Musculoskeletal pain in patients with COVID-19
Authors: Bogdanova Simona 
Published: August 2022

Introduction: The end of 2019 marked the beginning of a new disease for the mankind, which changed the lives of people all over the world. Almost 3 years have passed from the declaration of a global pandemic till today, but despite this, our knowledge of the disease COVID-19 caused by SARS CoV-2 is still the object of many researches. This is because the heterogeneous manifestation of the disease and the involvement of many organs and systems in the clinical presentation. The spectrum of rheumatological manifestations that directly concern the rheumatologist is also very miscellaneus. Most common are musculoskeletal pain phenomena as a rheumatic manifestation of the disease. Objectives: The purpose of the study is to assess the frequency and intensity of pain of musculoskeletal origin - joint (arthralgia) and muscle (myalgia) and its relationship with anxiety and depressive attitudes in hospitalized patients with COVID-19 in the Rheumatology Clinic - Varna. Material and methods: In a single-center, observational study, were included patients with diagnosed COVID-19, hospitalized in the Rheumatology Clinic, UMBAL "St. Marina" - Varna. The etiological diagnosis was accepted with a positive result of polymerase chain reaction (PCR) test or rapid antigen test for SARS-CoV-2. An inclusion criterion was new-onset musculoskeletal pain during the acute phase of COVID-19. Visual analogue scales (VAS) were used to assess pain intensity (muscular and joint) and Tsung self-report scales for depression (SDS) and anxiety (SAS). Laboratory acute inflammatory indicators and thrombotic biomarkers were investigated, chest imaging was performed in all patients. Descriptive statistics, Spearman Rho correlation analysis and SPSS linear regression analysis were used. A significance level of p<0.05 was accepted. Results: 226 patients (aged 26-91 years) with musculoskeletal pain were included. 46.5% (n=105) were women and 53.5% (n=121) were men. The mean age of the study population was 65.5 years (65.57 ± SD). A significant correlation (p=0.001) and predictive value was found between the score for depression and anxiety and the intensity of pain (for the two studied pain phenomena - arthralgias and myalgias). No correlation was found between pain intensity and inflammatory markers, nor with thrombogenic markers in patients with SARS-CoV-2. Of all examined patients with musculoskeletal pain, 46.5% (n=105) were women and 53.5% (n=121) were men. The average age of the study population was 65.5 years (65.57). After the correlation and regression analysis, a significant correlation (0.001) and predictive value was found between the score for depression and anxiety and the strength of pain (for the two studied pain phenomena - arthralgias and myalgias). On the other hand, in the studied patients, we found no correlation with either inflammation indicators or thrombogenic markers in the SARS-CoV-2 patients.mong all 226 COVID-19 patients with musculoskeletal pain, 46.5% (n =105) were women and 53.5% (n =121), were men. Mean age was 65 and a half years (65.57). After correlation and regression (ANOVA) analysis made we found strongly significant correlation (correlation is significant et the 0.001 level) and predictive value between depression and anxiety scales score from one side and pain intensity from other (both arthralgia and myalgia). On the other hand, musculoskeletal pain does not correlate with any of inflammation and thrombotic biomarkers assessed in SARS-CoV-2 patients. mong all 226 COVID-19 patients with musculoskeletal pain, 46.5% (n =105) were women and 53.5% (n =121), were men. Mean age was 65 and a half years (65.57). After correlation and regression (ANOVA) analysis made we found strongly significant correlation (correlation is significant et the 0.001 level) and predictive value between depression and anxiety scales score from one side and pain intensity from other (both arthralgia and myalgia). On the other hand, musculoskeletal pain does not correlate with any of inflammation and thrombotic biomarkers assessed in SARS-CoV-2 patients. Conclusion: Musculoskeletal pain is one of the most common clinical presentations of COVID-19. The intensity of the pain correlates with anxiety and depressive symptoms in these patients and does not correlate with the levels of inflammation and thrombotic biomarkers.