Department of Clinical Pathology/Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Internal Medicine/Rheumatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Eur Cytokine Netw. 2021 Dec 1;32(4):83-88. doi: 10.1684/ecn.2021.0471.
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.
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.
在患有 2019 年冠状病毒病（COVID-19）的患者中，已经描述了各种肌肉骨骼和自身免疫表现。目的：本研究旨在调查埃及 COVID-19 后患者关节炎的患病率和病因。方法：我们纳入了 100 名在 6 个月前康复的埃及 COVID-19 后患者，并评估了几种炎症和自身免疫标志物。结果：COVID-19 后关节炎的患病率为 37%。踝关节、膝关节和腕关节是最常受累的关节。年龄较大（P=0.010）、吸烟（P=0.001）和关节痛（P=0.049）与 COVID-19 后关节炎有关。治疗前（基线）白细胞介素（IL）-6 水平（46.41±3.67 比 24.03±2.46；P=0.001）以及 COVID-19 后 6 个月的 C 反应蛋白（CRP；98.49±67.55 比 54.32±65.73；P=0.002）和红细胞沉降率（ESR；109.08±174.91 比 58.35±37.87；P=0.029）在关节炎患者中明显更高。另一方面，补体 C3（P=0.558）和 C4（P=0.192）、抗核抗体（P=0.709）和抗环瓜氨酸肽（抗-CCP；P=0.855）无显著差异。只有治疗前 IL-6 水平是 COVID-19 后关节炎的显著单一预测因子，优势比（95%置信区间）为 3.988（1.460-10.892），P 值为 0.007。结论：在本研究中，与炎症标志物（ESR 和 CRP）的强烈关联以及与自身免疫血清标志物（ANA 和抗-CCP）的无显著关联支持以下观点，即 COVID-19 后关节炎的潜在机制主要是由于 COVID-19 感染相关的过度炎症过程，而不是自身免疫反应的结果。治疗前的 IL-6 水平可以预测 COVID-19 后关节炎，从而进行早期管理。
