s)
COVID-19/epidemiology , Outpatients/psychology , Stroke/physiopathology , Upper Extremity/physiopathology , Adult , COVID-19/virology , Chronic Disease , Female , Humans , Interrupted Time Series Analysis , Male , Middle Aged , Muscle Strength , Muscle Weakness/physiopathology , Observational Studies as Topic , SARS-CoV-2/isolation & purification , Stroke Rehabilitation , Surveys and Questionnaires
4.
Nutrients ; 13(11)2021 Nov 06.
Article in English | MEDLINE | ID: covidwho-1502478

ABSTRACT

Post-acute consequences of COVID-19, also termed long COVID, include signs and symptoms persisting for more than 12 weeks with prolonged multisystem involvement; most often, however, malnutrition is ignored. METHOD: The objective was to analyze persistent symptoms, nutritional status, the evolution of muscle strength and performance status (PS) at 6 months post-discharge in a cohort of COVID-19 survivors. RESULTS: Of 549 consecutive patients hospitalized for COVID-19 between 1 March and 29 April 2020, 23.7% died and 288 patients were at home at D30 post-discharge. At this date, 136 of them (47.2%) presented persistent malnutrition, a significant decrease in muscle strength or a PS ≥ 2. These patients received dietary counseling, nutritional supplementation, adapted physical activity guidance or physiotherapy assistance, or were admitted to post-care facilities. At 6 months post-discharge, 91.0% of the 136 patients (n = 119) were evaluated and 36.0% had persistent malnutrition, 14.3% complained of a significant decrease in muscle strength and 14.9% had a performance status > 2. Obesity was more frequent in patients with impairment than in those without (52.8% vs. 31.0%; p = 0.0071), with these patients being admitted more frequently to ICUs (50.9% vs. 31.3%; p = 0.010). Among those with persistent symptoms, 10% had psychiatric co-morbidities (mood disorders, anxiety, or post-traumatic stress syndrome), 7.6% had prolonged pneumological symptoms and 4.2% had neurological symptoms. CONCLUSIONS: Obese subjects as well as patients who have stayed in intensive care have a higher risk of functional loss or undernutrition 6 months after a severe COVID infection. Malnutrition and loss of muscle strength should be considered in the clinical assessment of these patients.


Subject(s)
COVID-19/complications , Malnutrition/etiology , Muscle Strength , Muscle Weakness/etiology , Muscle, Skeletal/physiopathology , Nutritional Status , Adult , Aged , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/therapy , Female , Functional Status , Hospitalization , Humans , Length of Stay , Male , Malnutrition/diagnosis , Malnutrition/physiopathology , Malnutrition/therapy , Middle Aged , Muscle Weakness/diagnosis , Muscle Weakness/physiopathology , Muscle Weakness/therapy , Obesity/complications , Prognosis , Prospective Studies , Risk Assessment , Risk Factors , Time Factors , Post-Acute COVID-19 Syndrome
5.
Eur J Phys Rehabil Med ; 57(4): 653-662, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1406909

ABSTRACT

BACKGROUND: Although there are some retrospective studies to present musculoskeletal findings of the COVID-19, still the muscle strength and fatigue has not been studied in detail. AIM: To reveal the symptoms of musculoskeletal system in COVID-19 patients, to evaluate myalgia, arthralgia and physical/mental fatigue, to assess handgrip muscle strength, and to examine the relations of these parameters with the severity and laboratory values of the disease. DESIGN: This study was designed as a cross-sectional, single-center case series. SETTING: This study took place from May 15, 2020, to June 30, 2020 at the Istanbul University-Cerrahpasa, Cerrahpasa Pandemia Services. POPULATION: Hospitalized 150 adults with laboratory and radiological confirmation of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) according to WHO interim guidance were included in the study. METHODS: The disease severity 2007 IDSA/ATS guidelines for community acquired pneumonia was used. Myalgia severity was assessed by numerical rating scale (NRS). Visual analog scale and Chalder Fatigue Scale (CFS) were used for fatigue severity determination. Handgrip strength (HGS) was measured by Jamar hand dynamometer. RESULTS: One hundred three patients (68.7%) were non-severe, and 47 patients (31.3%) were severe. The most common musculoskeletal symptom was fatigue (133 [85.3%]), followed by myalgia (102 [68.0%]), arthralgia (65 [43.3%]) and back pain (33 [22.0%]). Arthralgia, which was mostly notable at wrist (25 [16.7%]), ankle (24 [16.0%]) and knee (23 [15.3%]) joints, was significantly higher among the severe group. Severe myalgia was prevalent among myalgia sufferers regardless of COVID-19 severity. The physical fatigue severity score was significantly higher in severe cases, whereas this difference was not significant in mental fatigue score. Female patients with severe infection had "lower" grip strength, whereas grip strength among males did not differ significantly between non-severe and severe COVID-19 cases. Nevertheless, the mean values in both genders and in age decades were below the specified normative values. CRP, ferritin, and LDH levels were significantly higher in women with "lower" grip strength compared to the "normal" group. CONCLUSIONS: Aside from other multisystemic symptoms, musculoskeletal symptoms are quite common in patients with COVID-19. Patients have severe ischemic myalgia regardless of disease activity. Although there is a muscle weakness in all patients, the loss of muscle function is more of a problem among women in connection with disease severity. Muscular involvement in Coronavirus disease is a triangle of myalgia, physical fatigue, and muscle weakness. CLINICAL REHABILITATION IMPACT: Muscle involvement in COVID-19 patients does not mean only myalgia but also a combination of physical fatigue and muscle weakness, and this should be considered in planning the rehabilitation strategies of COVID-19 patients.


Subject(s)
COVID-19/complications , Fatigue/physiopathology , Hand Strength/physiology , Muscle Weakness/physiopathology , Musculoskeletal Pain/physiopathology , Adult , Aged , Female , Hospitalization , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Young Adult
6.
BMJ Case Rep ; 13(9)2020 Sep 21.
Article in English | MEDLINE | ID: covidwho-1304172

ABSTRACT

Clinical manifestations of COVID-19 are known to be variable with growing evidence of nervous system involvement. In this case report, we describe the symptoms of a patient infected with SARS-CoV-2 whose clinical course was complicated with Guillain-Barré syndrome (GBS). We present a case of a 58-year-old woman who was initially diagnosed with COVID-19 pneumonia due to symptoms of fever and cough. Two weeks later, after the resolution of upper respiratory tract symptoms, she developed symmetric ascending quadriparesis and paresthesias. The diagnosis of GBS was made through cerebrospinal fluid analysis and she was successfully treated with intravenous immunoglobulin administration.


Subject(s)
Coronavirus Infections/complications , Guillain-Barre Syndrome/physiopathology , Low Back Pain/physiopathology , Muscle Weakness/physiopathology , Paresthesia/physiopathology , Pneumonia, Viral/complications , Analgesics/therapeutic use , Betacoronavirus , Brain/diagnostic imaging , COVID-19 , Coronavirus Infections/diagnosis , Diagnosis, Differential , Female , Gabapentin/therapeutic use , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Lumbar Vertebrae/diagnostic imaging , Magnetic Resonance Imaging , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Radiculopathy/diagnosis , SARS-CoV-2 , Spinal Cord/diagnostic imaging
7.
BMC Anesthesiol ; 21(1): 64, 2021 03 02.
Article in English | MEDLINE | ID: covidwho-1115216

ABSTRACT

BACKGROUND: Few studies have evaluated muscle strength in COVID-19 ICU survivors. We aimed to report the incidence of limb and respiratory muscle weakness in COVID-19 ICU survivors. METHOD: We performed a cross sectional study in two ICU tertiary Hospital Settings. COVID-19 ICU survivors were screened and respiratory and limb muscle strength were measured at the time of extubation. An ICU mobility scale was performed at ICU discharge and walking capacity was self-evaluated by patients 30 days after weaning from mechanical ventilation. RESULTS: Twenty-three patients were included. Sixteen (69%) had limb muscle weakness and 6 (26%) had overlap limb and respiratory muscle weakness. Amount of physiotherapy was not associated with muscle strength. 44% of patients with limb weakness were unable to walk 100 m 30 days after weaning. CONCLUSION: The large majority of COVID-19 ICU survivors developed ICU acquired limb muscle weakness. 44% of patients with limb weakness still had severely limited function one-month post weaning.


Subject(s)
COVID-19/complications , Muscle Weakness/etiology , Aged , Arm/physiopathology , COVID-19/physiopathology , Cross-Sectional Studies , Female , Follow-Up Studies , France , Humans , Leg/physiopathology , Lung/physiopathology , Male , Middle Aged , Muscle Weakness/physiopathology , Retrospective Studies , SARS-CoV-2
10.
BMJ Case Rep ; 14(1)2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1035259

ABSTRACT

We describe a case of delayed onset, acute demyelinating neuropathy secondary to novel SARS-CoV-2 infection. A previously healthy 46-year-old man presented with bilateral leg pain and loss of sensation in his feet 53 days after having COVID-19 pneumonitis. He developed painful sensory symptoms followed by a rapidly progressive lower motor neuron weakness involving all limbs, face and respiratory muscles, needing ventilatory support. In keeping with a diagnosis of Guillain-Barré syndrome, cerebrospinal fluid examination showed albuminocytologic dissociation and nerve conduction studies supported the diagnosis of an acute inflammatory demyelinating polyradiculoneuropathy. The delayed neurological dysfunction seen in our patient following SARS-CoV-2 infection may indicate a novel mechanism of disease that is part of the emerging 'long COVID-19 syndrome'.


Subject(s)
COVID-19/complications , Guillain-Barre Syndrome/physiopathology , Muscle Weakness/physiopathology , Neuralgia/physiopathology , Paresthesia/physiopathology , COVID-19/physiopathology , Electrodiagnosis , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Late Onset Disorders , Male , Middle Aged , Neural Conduction , Noninvasive Ventilation , SARS-CoV-2 , Time Factors , Post-Acute COVID-19 Syndrome
11.
Int J Mol Sci ; 21(21)2020 Oct 22.
Article in English | MEDLINE | ID: covidwho-916452

ABSTRACT

Intensive care unit-acquired weakness (ICUAW) occurs in critically ill patients stemming from the critical illness itself, and results in sustained disability long after the ICU stay. Weakness can be attributed to muscle wasting, impaired contractility, neuropathy, and major pathways associated with muscle protein degradation such as the ubiquitin proteasome system and dysregulated autophagy. Furthermore, it is characterized by the preferential loss of myosin, a distinct feature of the condition. While many risk factors for ICUAW have been identified, effective interventions to offset these changes remain elusive. In addition, our understanding of the mechanisms underlying the long-term, sustained weakness observed in a subset of patients after discharge is minimal. Herein, we discuss the various proposed pathways involved in the pathophysiology of ICUAW, with a focus on the mechanisms underpinning skeletal muscle wasting and impaired contractility, and the animal models used to study them. Furthermore, we will explore the contributions of inflammation, steroid use, and paralysis to the development of ICUAW and how it pertains to those with the corona virus disease of 2019 (COVID-19). We then elaborate on interventions tested as a means to offset these decrements in muscle function that occur as a result of critical illness, and we propose new strategies to explore the molecular mechanisms of ICUAW, including serum-related biomarkers and 3D human skeletal muscle culture models.


Subject(s)
Coronavirus Infections/complications , Critical Care , Muscle Weakness/etiology , Muscular Atrophy/etiology , Pneumonia, Viral/complications , Animals , COVID-19 , Coronavirus Infections/therapy , Humans , Iatrogenic Disease , Muscle Weakness/physiopathology , Muscle Weakness/prevention & control , Muscular Atrophy/physiopathology , Muscular Atrophy/prevention & control , Pandemics , Pneumonia, Viral/therapy
12.
Cardiol Rev ; 29(1): 39-42, 2021.
Article in English | MEDLINE | ID: covidwho-900593

ABSTRACT

Patients older than 65 years hospitalized with COVID-19 have higher rates of intensive care unit admission and death when compared with younger patients. Cardiovascular conditions associated with COVID-19 include myocardial injury, acute myocarditis, cardiac arrhythmias, cardiomyopathies, cardiogenic shock, thromboembolic disease, and cardiac arrest. Few studies have described the clinical course of those at the upper extreme of age. We characterize the clinical course and outcomes of 73 patients with 80 years of age or older hospitalized at an academic center between March 15 and May 13, 2020. These patients had multiple comorbidities and often presented with atypical clinical findings such as altered sensorium, generalized weakness and falls. Cardiovascular manifestations observed at the time of presentation included new arrhythmia in 7/73 (10%), stroke/intracranial hemorrhage in 5/73 (7%), and elevated troponin in 27/58 (47%). During hospitalization, 38% of all patients required intensive care, 13% developed a need for renal replacement therapy, and 32% required vasopressor support. All-cause mortality was 47% and was highest in patients who were ever in intensive care (71%), required mechanical ventilation (83%), or vasopressors (91%), or developed a need for renal replacement therapy (100%). Patients older than 80 years old with COVID-19 have multiple unique risk factors which can be associated with increased cardiovascular involvement and death.


Subject(s)
Acute Kidney Injury/therapy , COVID-19/therapy , Hospital Mortality , Renal Replacement Therapy/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Vasoconstrictor Agents/therapeutic use , Academic Medical Centers , Accidental Falls , Acute Kidney Injury/etiology , Aged, 80 and over , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/physiopathology , Aspartate Aminotransferases/metabolism , C-Reactive Protein/metabolism , COVID-19/complications , COVID-19/metabolism , COVID-19/physiopathology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/metabolism , Cardiovascular Diseases/physiopathology , Cause of Death , Consciousness Disorders/physiopathology , Dyspnea/physiopathology , Female , Ferritins/metabolism , Fever/physiopathology , Fibrin Fibrinogen Degradation Products/metabolism , Hospitalization , Humans , Hypoxia/physiopathology , Hypoxia/therapy , Independent Living , Intensive Care Units/statistics & numerical data , Intracranial Hemorrhages/etiology , Intracranial Hemorrhages/physiopathology , Leukocyte Count , Liver Diseases/etiology , Liver Diseases/metabolism , Lymphocyte Count , Male , Muscle Weakness/physiopathology , Natriuretic Peptide, Brain/metabolism , Nursing Homes , Oxygen Inhalation Therapy , Procalcitonin/metabolism , Stroke/etiology , Stroke/physiopathology , Troponin I/metabolism
13.
Ann Palliat Med ; 9(5): 2993-2999, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-725775

ABSTRACT

BACKGROUND: To investigate the epidemiology and clinical characteristics of patients infected with coronavirus disease 2019 (COVID-19) in Weifang, China. METHODS: The demographic data of 43 COVID-19 patients identified in Weifang were used to investigate whether they had traveled to epidemic areas and whether they had close contact with confirmed cases. On admission, patients' symptoms and results of laboratory tests and imaging were analyzed. RESULTS: Among the 43 COVID-19 patients. including 9 third generation infected cases, 16 (37.2%) were imported, who infected the rest. Most cases were middle-aged with approximate sex ratio. A "super spreader", Mr. Zhang made it necessary to quarantine 69 medical personnel. Mr. Zhang directly infected six individuals who, in turn, infected another six individuals. Another patient, Mr. Wang, spread the infection to his five family members at a family gathering. Subsequently, the daughter infected her husband. The most common COVID-19 symptoms were fever, weakness, dry cough, and cough sputum. In most patients, white blood cell counts were not elevated and lymphocyte counts were decreased. Elevated C-reactive protein and serum amyloid A protein (SAA) levels were commonly observed. There was no death among the patients or infection among the medical staff. CONCLUSIONS: The infection by the COVID-19 in Weifang was mostly the result of close contact with imported cases. These circumstances underscore the need to comprehensively strengthen the management for patients to prevent and control the spread of the virus.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Quarantine , Travel-Related Illness , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Antiviral Agents/therapeutic use , Betacoronavirus , C-Reactive Protein/metabolism , COVID-19 , Child , Child, Preschool , China/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Cough/physiopathology , Drugs, Chinese Herbal/therapeutic use , Female , Fever/physiopathology , Headache , Humans , Infant , Lung/diagnostic imaging , Male , Middle Aged , Muscle Weakness/physiopathology , Myalgia/physiopathology , Oxygen Inhalation Therapy , Pandemics , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , SARS-CoV-2 , Serum Amyloid A Protein/metabolism , Tomography, X-Ray Computed , Young Adult
14.
Eur Rev Med Pharmacol Sci ; 24(15): 8210-8218, 2020 08.
Article in English | MEDLINE | ID: covidwho-696554

ABSTRACT

OBJECTIVE: To explore the CT imaging features/signs of patients with different clinical types of Coronavirus Disease 2019 (COVID-19) via the application of artificial intelligence (AI), thus improving the understanding of COVID-19. PANTIENTS AND METHODS: Clinical data and chest CT imaging features of 58 patients confirmed with COVID-19 in the Fifth Medical Center of PLA General Hospital were retrospectively analyzed. According to the Guidelines on Novel Coronavirus-Infected Pneumonia Diagnosis and Treatment (Provisional 6th Edition), COVID-19 patients were divided into mild type (7), common type (34), severe type (7) and critical type (10 patients). The CT imaging features of the patients with different clinical types of COVID-19 types were analyzed, and the volume percentage of pneumonia lesions with respect to the lung lobes (where the lesion was located) and to the whole lung was calculated with the use of AI software. SPSS 21.0 software was used for statistical analysis. RESULTS: Common clinical manifestations of COVID-19 patients: fever was found in 47 patients (81.0%), cough in 31 (53.4%) and weakness in 10 (17.2%). Laboratory examinations: normal or decreased white blood cell (WBC) counts were observed in 52 patients (89.7%), decreased lymphocyte counts (LCs) in 14 (24.1%) and increased C-reactive protein (CRP) levels in 18 (31.0%). CT imaging features: there were 48 patients (94.1%) with lesions distributed in both lungs and 46 patients (90.2%) had lesions most visible in the lower lungs; the primary manifestations in patients with common type COVID-19 were ground-glass opacities (GGOs) (23/34, 67.6%) or mixed type (17/34, 50.0%), with lesions mainly distributed in the periphery of the lungs (28/34, 82.4%); the primary manifestations of patients with severe/critical type COVID-19 were consolidations (13/17, 76.5%) or mixed type (14/17, 82.4%), with lesions distributed in both the peripheral and central areas of lungs (14/17,82.4%); other common signs, including pleural parallel signs, halo signs, vascular thickening signs, crazy-paving signs and air bronchogram signs, were visible in patients with different clinical types, and pleural effusion was found in 5 patients with severe/critical COVID-19. AI software was used to calculate the volume percentages of pneumonia lesions with respect to the lung lobes (where the lesion was located) and to the whole lung. There were significant differences in the volume percentages of pneumonia lesions for the superior lobe of the left lung, the inferior lobe of the left lung, the superior lobe of the right lung, the inferior lobe of the right lung and the whole lung among patients with different clinical types (p<0.05). The area under the ROC curve (AUC) of the volume percentage of pneumonia lesions for the whole lung for the diagnosis of severe/critical type COVID-19 was 0.740, with sensitivity and specificity of 91.2% and 58.8%, respectively. CONCLUSIONS: The clinical and CT imaging features of COVID-19 patients were characteristic to a certain degree; thus, the clinical course and severity of COVID-19 could be evaluated with a combination of an analysis of clinical features and CT imaging features and assistant diagnosis by AI software.


Subject(s)
Coronavirus Infections/diagnostic imaging , Coronavirus Infections/physiopathology , Lung/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/physiopathology , Adolescent , Adult , Aged , Aged, 80 and over , Artificial Intelligence , Betacoronavirus , C-Reactive Protein/metabolism , COVID-19 , Coronavirus Infections/classification , Coronavirus Infections/metabolism , Cough/physiopathology , Critical Illness , Female , Fever/physiopathology , Humans , Image Processing, Computer-Assisted , Lymphopenia/physiopathology , Male , Middle Aged , Muscle Weakness/physiopathology , Pandemics/classification , Pneumonia, Viral/classification , Pneumonia, Viral/metabolism , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Software , Tomography, X-Ray Computed , Young Adult
15.
Rheumatol Int ; 40(10): 1539-1554, 2020 10.
Article in English | MEDLINE | ID: covidwho-646938

ABSTRACT

The coronavirus disease-2019 (COVID-19) pandemic is likely to pose new challenges to the rheumatology community in the near and distant future. Some of the challenges, like the severity of COVID-19 among patients on immunosuppressive agents, are predictable and are being evaluated with great care and effort across the globe. A few others, such as atypical manifestations of COVID-19 mimicking rheumatic musculoskeletal diseases (RMDs) are being reported. Like in many other viral infections, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can potentially lead to an array of rheumatological and autoimmune manifestations by molecular mimicry (cross-reacting epitope between the virus and the host), bystander killing (virus-specific CD8 + T cells migrating to the target tissues and exerting cytotoxicity), epitope spreading, viral persistence (polyclonal activation due to the constant presence of viral antigens driving immune-mediated injury) and formation of neutrophil extracellular traps. In addition, the myriad of antiviral drugs presently being tried in the treatment of COVID-19 can result in several rheumatic musculoskeletal adverse effects. In this review, we have addressed the possible spectrum and mechanisms of various autoimmune and rheumatic musculoskeletal manifestations that can be precipitated by COVID-19 infection, its therapy, and the preventive strategies to contain the infection.


Subject(s)
Autoimmune Diseases/physiopathology , Coronavirus Infections/physiopathology , Musculoskeletal Diseases/physiopathology , Pneumonia, Viral/physiopathology , Rheumatic Diseases/physiopathology , Antibodies, Antinuclear/immunology , Antibodies, Antiphospholipid/immunology , Antiviral Agents/adverse effects , Arthralgia/etiology , Arthralgia/immunology , Arthralgia/physiopathology , Autoimmune Diseases/etiology , Autoimmune Diseases/immunology , Betacoronavirus , Blood Coagulation Disorders/etiology , Blood Coagulation Disorders/immunology , Blood Coagulation Disorders/physiopathology , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Coronavirus Infections/immunology , Cross Reactions/immunology , Extracellular Traps/immunology , Fibrin Fibrinogen Degradation Products , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/immunology , Guillain-Barre Syndrome/physiopathology , Humans , Lupus Coagulation Inhibitor/immunology , Molecular Mimicry , Mucocutaneous Lymph Node Syndrome/etiology , Mucocutaneous Lymph Node Syndrome/immunology , Mucocutaneous Lymph Node Syndrome/physiopathology , Muscle Weakness/etiology , Muscle Weakness/immunology , Muscle Weakness/physiopathology , Musculoskeletal Diseases/etiology , Musculoskeletal Diseases/immunology , Myalgia/etiology , Myalgia/immunology , Myalgia/physiopathology , Myocarditis/etiology , Myocarditis/immunology , Myocarditis/physiopathology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/drug therapy , Pneumonia, Viral/immunology , Rheumatic Diseases/etiology , Rheumatic Diseases/immunology , SARS-CoV-2 , COVID-19 Drug Treatment
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