A case of acute arthritis in a young woman following hospitalisation with COVID-19 suggests the SARS-CoV-2 virus could be involved in the onset of arthritis.

Reactive arthritis (ReA), which usually involves the lower extremities, generally occurs within several weeks following a remote mucosal infection. Common infections including those from Chlamydia trachomatis, Salmonella, and other bacteria and some viruses have been associated with the pathogenesis of ReA.

Rheumatologists in Hyderabad, India, have now reported a case of reactive arthritis following a COVID-19 infection, joining a short list of what appears to be a rare event. The case study was published in Rheumatology Advances in Practices.

The 27-year-old woman was hospitalised after two days of fever and body aches. PCR testing confirmed a SARS-CoV-2 infection. She was treated with oral methylprednisolone and favipiravir, and her fever subsided on her third day of hospitalisation. She was discharged on day 8.

Two weeks after her positive test for the SARS-CoV-2 virus, she developed acute onset arthritis in both lower extremities, along with relatively mild arthritis in the small joints of her right hand. At that point she tested negative for the virus, and rheumatoid factor (RF) was positive in low titres.

“The presence of RF in low titres was possibly attributable to an immune response to the recent infection,” the authors wrote.

She was treated with NSAIDs and oral opioids to manage the pain, and after several weeks the arthritis had improved significantly, allowing cessation of pain medications.

Six other cases of ReA associated with COVID-19 have been reported. One patient had hand joint involvement without any arthritis in the lower extremities. Another had acute right knee arthritis that arose three days after fever, and was simultaneous with the infection. Only one case has had severe respiratory distress involving mechanical ventilation.

“This case, along with previously reported cases, suggest SARS-CoV-2 infection as an aetiology in the pathogenesis of ReA,” the authors concluded. “More observations are required to strengthen this association.”