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  1. F. Alkindi1,
  2. K. Alseiari2,
  3. K. Al Naqbi3
  1. 1Tawam Hospital, Internal Medicine, Al Ain, United Arab Emirates
  2. 2Tawam Hospital, Internal Medicine, AlAin, United Arab Emirates
  3. 3Tawam Hospital, Rheumatology Department, AlAin, United Arab Emirates


Background: The incidence of COVID-19 infection is increasing globally with high mortality rate. Cytokine release syndrome might contribute to extra-pulmonary manifestations such as acute kidney injury, venous thrombosis, neurological complications, hepatic and myocardial injury. Reactive arthritis is an emerging musculoskeletal (MSK) manifestation post COVID-19 infection. Reactive arthritis manifests as asymmetrical, oligoarthritis mainly involving peripheral or axial joints of lower extremities and associated with extra-articular manifestations.

Objectives: review the clinical presentation and management outcomes of COVID-19 associated reactive arthritis.

Methods: A literature research was conducted using PubMed and Google scholar for published abstracts, case reports, and studies from January 2020 to January 2021. We used search keywords” reactive arthritis”, “COVID-19 pneumonia”, “ SARS CoV2 infection”, and “Musculoskeletal”. Descriptive analysis was used due to small sample size.

Results: COVID-19 associated reactive arthritis is rarely reported. In review of literature, 10 cases were identified and we included our case of hip arthritis and avascular necrosis post COVID-19 infection. The mean age of cases (n=11) was of 42.8 years and 54.5 % of patients were males. (Table 1) The median duration of reactive arthritis diagnosis from COVID-19 infection ranged from 1 to 8 weeks. The severity of COVID-19 infection varied from mild (n= 6) to severe disease (n=2) per description in each reported case. Majority of the patients had oligoarticular involvement (2 to 4 joints) 45.5%, followed by monoarticular 36.4%, and polyarticular (> 4 joints) in 18%. Extra-articular manifestations were identified in 54.5% of patients including skin rash (erythematous itchy rash), urticarial rash, wrist tendinitis, Achilles enthesitis /tendonitis and balanitis. HLA-B27 testing was done in five patients and only one patient had a positive result. Plain radiographs were normal. Therapy provided of such cases were NSAIDS (n=4), steroids (oral, intra-articular) (n=1) or combination of steroids and NSAIDS (n=3) with favorable outcomes. The median reported follow up period ranged from 1.5 to 8 weeks.

Table 1.

Characteristics of the reported reactive arthritis cases post COVID-19 infection

Conclusion: Reactive arthritis is a rare MSK manifestations post COVID-19 infection. HLA-B27 positive testing might indicate severe and delayed form of arthritis with risk of recurrence. Larger studies are required to delineate the potential risk factors and long-term management outcomes for reactive arthritis associated with COVID-19 infection.

References: [1]Ono K, Kishimoto M, Shimasaki T, et al. Reactive arthritis after COVID-19 infection, RMD Open 2020;6:e001350. doi: 10.1136/rmdopen-2020-001350

Disclosure of Interests: None declared

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