COVID-19 and rheumatic diseases: A mini-review

Abstract

Joint pain and arthralgia can be manifestations of COVID-19, and studies evaluating long COVID symptoms identified the persistence of these disorders. Moreover, some case reports highlighted the development of new inflammatory arthritis in patients with COVID-19, suggesting a possible relation. Viral infections and rheumatic diseases share a documented relationship; they have been associated with genetic and environmental risk factors responsible for some of them. There is crosstalk between viruses and the immune system during the development of several rheumatic diseases. Moreover, infections may participate in the pathogenesis of autoimmune rheumatic diseases and contribute to patient mortality. Therefore, it is crucial to provide a clearer insight into the interaction between viral infections and rheumatic diseases. Here, we provide a mini-review of the current literature with the aim of shedding light on the relationship between COVID-19 and rheumatic or musculoskeletal diseases, which is still unclear. Specifically, we examined several aspects: risk for the rheumatic population of acquiring the virus or developing severe symptoms, similarities of COVID-19 and arthritis, the possible rheumatic consequence of COVID-19, of rheumatic drugs and vaccines, and COVID-19 prevention in rheumatic patients through vaccination.

Keywords: COVID-19; infection; inflammation; musculoskeletal pain; reactive arthritis; rheumatic diseases.

Figure 1

Schematic representation of COVID-19 immune patterns. In the left-upper part of the scheme, SARS-CoV-2 enters the host's cells through the ACE-2 specific receptor and triggering several patterns. Clockwise from the left they are: T cell activation through a high expression of CD69, CD38, and CD44, 0X40 and 4-1BB; lymphopenia including NK, CD4-T, CD8-T and B-cells; lymphocyte dysfunction including NK and T-cells; monocytes and granulocyte abnormalities (increased neutrophil levels, decreased eosinophil, basophil, and monocyte levels), increased amount of antibodies and cytokines.