Ciaffi Jacopo, Meliconi Riccardo, Ruscitti Piero, Berardicurti Onorina, Giacomelli Roberto, Ursini Francesco
Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), via Pupilli 1, 40136 Bologna, Italy.
Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Rheumatology, University of Bologna, Bologna, Italy.
BMC Rheumatol. 2020 Oct 28;4:65. doi: 10.1186/s41927-020-00165-0. eCollection 2020.
Different proportions of musculoskeletal or autoimmune manifestations associated with COVID-19 have been reported in literature. We performed a systematic review and meta-analysis with the aim of assessing the prevalence of rheumatic manifestations in patients affected by COVID-19, as initial symptom or during disease course.
A database search was run on May 18th, 2020, using two distinct strategies. We were interested in the percentage of symptoms of potential rheumatologic interest observed in large population studies of COVID-19 cases, and in identifying uncommon autoimmune disorders described in patients with COVID-19. For manifestations individually reported, a meta-analysis was performed taking into consideration the proportion of COVID-19 patients presenting the symptom.
Eighty eight original articles were included in the systematic review and 51 in the meta-analysis. We found pooled estimates of 19% for muscle pain and 32% for fatigue as initial symptom of COVID-19 presentation and, respectively, of 16 and 36% during the disease course. Only one article discussed arthralgia as unique symptom. Additionally, we found that vasculitis, chilblains, presence of autoantibodies commonly found in patients with rheumatic diseases, or autoimmune haematological and neurological disorders have all been reported in patients with COVID-19.
In conclusion, our review and meta-analysis emphasises that symptoms potentially leading to rheumatologic referral are common in patients with COVID-19. Therefore, COVID-19 is a new differential diagnosis to bear in mind when evaluating patients with musculoskeletal symptoms and rheumatologists might play a crucial role in identifying COVID-19 cases in early phases of the illness.
文献报道了与新冠病毒病（COVID-19）相关的不同比例的肌肉骨骼或自身免疫表现。我们进行了一项系统评价和荟萃分析，旨在评估COVID-19患者作为初始症状或在病程中出现的风湿性表现的患病率。
2020年5月18日采用两种不同策略进行数据库检索。我们关注在COVID-19病例的大型人群研究中观察到的潜在风湿性相关症状的百分比，以及识别COVID-19患者中描述的罕见自身免疫性疾病。对于单独报告的表现，进行荟萃分析时考虑出现该症状的COVID-19患者的比例。
系统评价纳入了88篇原始文章，荟萃分析纳入了51篇。我们发现，作为COVID-19初始症状，肌肉疼痛的合并估计患病率为19%，疲劳为32%；在病程中，肌肉疼痛和疲劳的患病率分别为16%和36%。只有一篇文章将关节痛作为唯一症状进行了讨论。此外，我们发现血管炎、冻疮、风湿性疾病患者中常见的自身抗体的存在，或自身免疫性血液和神经系统疾病在COVID-19患者中均有报道。
总之，我们的综述和荟萃分析强调，可能导致风湿科转诊的症状在COVID-19患者中很常见。因此，在评估有肌肉骨骼症状的患者时，COVID-19是一个需要牢记的新的鉴别诊断，风湿科医生在疾病早期识别COVID-19病例中可能发挥关键作用。
