Long COVID from rheumatology perspective — a narrative review, 2021, Sapkota & Nune

Abstract
Long-term sequel of acute COVID-19, commonly referred to as long COVID, has affected millions of patients worldwide. Long COVID patients display persistent or relapsing and remitting symptoms that include fatigue, breathlessness, cough, myalgia, arthralgia, sleep disturbance, cognitive impairment and skin rashes. Due to the shared clinical features, laboratory and imaging findings, long COVID could mimic rheumatic disease posing a diagnostic challenge. Our comprehensive literature review will help rheumatologist to be aware of long COVID manifestations and differentiating features from rheumatic diseases to ensure a timely and correct diagnosis is reached.

Introduction
Post-viral sequelae are reported following many bacterial and viral infections. Hickie et al. described that 12% of patients presented with disabling fatigue, musculoskeletal pain, cognitive difficulties and mood disturbance 6 months after the diagnosis of a viral illness [1]. Reactive arthritis following gastrointestinal infections and sexually transmitted diseases (STD) is a well-known phenomenon. Patients recovering from acute-COVID-19 have also demonstrated a range of symptoms that have lasted for several months after recovery. This has been widely known as “long COVID”. Many studies have evaluated long COVID symptoms in hospitalised patients, which inevitably meant that only the more severe end of the spectrum was included.

An estimated incidence of long COVID following acute COVID-19 has been reported to be up to 30% [2]. As per the Office for National Statistics (ONS), 1.5 million people living in private households were experiencing self-reported long COVID symptoms as of 1 August 2021, in the UK alone [3]. Of these, 384,000 had or were suspected of having COVID-19 a year ago. This is defined as symptoms persisting for more than 4 weeks after the first suspected acute COVID-19 that cannot be attributed to an alternative diagnosis [3]. As of the same date, there had been 5.9 million confirmed cases of COVID-19 in the UK. Community cases were also not accounted for due to the lack of widespread testing during the first wave of the pandemic [4]. Along with the rising incidence of acute COVID-19 cases, the proportion of patients with long COVID will inevitably increase. Collectively, this highlights the extent of the burden that long COVID has posed to the current healthcare system in the UK and across the globe.

The most commonly reported long COVID symptoms include breathlessness, cough, fatigue, arthralgia, sleep disturbance and myalgia. Systemic autoimmune rheumatic diseases (SARDs), including rheumatoid arthritis (RA), connective tissue disease (CTD), idiopathic inflammatory myositis (IIM) and fibromyalgia (FM) and chronic fatigue syndrome (CFS), share similar symptoms with long COVID. Patients with a history of rheumatic diseases and a previous diagnosis of COVID-19 who have developed persistent joint or muscle symptoms pose a significant challenge to clinicians. Such patients may be experiencing long COVID or a flare-up of their pre-existing rheumatic disease.

This article provides a comprehensive literature review of long COVID symptoms and highlights the differentiating features between long COVID and SARD. We also provided an easy-to-follow management algorithm when facing a patient with shared clinical features.

Open access full text
https://link.springer.com/article/10.1007/s10067-021-06001-1

 

Hmmmmmm. (X) Doubt.