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Synovial fluid evaluation in COVID-19 patients

  • Jainal Arifin ,
  • Jainal Arifin ,
  • Muhammad Nasrum Massi ,
  • Yosua Adi Nugroho ,
  • Mirza Ariandi ,
  • Yosia Handoko ,


Abstract

Background: COVID-19 can provide symptoms outside the respiratory tract and musculoskeletal symptoms. Some viruses can indeed cause arthritis, and the genetic material of these viruses can be found in a joint fluid using PCR assays. With this study, we will conduct an examination using PCR on the joint fluid of COVID-19 patients who have musculoskeletal symptoms, especially arthralgia, during the infection.

Methods: This cross-sectional study with a descriptive explanation of synovial fluid in COVID-19 patients was performed from April 1st to July 30th, 2021, with patient data collection conducted centrally at Wahidin Sudirohusodo Hospital Makassar Synovial fluid was taken from the knee using the sterile procedure in a patient that met the inclusion criteria, such as hospitalized patients who had positive PCR swab results in the nasopharynx for less than 2 weeks and had arthralgia symptoms on April – July 2021. Other musculoskeletal symptoms (e.g., myalgia and fatigue) were noted. About 2 ml sample of synovial fluid was tested using a PCR kit (M BioCov) in the laboratory. The sample shows a positive result when there is an amplification of RDNP with a CT value below 40.

Results: 189 patients with 21 participated, 14 subjects were male, and 7 subjects were female. Age range 18 - 72 years with arthralgia, myalgia, and fatigue symptoms. Only 2 patients had arthralgia, 13 patients had myalgia and arthralgia, 1 patient had fatigue and arthralgia, and 5 patients had all of the symptoms (arthralgia, myalgia, and fatigue). Only 1 patient had direct contact with the COVID-19 patient. PCR test for synovial fluid in all patients showed negative for COVID-19.

Conclusion: COVID-19 infection can be manifest in the musculoskeletal system. Detection of COVID-19 virus using a specimen from knee synovial fluid in a patient with musculoskeletal symptoms (arthralgia, myalgia, fatigue) was negative.

Keywords: COVID-19 musculoskeletal symptoms synovial fluid

References

  1. Fu L, Wang B, Yuan T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect. 2020;80(6):656-665. doi:10.1016/j.jinf.2020.03.041.
  2. Chen Y, Liu Q, Guo D. Emerging coronaviruses: Genome structure, replication, and pathogenesis [published correction appears in J Med Virol. 2020 Oct;92(10):2249]. J Med Virol. 2020;92(4):418-423. doi:10.1002/jmv.25681.
  3. Vetter P, Vu DL, L'Huillier AG, Schibler M, Kaiser L, Jacquerioz F. Clinical features of covid-19. BMJ. 2020;369:m1470. Published 2020 Apr 17. doi:10.1136/bmj.m1470.
  4. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032.
  5. Goyal P, Choi JJ, Pinheiro LC, et al. Clinical Characteristics of Covid-19 in New York City. N Engl J Med. 2020;382(24):2372-2374. doi:10.1056/NEJMc2010419.
  6. Cipollaro L, Giordano L, Padulo J, Oliva F, Maffulli N. Musculoskeletal symptoms in SARS-CoV-2 (COVID-19) patients. J Orthop Surg Res. 2020;15(1):178. Published 2020 May 18. doi:10.1186/s13018-020-01702-w.
  7. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020 Jan 30;:]. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5.
  8. Schett, G., Manger, B., Simon, D. et al. COVID-19 revisiting inflammatory pathways of arthritis. Nat Rev Rheumatol. 2020;16. 465–470. https://doi.org/10.1038/s41584-020-0451-z.
  9. Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA. 2020;323(18):1843-1844. doi:10.1001/jama.2020.3786.
  10. Marks M and Marks, JL. Viral arthritis. Clinical Medicine. 2016;16(2). p129–134. https://doi.org/10.7861/clinmedicine.16-2-129.
  11. Vassilopoulos D, Calabrese LH. Virally associated arthritis 2008: clinical, epidemiologic, and pathophysiologic considerations. Arthritis Res Ther. 2008;10(5):215. doi:10.1186/ar2480.
  12. Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol. 2020;215:108427. doi:10.1016/j.clim.2020.108427.
  13. Johns Hopkins University of Medicine: Corona Research Center, Journal (2020). Retrieved from https://coronavirus.jhu.edu/map.html.
  14. Akram, A., & Mannan, N. Molecular Structure, Pathogenesis and Virology of SARS-CoV-2: A Review. Bangladesh Journal of Infectious Diseases. 2020;7. S36–S40. https://doi.org/10.3329/bjid.v7i0.46799
  15. Naqvi AAT, Fatima K, Mohammad T, et al. Insights into SARS-CoV-2 genome, structure, evolution, pathogenesis and therapies: Structural genomics approach. Biochim Biophys Acta Mol Basis Dis. 2020;1866(10):165878. doi:10.1016/j.bbadis.2020.165878.
  16. Mason RJ. Pathogenesis of COVID-19 from a cell biology perspective. Eur Respir J. 2020;55(4):2000607. Published 2020 Apr 16. doi:10.1183/13993003.00607-2020.
  17. Dong X, Cao YY, Lu XX, et al. Eleven faces of coronavirus disease 2019. Allergy. 2020;75(7):1699-1709. doi:10.1111/all.14289.
  18. Liang J, Jin G, Liu T, et al. Clinical characteristics and risk factors for mortality in cancer patients with COVID-19. Front Med. 2021;15(2):264-274. doi:10.1007/s11684-021-0845-6.
  19. Zhu Z, Cai T, Fan L, et al. Clinical value of immune-inflammatory parameters to assess the severity of coronavirus disease 2019. Int J Infect Dis. 2020;95:332-339. doi:10.1016/j.ijid.2020.04.041.
  20. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-1034. doi:10.1016/S0140-6736(20)30628-0.
  21. Xu T, Chen C, Zhu Z, et al. Clinical features and dynamics of viral load in imported and non-imported patients with COVID-19. Int J Infect Dis. 2020;94:68-71. doi:10.1016/j.ijid.2020.03.022.
  22. Disser NP, De Micheli AJ, Schonk MM, et al. Musculoskeletal Consequences of COVID-19. J Bone Joint Surg Am. 2020;102(14):1197-1204. doi:10.2106/JBJS.20.00847.
  23. Padhye, N. S. Reconstructed diagnostic sensitivity and specificity of the RT-PCR test for COVID-19. MedRxiv. 2020. p1-12. https://doi.org/10.1101/2020.04.24.20078949
  24. WHO Global. Molecular assays to diagnose COVID-19: Summary table of available protocols (in house assays). COVID-19: WHO Laboratory and Diagnosis. 2020 1–80. https://www.who.int/publications/m/item/molecular-assays-to-diagnose-covid-19-summary-table-of-available-protocols
  25. Tahamtan A, Ardebili A. Real-time RT-PCR in COVID-19 detection: issues affecting the results. Expert Rev Mol Diagn. 2020;20(5):453-454. doi:10.1080/14737159.2020.1757437.
  26. Li Y, Yao L, Li J, et al. Stability issues of RT-PCR testing of SARS-CoV-2 for hospitalized patients clinically diagnosed with COVID-19. J Med Virol. 2020;92(7):903-908. doi:10.1002/jmv.25786.
  27. Hadaya J, Schumm M, Livingston EH. Testing Individuals for Coronavirus Disease 2019 (COVID-19). JAMA. 2020;323(19):1981. doi:10.1001/jama.2020.5388.
  28. Tamer TM. Hyaluronan and synovial joint: function, distribution and healing. Interdiscip Toxicol. 2013;6(3):111-125. doi:10.2478/intox-2013-0019.
  29. Ropes MW, Rossmeisl EC, Bauer W. The origin and nature of normal human synovial fluid. J Clin Invest. 1940;19(6):795-799. doi:10.1172/JCI101182.
  30. Gasque, P. Chapter 114 Viral Arthritis. 2020. (p. 1943-1955.e3). https://doi.org/10.1016/b978-0-323-31696-5.00114-5.
  31. Depkes RI. Kategori Usia. 2009. (Available at: https://dokumen.tips/documents/kategori-umur-menurut-depkes.html).
  32. Mao, D. W., Thor, J., Pagkaliwagan, E. H., Kon, C., & King, K. Absence of SARS-CoV-2 in Synovial Fluid of COVID-19 Positive Patient : A Case Report. Hong Kong Journal of Orthopaedic Research 2020; 3(3): 49-51. DOI: 10.37515/ortho.8231.3301.
  33. Hoong CWS, Amin MNME, Tan TC, Lee JE. Viral arthralgia a new manifestation of COVID-19 infection? A cohort study of COVID-19-associated musculoskeletal symptoms. Int J Infect Dis. 2021;104:363-369. doi:10.1016/j.ijid.2021.01.031.
  34. Liew IY, Mak TM, Cui L, Vasoo S, Lim XR. A Case of Reactive Arthritis Secondary to Coronavirus Disease 2019 Infection. J Clin Rheumatol. 2020;26(6):233. doi:10.1097/RHU.0000000000001560.
  35. Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631-637. doi:10.1002/path.1570.
  36. Mokuda S, Tokunaga T, Masumoto J, Sugiyama E. Angiotensin-converting Enzyme 2, a SARS-CoV-2 Receptor, Is Upregulated by Interleukin 6 through STAT3 Signaling in Synovial Tissues. J Rheumatol. 2020;47(10):1593-1595. doi:10.3899/jrheum.200547.
  37. Chen L, Lou J, Bai Y, Wang M. COVID-19 Disease With Positive Fecal and Negative Pharyngeal and Sputum Viral Tests. Am J Gastroenterol. 2020;115(5):790. doi:10.14309/ajg.0000000000000610.

How to Cite

Jainal Arifin, Jainal Arifin, Muhammad Nasrum Massi, Yosua Adi Nugroho, Mirza Ariandi, & Yosia Handoko. (2022). Synovial fluid evaluation in COVID-19 patients. Bali Medical Journal, 11(2), 946–949. https://doi.org/10.15562/bmj.v11i2.3661
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