Arthralgia and other pathologies of large joints as a consequence of a new coronavirus infection (COVID-19)

Abstract

Introduction. Coronavirus disease 2019 is a new pandemic caused by severe acute respiratory distress-coronavirus 2. This virus mainly affects the respiratory system, but can also affect other organ systems, including musculoskeletal. In the scientific literature, there are data on pathological changes in the joints as one of the symptoms of long-term Covid-19. The aim of the work was a retrospective analysis of cases of arthralgia and severe lesions of large joints and spine as long-term complications of Covid-19. Materials and methods. Data collection was carried out in two stages after the acute Covid-19 was stopped: after 2 months (72 people, group №1) and after 2 years (700 people, group №2), the cohorts of the subjects did not overlap. Some of the respondents in group №1 complained of pain in the joints and spine (29 people, group №1B), the rest had no pain (43 people, group №1A). Clinical, instrumental and laboratory data (including IgG) were studied in all of them and questionnaire data were obtained. The questionnaires included questions about anthropometric data, the nature of the course of the disease, complications and other information. To evaluate the results, cluster analysis was used, basic statistics were determined, Chi-Square test was performed (program Statistica v.12.5.192.5, StatSoft, Inc., USA). Results. It was found that the gender, height, weight, age of the patient, body mass index cannot be associated with the occurrence of joint/muscle pain. Among the factors that correlated with arthralgia were: pulmonary insufficiency (p=0,03), the volume of lung tissue damage (p=0,02), the use of nonspecific immunoprophylactic agents, in particular umifenovir hydrochloride monohydrate (p=0,04), the use of antiviral agents in the treatment, in particular, vitaglutam (p=0,04). In addition, respondents who experienced pain in the joints and spine were significantly more likely (1,8 times) to complain of fatigue (p=0,02). The second stage — evaluation of the results of the examination of patients in group №2 — showed that Covid-19 resulted in a 3-4-fold increase in cases of primary detection of bilateral aseptic necrosis of the femoral head in young (up to 40 years old) patients. Discussion. The results of the study further confirm that pathological changes in the joints should be considered as one of the typical signs of postcovid syndrome. It can be argued that among the numerous parameters studied, there is no one that would uniquely determine the development of articular pathology. In general, there is a group of conditions that may be associated with arthralgia. These include: the use of non specific immunoprophylaxis, pneumonia and taking antiviral drugs during treatment. Conclusion. Thus, the presence of transient arthralgias and, to a lesser extent, more severe joint pathologies can be considered as one of the manifestations of postcovid syndrome. It cannot be excluded that immunoactive substances used for the prevention and treatment of a new coronavirus infection may be associated with a pathological process in the joints. In general, the pathogenesis of Covid-19 complications currently needs further study to be deciphered. From the point of view of practical application of the data obtained, it is important that the occurrence of arthralgia is associated with complaints of increased fatigue after Covid-19, which should suggest the need for additional examination of such patients as a preventive measure in the development of an irreversible process in large joints.