Post-COVID syndrome: rheumatological aspects

DOI: https://doi.org/10.29296/25877305-2023-07-01
Issue: 
7
Year: 
2023

Professor G. Bagirova, MD; Professor L. Kozlova, MD
Orenburg State Medical University, Ministry of Health of Russia

The paper summarizes literature data on the rheumatological manifestations of the novel coronavirus infection, mainly within the post-COVID syndrome (PCS). Patients after COVID-19 may be observed to have symptoms of rheumatic diseases; those with already existing rheumatological diseases may frequently have an exacerbation of their course in the PCS period. These patients should be referred to a rheumatologist for advice to expand a differential diagnostic search to make a final diagnosis and to prescribe adequate pathogenetic therapy. The authors describe a clinical case from their own practice.

Keywords: 
infectious diseases
COVID-19
post-COVID syndrome
rheumatic diseases
tactics of patient management and treatment.



References: 
  1. Особенности течения Long-COVID инфекции. Терапевтические и реабилитационные мероприятия. Методические рекомендации [Osobennosti techeniya Long-COVID infektsii. Terapevticheskie i reabilitatsionnye meropriyatiya. Metodicheskie rekomendatsii (in Russ.)]. URL: https://www.rnmot.ru/public/uploads/2022/rnmot/МЕТОДИЧЕСКИЕ%20РЕКОМЕНДАЦИИ%20LONG%20COVID.pdf
  2. Каратеев А.Е., Амирджанова В.Н., Насонов Е.Л. и др. «Постковидный синдром»: в центре внимания скелетно-мышечная боль. Научно-практическая ревматология. 2021; 59 (3): 255–62 [Karateev A.E., Amirdzhanova V.N., Nasonov E.L. et al. “Post-COVID syndrome”: The focus is on musculoskeletal pain. Rheumatology Science and Practice. 2021; 59 (3): 255–62 (in Russ.)]. DOI: 10.47360/1995-4484-2021-255-262
  3. COVID-19 rapid guideline: vanaging the longterm effects of COVID-19. 2021. URL: https://www.nice.org.uk/guidance/ng188
  4. WHO-2019-nCoV-Post COVID-19 condition – Clinical case definition-2021.1. URL: https://www.who.int/publications/i/item
  5. Рекомендации по ведению больных с коронавирусной инфекцией COVID-19 в острой фазе и при постковидном синдроме в амбулаторных условиях. Под ред. П.А. Воробьева. Проблемы стандартизации в здравоохранении. 2021; 7-8: 3–96 [Recommendations for management of patients with COVID-19 coronavirus infection in the acute phase and in the post-coVID syndrome in outpatient settings. Edited by P.A. Vorobyov. Health Care Standardization Problems. 2021; 7-8: 3–96 (in Russ.)]. DOI: 10.26347/1607-2502202107-08003-096
  6. Зайратьянц О.В., Малявин А.Г., Самсонова М.В. и др. Патоморфологические изменения в легких при COVID-19: клинические и терапевтические параллели. Терапия. 2020; 5: 35–46 [Zayratyants O.V., Malyavin A.G., Samsonova M.V. et al. Pathomorphological changes in lungs in case of COVID-19: clinical and therapeutic parallels. Therapy. 2020; 5: 35–46 (in Russ.)]. DOI: 10.18565/therapy.2020.5.35-46
  7. Javed A. Neurological associations of SARS-CoV-2 infection: A systematic review. CNS Neurol Disord Drug Targets. 2022; 21 (3): 246–58. DOI: 10.2174/1871527320666210216121211
  8. Bandeira I.P., Schlindwein M.A.M., Breis L.C. et al. Neurological complications of the COVID-19 pandemic: What have we got so far? Adv Exp Med Biol. 2021; 1321: 21–31. DOI: 10.1007/978-3-030-59261-5_2
  9. Mohanty A., Kabi A., Mohanty A.P. et al. Laboratory diagnosis of COVID-19 infection: Issues and Challenges: An Indian Perspective. Journal of Advances in Medicine and Medical Research. 2020; 32 (14): 10–7. DOI: 10.9734/jammr/2020/v32i1430559
  10. Mohanty A., Kabi A., Kumar S. et al. Role of rapid antigen test in the diagnosis of COVID-19 in India. Journal of Advances in Medicine and Medical Research. 2020; 32 (18): 77–80. DOI: 10.9734/jammr/2020/v32i1830657
  11. Nalbandian A., Sehgal K., Gupta A. et al. Post-acute COVID-19 syndrome. Nat Med. 2021; 27 (4): 601–15. DOI: 10.1038/s41591-021-01283-z
  12. Fang Z., Zhang Y., Hang C. et al. Comparisons of viral shedding time of SARS-CoV-2 of different samples in ICU and non-ICU patients. J Infect. 2020; 81 (1): 147–78. DOI: 10.1016/j.jinf.2020.03.013
  13. Liu Y., Yan L.-M., Wan L. et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis. 2020; 20 (6): 656–7. DOI: 10.1016/S1473-3099(20)30232-2
  14. Сайганов С.А., Мазуров В.И., Бакулин И.Г. и др. Клиническое течение, эффективность терапии и исходы новой коронавирусной инфекции: предварительный анализ. Вестник Северо-Западного государственного медицинского университета им. И.И. Мечникова. 2020; 12 (2): 27–38 [Sayganov S.A., Mazurov V.I., Bakulin I.G. et al. Current, effectiveness of therapy and outcomes of new coronavirus infection: preliminary analysis. HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020; 12 (2): 27–38 (in Russ.)]. DOI: 10.17816/mechnikov202012227-38
  15. Мазуров В.И., Гайдукова И.З., Бакулин И.Г. и др. Особенности течения и факторы неблагоприятного прогноза коронавирусной инфекции COVID-19 у пациентов с иммуновоспалительными заболеваниями. РМЖ. 2020; 11: 4–8 [Mazurov V.I., Gaidukova I.Z., Mazurov I.G. et al. Patterns of COVID-19 infection course and factors of adverse prognosis in patients with immune-mediated inflammatory disease. RMJ. 2020; 11: 4–8 (in Russ.)].
  16. Ткаченко О.Ю., Первакова М.Ю., Лапин С.В. и др. Прогностическая роль исследования цитокинов при COVID-19 ассоциированной пневмонии. Вестник Северо-Западного государственного медицинского университета им. И.И. Мечникова. 2021; 13 (1): 59–69 [Tkachenko O.Y., Pervakova M.Y., Lapin S.V. et al. Prognostic value of cytokines in COVID-19 associated pneumonia. HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021; 13 (1): 59–69 (in Russ.)]. DOI: 10.17816/mechnikov61610
  17. Мазуров В.И., Беляева И.Б., Саранцева Л.Е. Рациональная фармакотерапия коморбидных пациентов с заболеваниями опорно-двигательного аппарата в условиях пандемии COVID-19. Эффективная фармакотерапия. 2021; 17 (21): 40–6 [Belyaeva I.B., Mazurov V.I., Sarantseva L.Ye. Rational pharmacotherapy of comorbid patients with musculosceletal system diseases in the conditions of COVID-19 pandemic. Effektivnaya farmakoteriya. 2021; 17 (21): 40–6 (in Russ.)]. DOI 10.33978/2307-3586-2021-17-21-40-46
  18. Беляева И.Б., Мазуров В.И., Саранцева Л.Е., Трофимов Е.А. Особенности ведения и вакцинации пациентов с ревматическими заболеваниями в условиях пандемии новой коронавирусной инфекции Эффективная фармакотерапия. 2021; 17 (36): 28–33 [Belyayeva I.B., Mazurov V.I., Sarantseva L.Ye. et al. Features of management and vaccination of comorbid patients with rheumatic diseases in a pandemic of a new coronavirus infection. Effektivnaya farmakoteriya. 2021; 17 (36): 28–33 (in Russ.)]. DOI: 10.33978/2307-3586-2021-17-36-28-33
  19. Мазуров В.И., Беляева И.Б., Саранцева Л.Е. и др. Влияние новой коронавирусной инфекции на клиническое течение иммуновоспалительных ревматических заболеваний. Вестник Северо-Западного государственного медицинского университета им. И.И. Мечникова. 2021; 13 (2): 39–47 [Mazurov V.I., Belyaeva I.B., Sarantseva L.E. et al. Impact of a new coronavirus infection on the clinical course of immunoinflammatory rheumatic diseases. HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021; 13 (2): 39–47 (in Russ.)]. DOI: 10.17816/mechnikov72269
  20. Ehrenfeld M., Tincani A., Andreoli L. et al. Covid-19 and autoimmunity. Autoimmun Rev. 2020; 19 (8): 102597. DOI: 10.1016/j.autrev.2020.102597
  21. Dotan A., Muller S., Kanduc D. et al. SARS-CoV-2 as an instrumental trigger of autoimmunity. Autoimmun Rev. 2021; 20 (4): 102792. DOI: 10.1016/j.autrev.2021.102792
  22. Parisi S., Borrelli R., Bianchi S. et al. Viral arthritis and COVID-19. Lancet Rheumatol. 2020; 2 (11): 655–7. DOI: 10.1016/S2665-9913(20)30348-9
  23. Gasparotto M., Framba V., Piovella C. et al. Post-COVID-19 arthritis: A case report and literature review. Clin Rheumatol. 2021; 40 (8): 3357–62. DOI: 10.1007/s10067-020-05550-1
  24. Насонов Е.Л. Коронавирусная болезнь 2019 (COVID-19) и аутоиммунитет. Научно-практическая ревматология. 2021; 59 (1): 5–30 [Nasonov E.L. Coronavirus disease 2019 (COVID-19) and autoimmunity. Rheumatology Science and Practice. 2021; 59 (1): 5–30 (in Russ.)]. DOI: 10.47360/1995-4484-2021-5-30
  25. Oronsky B., Larson C., Hammond T.C. et al. A review of persistent post-COVID syndrome (PPCS). Clin Rev Allergy Immunol. 2021; 20: 1–9. DOI: 10.1007/ s12016-021-08848-3
  26. Weatherhead J.E., Clark E., Vogel T.P. et al. Inflammatory syndromes associated with SARSCoV-2 infection: dysregulation of the immune response across the age spectrum. J Clin Invest. 2020; 130 (12): 6194–7. DOI: 10.1172/JCI145301
  27. Mohabbat A.B., Mohabbat N.M.L., Wight E.C. Fibromyalgia and chronic fatigue syndrome inthe age of COVID-19. Mayo Clin Proc Innov Qual Outcomes. 2020; 4 (6): 764–6. DOI: 10.1016/j.mayocpiqo.2020.08.002
  28. Komaroff A.L., Bateman L. Will COVID-19 lead to myalgic encephalomyelitis/chronic fatigue syndrome? Front Med (Lausanne). 2021; 7: 606824. DOI: 10.3389/fmed.2020.606824
  29. Walitt B., Bartrum E. A clinical primer for the expected and potential post-COVID-19 syndromes. Pain Rep. 2021; 6 (1): 887. DOI: 10.1097/PR9.0000000000000887
  30. Marinangeli F., Giarratano A., Petrini F. Chronic pain and COVID-19: Pathophysiological, clinical and organizational issues. Minerva Anestesiol. 2021; 87 (7): 828–32. DOI: 10.23736/S0375-9393.20.15029-6
  31. Ciaffi J., Meliconi R., Ruscitti P. et al. Rheumatic manifestations of COVID-19: a systematic review and meta-analysis. BMC Rheumatol. 2020; 4: 65. DOI: 10.1186/s41927-020-00165-0
  32. Ramani S.L., Samet J., Franz C.K. et al. Musculoskeletal involvement of COVID-19: review of imaging. Skeletal Radiol. 2021; 50 (9): 1763–73. DOI: 10.1007/s00256-021-03734-7
  33. Marks M., Marks J.L. Viral arthritis. Clin Med. 2016; 16 (2): 129–34. DOI: 10.7861/clinmedicine.16-2-129
  34. Schett G., Manger B., Simon D. et al. COVID-19 revisiting inflammatory pathways of arthritis. Nat Rev Rheumatol. 2020; 16 (8): 465–70. DOI: 10.1038/s41584-020-0451-z
  35. Clinical management of COVID-19 patients: living guidance, 25 January 2021, World Health Organization.
  36. Баймухамедов Ч.Т., Ботабекова А.К., Досыбаева Г.Н., и др. Ревматоидный артрит и постковидный синдром. Научно-практическая ревматология. 2022; 60 (3): 276–9 [Baimukhamedov C.T., Botabekova A.K., Dossybayeva G.N. et al. Rheumatoid arthritis and post-COVID-19 syndrome. Rheumatology Science and Practice. 2022; 60 (3): 276–9 (in Russ.)]. DOI: 10.47360/1995-4484-2022-276-279
  37. Белов Б.С., Муравьева Н.В., Тарасова Г.М. COVID-19: ревматологические аспекты. Эффективная фармакотерапия. 2020; 16 (16): 18–25 [Belov B.S., Muravyova N.V., Tarasova G.M. COVID-19: rheumatological aspects. Effektivnaya farmakoteriya. 2020; 16 (16): 18–25 (in Russ.)]. DOI: 10.33978/2307-3586-2020-16-16-18-25
  38. Ceravolo M.G., Aryenti S., de Cyr A. et al. International Multidisciplinary Steering Committee of the Cochrane Rehabilitation Program. Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living systematic196 review. Eur J Phys Rehabil Med. 2020; 56 (5): 642–51. DOI: 10.23736/S1973-9087.20.06501
  39. Xu X., Chen P., Wang J. et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci. 2020; 63 (3): 457–60. DOI: 10.1007/s11427-020-1637-5
  40. Mehta P., McAuley D.F., Brown M. et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020; 395 (10229): 1033–4. DOI: 10.1016/S0140-6736(20)30628-0
  41. Liu T., Zhang J., Yang Y. et al. The potential role of IL-6 in monitoring severe case of coronavirus disease 2019. MedRxiv. 2020; 12 (7): 12421. doi: 10.1101/2020.03.01.20029769
  42. Гриневич В.Б., Лазебник Л.Б., Кравчук Ю.А. и др. Поражения органов пищеварения при постковидном синдроме. Клинические рекомендации. Экспериментальная и клиническая гастроэнтерология. 2022; 208 (12): 4–68 [Grinevich V.B., Lazebnik L.B., Kravchuk Yu.A. et al. Gastrointestinal disorders in post-COVID syndrome. Clinical guidelines. Experimental and Clinical Gastroenterology. 2022; 208 (12): 4–68 (in Russ.)]. DOI: 10.31146/1682-8658-ecg-208-12-4-68
  43. Поляев Б.А. Практическое руководство по детским болезням. Восстановительное лечение в педиатрии. Под ред. Б.А. Поляева, О.А. Лайшевой. М.: Медпрактика-М, 2008; 492 с. [Polyayev B.A. A Practical Guide to Childhood Illnesses. Restorative treatment in pediatrics. Ed. by B.A. Polyayev, O.A. Laisheva. Moscow: Medpraktika-M, 2008; 492 p. (in Russ.)]. URL: https://www.books-up.ru/ru/book/prakticheskoe-rukovodstvo-po-detskim-boleznyam-t-10-vosstanovitelnoe-lechenie-v-pediatrii-3647681/
  44. Hsu T.Y.-T., D’Silv K.D., Patel N.J. et al. Laboratory trends, hyperinflammation, and clinical outcomes for patients with a systemic rheumatic disease admitted to hospital for COVID-19: a retrospective, comparative cohort study. Lancet Rheumatol. 2021; 3 (9): 638–47. DOI: 10.1016/S2665-9913(21)00140-5
  45. Дедов Д.В. Новая коронавирусная инфекция: клинико-патогенетические аспекты, профилактика, значение витаминов и микроэлементов. Врач. 2022; 33 (2): 47–9 [Dedov D.V. New coronavirus infection: clinical and pathogenetic aspects, prevention, importance of vitamins and trace elements. Vrach. 2022; 33 (2): 47–9 (in Russ.)]. DOI: 10.29296/25877305-2022-02-07
  46. Каратеев А.Е., Насонов Е.Л., Лила А.М. Вызывают ли нестероидные противовоспалительные препараты специфические осложнения при коронавирусной инфекции COVID-19? Научно-практическая ревматология. 2020; 58 (3): 340–3 [Karateev A.E., Nasonov E.L., Lila A.M. Do nsaids cause specific complications in COVID-19 coronavirus infection? Rheumatology Science and Practice. 2020; 58 (3): 340–3 (in Russ.)]. DOI: 10.14412/1995-4484-2020-340-343
  47. Isaacs J.D., Burmester G.R. Smart battles: immunosuppression versus immunomodulation in the inflammatory RMDs. Ann Rheum Dis. 2020; 79 (8): 991–3. DOI: 10.1136/annrheumdis-2020-218019
  48. Насонов Е.Л., Лила А.М., Мазуров В.И. и др. Коронавирусная болезнь 2019 (COVID-19) и иммуновоспалительные ревматические заболевания. Рекомендации Общероссийской общественной организации «Ассоциация ревматологов России». Научно-практическая ревматология. 2021; 59 (3): 239–54 [Nasonov E.L., Lila A.M., Mazurov V.I. et al. Coronavirus Disease 2019 (COVID-19) and Immune-mediated Rheumatic Diseases. Recommendations of the Association of Rheumatologists of Russia. Rheumatology Science and Practice. 2021; 59 (3): 239–54 (in Russ.)]. DOI: 10.47360/1995-4484-2021-239-254
  49. Аронова Е.С., Белов Б.С., Гриднева Г.И. Ревматологические маски постковидного синдрома. Эффективная фармакотерапия. 2022; 18 (8): 42–7 [Aronova E.S., Belov B.S., Gridneva G.I. Rheumatological masks of post-COVID syndrome. Effektivnaya farmakoteriya. 2022; 18 (8): 42–7 (in Russ.)]. DOI: 10.33978/2307-3586-2022-18-8-42-46