key: cord-0887882-ifjszwfr
authors: Jovani, Vega; Pascual, Eliseo; Vela, Paloma; Andrés, Mariano
title: Acute arthritis following SARS‐CoV‐2 infection
date: 2020-08-18
journal: J Med Virol
DOI: 10.1002/jmv.26440
sha: 4e1b79cba934650b19d6c7ebaadd42bff0491d94
doc_id: 887882
cord_uid: ifjszwfr

We have read with interest the article by Saricaoglu EM et al (1) published in the recent issue of the Journal of Medical Virology. The authors diagnosed reactive arthritis in a 73 year old male patient after debut of polyarthritis in feet eight days after finishing treatment for COVID‐19. Although viral‐associated arthritis or a reactive arthritis should be considered in differential diagnosis, they do not describe if synovial fluid was analysed. This article is protected by copyright. All rights reserved.

Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of the present letter.

We have read with interest the article by Saricaoglu EM et al 1 published in the recent issue of the Journal of Medical Virology. The authors diagnosed reactive arthritis in a 73 year old male patient after debut of polyarthritis in feet eight days after finishing treatment for COVID-19. Although viral-associated arthritis or a reactive arthritis should be considered in differential diagnosis, they do not describe if synovial fluid was analysed. Some recent studies have described acute arthritis following SARS-CoV-2 infection [2] [3] [4] . Differential diagnosis should be made among viral arthritis, crystalassociated arthritis, septic arthritis, or recent onset of any inflammatory rheumatic disease. Synovial fluid examination is essential to approach the diagnosis.

Crystal-associated arthritis, such as gout or pseudogout are common in hospitalised patients for infections or other diseases 5 . We described our experience of acute arthritis during COVID-19 admission in four patients 2 . 306 patients with proven COVID-19 were admitted in our hospital. Eighty-one (26.4%) complained of muscle and joint pain at presentation. No patient had evident arthritis at admission, but four (1.3%) developed acute arthritis during hospitalisation all due to crystalproven flares (gout and calcium pyrophosphate disease). Days from first COVID-19 symptom to acute arthritis onset were respectively 8, 19, 8, and 27. The synovial fluid analysis allowed definitive diagnoses. Normal radiographies and normal uric acid do not exclude crystal-associated arthritis since radiographies are normal in most gout patients and serum uric acid descends during the gout flares due to raised urate renal clearance 6 . Sensitivity of the feet radiographies for CPP arthritis in the affected joints has not been evaluated.

In the patient described by Saricaoglu EM 1 , we noticed pathological nails that could correspond to psoriatic nails and if so, the arthritis could also be the onset of psoriatic arthritis. The diagnosis of reactive arthritis without a complete study and without a long follow up it is inaccurate.

It is necessary to follow-up patients with SARS-CoV-2 who developed new onset of arthritis but we want to insist that it remains essential to check synovial fluid in every arthritis by polarised microscopy, -especially in recent or acute arthritiseven during the SARS-CoV-2 pandemic.

The first reactive arthritis case associated with COVID-19

Case series of acute arthritis during COVID-19 admission

Comparative analysis of synovial inflammation after SARS-CoV-2 infection

Case of acute arthritis following SARSCoV-2 infection

Hospitalization Increases the Risk of Acute Arthritic Flares in Gout: A Population-based Study over 2 Decades

Serum uric acid in acute gout