Disclosures: Christopher Yih, DO: No financial relationships or conflicts of interest

Case Diagnosis: COVID-19 antibody induced polyarthropathy

Case Description or Program Description: A 71-year-old female with no medical history developed unrelenting and progressive polyarthropathy. An extensive medical workup including comprehensive rheumatologic labs, electrodiagnostic studies, and orthopedic imaging were all negative apart from a positive COVID-19 antibody test. Furthermore, the timing of her positive COVID-19 antibody test, rather than any COVID-19 PCR test, coincided precisely with the onset of her symptoms. She completed regimens of oral steroids, NSAIDS, SSRI’s, and opioids without any relief. Physical therapy provided mild relief with active movement, apart from pain upon initiation of passive movement and active exercises.

Setting: Outpatient clinic

Assessment/Results: The inter-specialty and inter-professional consensus for this patient’s seronegative polyarthropathy non-responsive to medications, negative for all rheumatologic labs and orthopedic imaging, and only mildly responsive to active exercise was that the COVID-19 antibodies themselves were the likely etiologic source.

Discussion (relevance): Human coronaviruses have well-documented rheumatologic and nociceptive sequelae. Viral RNA has been identified to spark novel inflammatory conditions or exacerbate preexisting autoimmune conditions. During previous outbreaks of the closely related MERS-CoV infection as well as other viruses, rheumatologic and neurologic conditions such as Systemic Lupus Erythematosus, Rheumatoid Arthritis, Guillain-Barré Syndrome, and Acute Inflammatory Demyelinating Polyneuropathy have been documented in the presence of resultant antibodies rather than viral RNA or antigens. As we progress from the current pandemic, a growing body of literature is highlighting the significant and potentially severe nociceptive effects that COVID-19 antibodies can have on patients.

Conclusions: A physiatric approach is vital to these rising cases of polyarticular pain as many patients are not finding relief with established medications and approaches. As physiatrists, becoming familiar with the increasing prevalence of seronegative polyarthropathies in the setting of only a positive COVID antibody test is imperative to delivering timely and effective patient care.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/covid-19-antibody-induced-polyarthropathy/