@Article{ecn.2021.0471,
AUTHOR = {Sara Ibrahim Taha, Sara Farid Samaan, Rehab Ali Ibrahim, Eman Mousa El-Sehsah, Mariam Karam Youssef},
TITLE = {Post-COVID-19 arthritis: is it hyperinflammation or autoimmunity?},
JOURNAL = {European Cytokine Network},
VOLUME = {32},
YEAR = {2021},
NUMBER = {4},
PAGES = {83--88},
URL = {http://www.techscience.com/ECN/v32n4/65056},
ISSN = {1952-4005},
ABSTRACT = {Background: Various musculoskeletal and autoimmune manifestations have been described in patients
with coronavirus disease 2019 (COVID-19). Objectives: This study aims to investigate the prevalence and etiology of
arthritis in post-COVID Egyptian patients. Methods: We included 100 post-COVID Egyptian patients who recovered
6 months ago and assessed several inflammatory and autoimmune markers. Results: The prevalence of post-COVID
arthritis was 37%. Ankle, knee, and wrist were the most commonly affected joints. Old age (P = 0.010), smoking
(P = 0.001), and arthralgia (P = 0.049) were all linked with post-COVID arthritis. Levels of pretreatment (baseline)
interleukin (IL)-6 (46.41  3.67 vs. 24.03  2.46; P = 0.001), as well as 6-month post-COVID C-reactive protein
(CRP; 98.49  67.55 vs. 54.32  65.73; P = 0.002), and erythrocyte sedimentation rate (ESR; 109.08  174.91 vs.
58.35  37.87; P = 0.029) were significantly higher in patients with arthritis compared to those without. On the other
hand, complement C3 (P = 0.558) and C4 (P = 0.192), anti-nuclear antibodies (P = 0.709), and anti-cyclic citrullinated
peptides (anti-CCP; P = 0.855) did not show significant differences. Only pretreatment IL-6 level was the significant
single predictor of post-COVID arthritis with an odds ratio (95% confidence interval) of 3.988 (1.460–10.892) and
a P-value of 0.007. Conclusion: The strong association observed with inflammatory markers (ESR and CRP) and the
insignificant association with serologic markers of autoimmunity (ANA and anti-CCP) in our study support the notion
that the underlying mechanism of post-COVID-19 arthritis is primarily due to the hyperinflammatory process
associated with COVID-19 infection, and not the result of an autoimmune reaction. IL-6 levels before therapy can
predict post-COVID arthritis allowing for early management.},
DOI = {10.1684/ecn.2021.0471}
}