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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 Jan 18:S1201-9712(21)00043-6. doi: 10.1016/j.ijid.2021.01.031. Epub ahead of print. PMID: 33476761; PMCID: PMC7813485.

Objectives: Musculoskeletal symptoms are often not recognised as a prominent feature of COVID-19 infection. We hypothesised that viral arthralgia is an uncommon but distinct manifestation of COVID-19 infection. In addition, we aimed to characterise the other musculoskeletal presentations of COVID-19 infection and study their prognostic implications.

Methods: Patients hospitalised with COVID-19 infection were divided into 2 groups: those with and without musculoskeletal symptoms. Those with musculoskeletal symptoms were subdivided according to 4 patterns of musculoskeletal involvement: myalgia, arthralgia, backache and generalised bodyache. Using binary regression logistic analysis, we compared the risk of developing a viral pneumonia in patients with and without musculoskeletal complaints.

Results: Of 294 hospitalised patients with COVID-19, 88 (30%) reported musculoskeletal complaints. Among these 88 patients, 37.5% had myalgia, 5.7% arthralgia, 6.8% new-onset backache and 50% generalized bodyache. The presence of musculoskeletal complaints was not associated with the risk of developing viral pneumonia (6.8% versus 9.7%, OR: 0.68, 95%CI: 0.26-1.76, p = 0.426). COVID-19 arthralgia was often more severe and had variable onset, while generalised bodyache and myalgia were milder and coincided with the occurrence of fever or respiratory symptoms.

Conclusion: Viral arthralgia is novel clinical manifestation of COVID-19, not typical of a viral prodrome nor a reactive arthropathy. While musculoskeletal symptoms were not associated with developing a pneumonia, clinicians should be aware of its variable onset to avoid missing a diagnosis of COVID-19, particularly when respiratory symptoms are absent at the time of presentation.

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