Reactive arthritis after SARS-CoV-2 infection

Area of Science:

• Rheumatology
• Infectious Diseases
• Immunology

Background:

• SARS-CoV-2 (COVID-19) is increasingly recognized as a potential trigger for various forms of arthritis.
• New-onset arthritis post-COVID-19 presents heterogeneously, complicating diagnosis and distinguishing it from other arthritic conditions.
• While viral arthritis and crystal-induced arthritis have been reported, the capacity of SARS-CoV-2 to induce true reactive arthritis (ReA) remains unclear, especially given atypical features in some reported cases.

Observation:

• A 30-year-old patient developed acute arthritis in the MTP joint and ankle, along with synovitis and peritendinitis, seven days after resolving SARS-CoV-2 infection.
• Clinical presentation and diagnostic findings strongly suggested ReA.
• Standard screening for typical ReA-associated bacterial infections yielded negative results.

Findings:

• The patient exhibited typical clinical and genetic characteristics of ReA, despite the absence of common bacterial triggers.
• The absence of HLA-B27, a common genetic marker for ReA, in this patient aligns with some post-viral ReA presentations.
• The patient responded well to non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids, achieving a symptom-free status post-treatment.

Implications:

• This case provides strong evidence supporting a direct association between SARS-CoV-2 infection and the development of true reactive arthritis.
• The findings challenge the notion that respiratory infections rarely cause ReA and highlight the need to consider COVID-19 as a potential trigger.
• Further research is warranted to elucidate the precise mechanisms by which SARS-CoV-2 may induce ReA and to inform clinical diagnostic and management strategies.