Diagnosis of COVID-19 associated arthritis in patients with or without underlying rheumatic and musculoskeletal disease supported by musculoskeletal ultrasound: a case series from three European centres

Objectives: The coronavirus disease 19 (COVID-19) pandemic concerns the field of rheumatology in many ways. Arthritis in conjunction with COVID-19 is increasingly reported. However, clinical data are still limited and there is lack of a detailed characterisation of COVID-19 associated arthritis by musculoskeletal ultrasound (MSUS). This case series reports different forms of COVID-19 associated arthritis supported by MSUS in patients with or without underlying rheumatic and musculoskeletal disease (RMD). Methods: From March 2020 to July 2021, adult patients (n=10) with arthritis timely related to COVID-19 were assessed in three European centres by clinical and laboratory values and additionally MSUS. Results: In the group without underlying RMD (n=6), two patients presented with polyarticular arthralgia during severe COVID-19, swelling was rarely seen and MSUS demonstrated arthritis only in a few joints affected. The other four patients showed arthritis four to 16 weeks after mild or moderate COVID-19 (without hospitalisation): polyarthritis (n=1), oligoarthritis of the upper and lower limb (n=2), and in one case, late-onset rheumatoid arthritis (LORA) was newly diagnosed. In the group with an underlying RMD (n=4), an increase of disease activity was reported by MSUS during mild and mild-moderate COVID-19. In general, MSUS often presented power Doppler (PD) positive synovitis and tenosynovitis. Conclusions: In our patients without underlying RMD, arthritides associated with COVID-19 are comparable to the clinical picture of a reactive arthritis (ReA) or other virus-related arthritides (e.g. parvovirus B19). New onset or flares of RMD possibly triggered by COVID-19 are noteworthy.