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Rheumatic manifestations of COVID-19: a systematic review and meta-analysis
Jacopo Ciaffi1, Riccardo Meliconi1,2, Piero Ruscitti3
1Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), via Pupilli 1, 40136 Bologna, Italy.
Insights
Musculoskeletal and autoimmune symptoms are common in patients with COVID-19. Rheumatologists can help identify early COVID-19 cases presenting with these symptoms.
Area of Science:
- Rheumatology
- Infectious Diseases
- Epidemiology
Background:
- Literature reports varying proportions of musculoskeletal and autoimmune manifestations in COVID-19 patients.
- Systematic review and meta-analysis conducted to assess rheumatic manifestation prevalence in COVID-19.
Purpose of the Study:
- To determine the prevalence of rheumatic manifestations in patients with COVID-19.
- To identify uncommon autoimmune disorders associated with COVID-19.
Main Methods:
- Systematic review of 88 articles and meta-analysis of 51 articles.
- Database search conducted May 18th, 2020, focusing on rheumatologic symptoms and autoimmune disorders in COVID-19 cases.
- Meta-analysis calculated pooled estimates for reported manifestations.
Main Results:
- Pooled estimates: 19% muscle pain and 32% fatigue as initial COVID-19 symptoms; 16% muscle pain and 36% fatigue during disease course.
- Arthralgia reported as a unique symptom in only one article.
- Reported manifestations include vasculitis, chilblains, autoantibodies common in rheumatic diseases, and autoimmune neurological/hematological disorders.
Conclusions:
- Symptoms potentially requiring rheumatologic referral are common in COVID-19 patients.
- COVID-19 should be considered in differential diagnoses for patients with musculoskeletal symptoms.
- Rheumatologists play a key role in early COVID-19 identification.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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