Table 1

Clinical features and management of four patients with acute arthritis during COVID-19 admission

Patient1234
Age (years)/gender71/male61/male64/male45/male
Days from COVID-19 symptom onset to arthritis 8 19 8 27
Days from admission to arthritis 3 17 7 21
COVID-19 managementHydroxychloroquineHydroxychloroquine, azithromycin, tocilizumab, pulses of methylprednisoloneHydroxychloroquine, azithromycin, lopinavir–ritonavir, tocilizumabHydroxychloroquine, tocilizumab, pulses of methylprednisolone
Known inflammatory arthritisGout, on allopurinol 100 mg/dayGout, on allopurinol 100 mg/day (irregular)Previous recurrent arthritis, not studied or treatedCrystal-proven gout, on allopurinol 300 mg/day
Allopurinol stopped during admissionNoNoYes
Involved jointsFirst MTPAnkleBoth kneesKnee and ankle
SF characteristicsNDGlucose: 38 mg/dL
Leucocytes: 137 534/μL (95% PMN)
Glucose: 94 mg/dL
Leucocytes: 1362/μL (77% PMN)
Glucose: 38 mg/dL
Leucocytes: 39 065/μL (96% PMN)
Polarised light microscopyMSU crystalsMSU crystalsCPP crystalsMSU crystals
SF cultureNDNegativeNegativeNegative
SF RT-PCR for SARS-CoV-2NDNegativeNegativeNegative
Acute arthritis management
  • Intra-articular triamcinolone plus mepivacaine.

  • Colchicine.

  • Oral prednisone.

  • Colchicine.

  • Intra-articular triamcinolone plus mepivacaine.

  • Colchicine.

  • CPP, calcium pyrophosphate; MSU, monosodium urate; MTP, metatarsophalangeal; ND, not done (insufficient amount of fluid was obtained); PMN, polymorphonuclear; RT-PCR, reverse transcriptase PCR; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SF, synovial fluid.