“COVID-19 may cause the body to attack”

MRI image of the patient’s shoulder. A red arrow indicates inflammation in the wrist. The COVID virus triggered rheumatoid arthritis in this patient with prolonged shoulder pain after other symptoms of the disease had resolved. Credit: Northwestern University

The recording illustrates the seriousness, the long-term prognosis COVID-19-connected muscles, joint pain.

Muscle pain and sore joints are common symptoms in patients with COVID-19. But for some people, the symptoms are more serious, long-lasting, and even bizarre, including cancers of rheumatoid arthritis, autoimmune myositis, or “COVID toes.”

A new study of northwestern medicine has for the first time confirmed and illustrated the causes of these symptoms by radiological imaging.

“We realized that the COVID virus can trigger the body to attack in different ways, which can lead to rheumatic problems that require lifelong management,” said the corresponding author, Dr. Swati Deshmukh.

The paper will be published today (February 17, 2021) in the journal Bone radiology. The study is a retrospective review of patient data submitted to Northwestern Memorial Hospital between May 2020 and December 2020.

MRI of the foot COVID

MRI of the foot in a patient with severe COVID-19. The gray part of the foot is devitalized tissue (gangrene). Credit: Northwestern University

“Many patients with musculoskeletal disorders associated with COVID recover, but in some individuals their symptoms become serious, deeply worrying about the patient or affecting their quality of life, prompting them to seek medical help and imaging,” he said. Deshmukh, assistant professor of radiology of the musculoskeletal system at Northwestern University Feinberg School of Medicine and radiologist of the musculoskeletal system of Northwestern Medicine. “This imaging allows us to see if COVID-related muscle and joint pain is not just body pain similar to what we see with the flu – but something more insidious.”

Imaging (CT, MRI, ultrasound) can explain to you why someone may have had prolonged musculoskeletal symptoms after COVID, directing them to seek the right doctor for treatment, such as a rheumatologist or dermatologist.

In some cases, radiologists may even suggest a diagnosis of COVID based on imaging of the musculoskeletal system in patients who did not previously know they were infected with the virus, Deshmukh said.

What does painting look like?

“We could see edema and inflammatory tissue changes (fluid, swelling), hematomas (blood collection) or devitalized tissue (gangrene),” Deshmukh said. “In some patients the nerves are injured (bright, enlarged), and in others the problem is impaired blood flow (clots).”

How can imaging lead to better treatment?

“I think it’s important to distinguish between what the virus directly causes and what drives the body,” Deshmukh said. “It’s important that doctors know what’s going on in order to be treated properly.”

For example, Deshmukh said, if a patient has persistent shoulder pain that began after a COVID infection, his primary care provider may order an MRI / ultrasound. If the radiologist knows that COVID can trigger inflammatory arthritis, and the scan shows inflammation of the joint, then they can send the patient for an evaluation to a rheumatologist.

“Some doctors require imaging patients with‘ COVID toes ’, for example, but there has been no literature on imaging foot and soft tissue complications of COVID,” Deshmukh said. “How do you find something if you’re not sure what to look for?” Thus, in our paper, we discuss the different types of musculoskeletal abnormalities that radiologists should look for and give examples for imaging. “

Reference: February 17, 2021, Bone radiology.

Other authors from the Northwest in the paper were Santhoshini Leela Ramani (Northwestern University medical student), Ph.D. Jonathan Samet (radiology), dr. Colin Franz (PMR and Neurology), Ph.D. Christine Hsieh (rheumatology), dr. Cuong Nguyen (dermatology) and Dr. Craig Horbinski (pathology).