Diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may accelerate the onset of autoimmune rheumatic diseases, according to a case report published in Lancet Rheumatology.
Previous research has described the potential association between SARS-CoV-2 infections and rheumatic diseases. Studies have also shown that severe cases of coronavirus disease 2019 (COVID-19) may be associated with a hyperinflammatory response, which could lead to the development of the cytokine storm syndrome. There are also reports of a multisystemic inflammatory disease and atypical Kawasaki disease in patients with COVID-19.
Authors of this case report described a previously healthy man, aged 45 years, with a family history of ankylosing spondylitis. On March 2020, the patient developed acute symmetric polyarthritis of the metacarpophalangeal and proximal interphalangeal joints of the hands, associated with diffuse myalgia, followed by anosmia and dysgeusia. The patient was tested positive for SARS-CoV-2, using nasopharyngeal and oropharyhgeal swabs. His wife developed respiratory symptoms and also tested positive for SARS-CoV-2 infection.
After 3 weeks, the patient had partial remission of arthritis and myalgia, along with complete remission of anosmia and dysgeusia. Repeat testing for SARS-CoV-2 showed negative results. However, several weeks later, the patient had a worsening of inflammatory arthritis and myalgia. Rheumatology evaluation with an ultrasound examination of the involved joints of the hands revealed a slight effusion of the right wrist and bilateral effusion of the fifth proximal interphalangeal joint, with no synovial hyperplasia or power Doppler signal.
Blood tests indicated elevated creatine phosphokinase (279 U/L) and moderately increased erythrocyte sedimentation rate (13 mm/h) with normal C-reactive protein levels (1.6 mg/L). In addition, testing for rheumatoid factor showed negative results and that for anticyclic citrullinated peptide was found to be positive. Echocardiogram showed moderate pericardial effusion.
Shortly after methylprednisolone was administered, the patient reported complete remission of articular symptoms and significant improvement of myalgia. However, shortly after suspending corticosteroid treatment, the patient reported a slight exacerbation of arthralgia. According to the authors, the arthralgia and myalgia in this case may be secondary to reactive arthritis or part of a chronic inflammatory process.
“[W]hat seems to be crucial is the need for further investigations on the specific mechanisms underlying the virus interaction with the immune system, especially regarding the potential association between the SARS-CoV-2 infection and systemic autoimmune diseases,” they concluded.
Talarico R, Stagnaro C, Ferro F, Carli L, Mosca M. Symmetric peripheral polyarthritis developed during SARS-CoV-2 infection. Lancet Rheumatol. Published online July 13, 2020. doi:10.1016/S2665-9913(20)30216-2