After COVID, patients often experience residual symptoms, including joint and muscle pain. If symptoms occur within 3 months of the onset of the disease, persist for more than 2 months, and cannot be explained by an alternative diagnosis, doctors diagnose post-COVID syndrome. If patients suffer from joint pain for less than 2 months, this is not yet post-COVID syndrome, but a period of convalescence (health recovery), typical for any severe infectious diseases. To reduce symptoms, rule out dangerous diagnoses, and restore joints after COVID, contact Dr. Glazkov’s Clinic.
Complications after coronavirus
We are an orthopedic clinic, so we will not discuss COVID complications related to the lungs, heart and other organs, but will focus exclusively on the musculoskeletal system.
Among the most severe complications after COVID that orthopedists face is post-COVID aseptic bone necrosis. This is the death of subchondral (under the cartilage) bone. The hip joint is most often affected. The outcome of this complication is deforming osteoarthrosis. Many patients need endoprosthetics.
Causes of aseptic necrosis during or after COVID:
- systemic inflammation;
- activation of cytokines that suppress the division and maturation of bone cells;
- vasculitis (inflammation of blood vessels);
- hypercoagulation state (increased blood clotting);
- vascular thrombosis;
- deterioration of bone metabolism under the influence of corticosteroids.
The mechanism of development of aseptic necrosis is a significant deterioration of blood supply. The risk of pathology is significantly higher in patients who were treated with high doses of steroids.
According to various authors, the risk of aseptic necrosis in severe cases of coronavirus infection is 5-58%. Although the femoral head is usually affected, necrotic changes may also develop in other bones of the arms and legs: the condyles of the femur and tibia (knee), the head of the humerus, the talus and calcaneus.
It is important to detect aseptic necrosis in time. When detected at stage I, the probability of recovery with conservative treatment is 97%, at stage II – 92%.
Causes of Muscle and Joint Pain After Covid-19
The causes of muscle aches are usually intoxication during an infection, prolonged bed rest and weakened muscles.
Joint pain can be associated with the following reasons:
- exacerbation of existing chronic joint diseases against the background of coronavirus;
- manifestation of post-covid syndrome;
- reactive arthritis – the effect of coronavirus on joints is associated with excessive activity of the immune system, which begins to attack its own tissues;
- aseptic necrosis of bones in the joint area;
- atrophic processes in the musculoskeletal system in patients who have spent several weeks or even months in bed.
Thus, problems with joints can have different origins. Before choosing a treatment plan, it is necessary to conduct an examination to determine why the joints hurt.
Post-Covid Rheumatoid Arthritis
As a diagnosis, post-COVID rheumatoid arthritis does not exist.
Post-Covid syndrome may be accompanied by joint pain, but it is a condition that occurs after a coronavirus infection and cannot be explained by reasons other than COVID. In the case of rheumatoid arthritis, the cause of joint pain is explainable: it is rheumatoid arthritis itself. Accordingly, it does not belong to post-Covid syndrome.
However, patients with rheumatoid arthritis and other IIDs (immunoinflammatory rheumatic diseases) are at risk for severe COVID and complications, and after the infection they are more likely to suffer from joint problems. The established effect of IIDs on COVID:
- against the background of IVRZ, there is a higher risk of severe lung damage according to X-ray and CT data;
- COVID-19-associated hyperinflammatory syndrome develops more frequently;
- higher risk of severe disease and death from COVID-19;
- the symptoms of the disease persist longer.
These effects are not only related to rheumatoid arthritis, but also to the immunosuppressive (immune suppressing) therapy these patients receive. As a result of immune suppression, the body becomes more vulnerable to COVID.
In turn, coronavirus has a negative effect on the course of rheumatoid arthritis, aggravating systemic inflammation. Therefore, exacerbations of rheumatoid arthritis after coronavirus infection occur more often and lead to more severe joint damage.
Finally, rheumatoid arthritis can debut during COVID or shortly after an infection. To distinguish joint pain in post-COVID syndrome from the onset of rheumatoid arthritis, all patients with joint syndrome are examined: at a minimum, tests for inflammation markers in the blood are necessary.
Symptoms
Joint pain is the main symptom. Some patients also notice swelling, deformation, redness. Morning stiffness is common: the longer it lasts, the higher the probability that the cause of the pain is rheumatic inflammation. Impaired mobility (active, passive), discomfort, crunching, a feeling of instability are also possible.
Treatment of joints after coronavirus
Treatment depends on the cause of joint pain.
In case of aseptic necrosis, bisphosphonate therapy and unloading of the joint for at least 3 months are required. Vitamin D, intra-articular injections of hyaluronic acid, platelet-rich plasma or stem cells to normalize regenerative processes may also be prescribed.
In case of rheumatoid arthritis and other rheumatoid arthritis, therapy with anti-inflammatory drugs is carried out, which is selected individually, depending on the phase and severity of inflammation.
Reactive arthritis is treated with symptomatic and anti-inflammatory drugs. It usually resolves without long-term consequences (without joint destruction).
In case of arthralgia (joint pain) that is not accompanied by a pronounced inflammatory reaction, without anatomical changes in the joint area, without damage to cartilage, bones and other structures, patients require only symptomatic therapy. Painkillers, exercise therapy, massage, and physiotherapy are used to restore joints.
Therapy methods
The following methods are used to treat arthralgia and inflammatory joint diseases that arise after COVID:
- drug therapy;
- lifestyle modification, including joint relief;
- orthoses;
- kinesio taping;
- physiotherapy;
- massage;
- physiotherapy;
- electrical myostimulation;
- passive development of the joint;
- intra-articular injections;
- drug blockades;
- surgical operations.
What symptoms require you to see a doctor?
You should contact an orthopedic doctor in the following cases:
- joint pain after COVID;
- morning stiffness;
- limitation of active or passive movements;
- swelling, redness.
Even in the absence of symptoms, all patients who have received glucocorticoids, especially in high doses, for a long period of time should see a doctor. These drugs increase the risk of aseptic necrosis. To assess the risk of complications, you can undergo a medical examination, take a test for plasminogen activator inhibitor-1, and if symptoms or objective signs of joint damage appear, do an MRI.
Recovery after Covid in the clinic of Doctor Glazkov
If you have joint pain after COVID, here’s what you can do about it:
- Contact Dr. Glazkov’s Clinic in Moscow.
- Undergo diagnostics. You will be examined by an experienced orthopedist. If necessary, he will refer you for tests and instrumental diagnostics.
- Confirmation of diagnosis or exclusion of joint diseases. If all diagnoses are excluded, and the joints hurt, this means that the pain is associated with post-Covid syndrome.
- Treatment, which may vary depending on the diagnosis.
- Rehabilitation – includes exercise therapy, physical therapy, massage, kinesiotaping and other measures to restore the function of problem joints.
Most patients require only conservative therapy: drug and non-drug. In the case of aseptic bone necrosis leading to severe osteoarthritis, joint replacement may be required.
If you have any joint problems after coronavirus, contact Dr. Glazkov’s Clinic. We will find out what is causing the symptoms and select an effective treatment.
