A clinical scenario often encountered at the Chicago Arthritis involves patients presenting with joint pain and swelling, mentioning a COVID infection three to four months prior. Recently, a young woman described finger and toe stiffness and wondered if her previous COVID infection could be related to her current symptoms. So, what’s going on here?
Post-Viral Arthritis or Reactive Arthritis
In rheumatology, there’s a concept of post-viral arthritis or reactive arthritis, where the immune system, which protects against bacteria and viruses, continues to stay active even after the infection has resolved. This can lead to inflammation in the joints due to accidental attacks on cells with similar genetic or protein expressions to those of the virus. This phenomenon can occur weeks after the infection and last for a few weeks or months.
Persistent Viral Infection
Another possibility is a persistent viral infection, where a small amount of the virus remains in the body, keeping the immune system hypervigilant and causing inflammation, possibly in the joints. This concept is often associated with long COVID, where the immune system remains active due to the lingering virus, causing joint inflammation.
Coincidental Inflammatory Arthritis
A third scenario is that the COVID infection might be coincidental, and the patient could be developing inflammatory arthritis independently. Conditions like rheumatoid arthritis, which affects about 1% of the population, and psoriatic arthritis, occurring in 20% of psoriasis patients, are examples. Other conditions like gout, lupus, and various autoimmune diseases could also be the cause.
Diagnosing the Difference
To diagnose the difference, it’s crucial to determine if there is truly inflammatory arthritis. This involves checking for objective signs of joint inflammation through physical examination, blood tests showing inflammation, or imaging like ultrasound or MRI. Sometimes, wear and tear arthritis like osteoarthritis or tendonitis can feel like inflammation but aren’t the same.
If inflammatory arthritis is suspected, additional antibodies should be checked, such as rheumatoid factor, CCP antibody, and possibly HLA B27 or other antibodies for conditions like lupus. If there are systemic symptoms indicating a persistent infection, checking for active COVID in the blood might be necessary. Other conditions like hypothyroidism, adrenal deficiency, low vitamin D, and B12 levels should also be ruled out.
Treatment Approaches
Treatment varies based on the diagnosis. For post-viral or reactive arthritis, which is usually self-limited, conservative care with anti-inflammatory medications, pain management, and possibly short-term steroids might be sufficient. If a chronic inflammatory condition like rheumatoid arthritis is diagnosed, disease-modifying treatments are necessary.
For long COVID without active infection, conservative management is recommended. If there’s evidence of an ongoing infection, treating that is crucial. Visiting a long COVID clinic could be beneficial for specialized care and management.
In conclusion, joint pain and swelling post-COVID can have multiple causes, including reactive arthritis, persistent COVID, or unrelated inflammatory arthritis. Proper diagnosis and treatment are key to improving symptoms and overall well-being.