AB0692 REACTIVE ARTHRITIS ASSOCIATED WITH COVID-19 INFECTION: A REVIEW
Authors: F. Alkindi, K. Alseiari, K. Al Naqbi
Journal: Annals of the Rheumatic Diseases (2021)

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 (&gt; 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 Clinical data of patients (n=11) Results (n=11 ) Age (mean ) 42.8 Years old Sex % Female (n= 5 [45.5%]) Male (n= 6 [54.5%]) Severity of COVID-19 infection Mild (n=6 [54.5%]) Moderate (n=3 [27.3%]) Severe (n= 2 [18%]) Prior history of rheumatologic disease (n=0) Time to onset of reactive arthritis (median ) 1 to 8 weeks Number of joints involved at time of diagnosis Monoarticular (n= 4[36.4%]) Oligoarticular (n= 5[45.5%]) Polyarticular (n= 2[18%]) Location of involved joints (upper vs. lower limbs ) Upper joints (18%) Lower joints (54.5%) Both (27.3%) Enthesitis (n= 1[9%]) Achilles Tendonitis (n= 2[18%]) (wrist / Achilles tendonitis) Extra-articular involvement (eyes, skin, GI, GU, others ) - Skin rash (n=2 [18%]) (erythematous itchy rash, urticarial rash) - GU: balanitis (n=1 [9%]) Inflammatory back pain (n=0) Avascular necrosis of bone (n= 1[9%]) HLA-B27 (n= 1[9%]), (n = 5 tested) Autoimmune workup Negative Treatment of reactive arthritis: DMARDs (n=0) NSAIDs (n=4 [36.4%]) Steroids (n=1 [9%]) NSAIDs and steroids (n= 3[27.3%]) Not provided (n=2), others (n=1) Outcomes of MSK symptoms Improvement (n=11 [100%]) Follow up period (Median, weeks ) 1.5 to 8 weeks Gastrointestinal (GI), genitourinary (GU), NSAIDs: non-steroidal anti-inflammatory drug 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