Summarising evidence of associations of COVID-19 with a future diagnosis of inflammatory rheumatic and musculoskeletal diseases: a rapid review.

Musculoskeletal symptoms are commonly reported following acute coronavirus disease 2019 (COVID-19). It is unclear whether those with musculoskeletal symptoms subsequently develop inflammatory rheumatic musculoskeletal disease (iRMD). This review seeks to identify evidence for an association between acute COVID-19 and subsequent iRMD diagnosis. A rapid review of the literature using a systematic search of Medline, EMBASE and two COVID-19 databases was undertaken until August 2022. Case studies, case series, cross-sectional, case-control, and cohort studies reporting patients with an incident iRMD following COVID-19 were included. Title and abstract screening were conducted by one reviewer, and full text screening by two reviewers. Data extraction and quality appraisal were by one reviewer, with a second verifying. Study-type specific critical appraisal tools were used. Results were narratively synthesised. 80 studies were included (69 case reports, 10 case series and 1 cross-sectional study). Commonly reported iRMDs were 'reactive arthropathies' (studies=47), 'inflammatory arthropathies unspecified' (studies=18), rheumatoid arthritis (studies=12) and lupus erythematosus (studies=11). The cross-sectional study reported 37% of those with COVID-19 developed 'post-covid arthritis.' Time from diagnosis of COVID-19 to iRMD presentation ranged from 0-120 days. Several mechanisms were proposed to explain the association between COVID-19 and iRMD development: auto-immune processes, aberrant inflammatory responses, colonisation of joint spaces, direct damage from the SARS-CoV2 virus and genetic predisposition. The level of evidence of the studies included in this review was low, and the quality generally poor. Prospective observational studies are required to confirm associations and likely impact of post COVID-19 iRMDs at a population level.