MUSCULOSKELETAL MANIFESTATIONS among PATIENTS with COVID-19 INFECTION

ABSTRACT

Background: Coronavirus disease-2019 (COVID-19) is declared as a global pandemic [1]. It is caused by a novel coronavirus with structural similarities to the virus that causes severe acute respiratory syndrome (SARS) [2].While the pulmonary consequences have received a lot of attention, the impact of the disease extends far beyond the respiratory system and affects other organs of the body such as heart,kidney or liver [3]. Although different musculoskeletal (MSK) manifestations have been linked to COVID-19 infection, a systematic approach to outline these manifestations is still lacking [4]. Objectives: The aim of this study was to determine the prevalence, distribution and determinants of MSK manifestations in patients with COVID-19 infection. Methods: Patients with a history of confrmed COVID-19 infection were asked to answer a web-based survey. The survey consisted of multiple questions centered around demographic, clinical and COVID-19 infection data in addition to MSK discomfort form based on the Nordic MSK Questionnaire. The inclusion criteria included age of ≥18 years. Patients who had malignancies or any chronic rheumatic, MSK, neurological disease were excluded. Results: There was a total of 110 participants, mostly females (72.7%), with mean age 37.7 years, only 9 (8.2%) were current smokers while 31 (28.2%) had associated comorbid conditions. Headache (75.5%), loss of smell (61.8%) and fever were the most main COVID-19 presenting symptoms. The MSK manifestations reported during or shortly after COVID-19 infection were myalgia (95.5%), arthralgia (81.8%) and facial muscle pain (7.3%). The severity of COVID-19 related arthralgia ranged from mild (18.2%), moderate (32.7%), severe (23.6%) and very severe (7.3%). The most affected part was low back (60%), neck (33.3%), and upper back (30%) (Figure 1). MSK manifestations were significantly associated with shortness of breath (p=0.004), fever (p=0.004), loss of taste (p<0.001), diarrhea (p=0.018), fatigue (p<0.001), higher severity of COVID-19 infection (p<0.001), and longer duration of COVID-19 symptoms (from the first day until symptoms resolved) (p<0.001). Conclusion: MSK manifestations are prevalent among patients with COVID-19 infection. They are usually associated with more severe COVID-19 infection and longer disease duration.