Assessment of risk factors in post- COVID-19 patients and its associated musculoskeletal manifestations: A cross-sectional study in India

Madhan Jeyaraman; Preethi Selvaraj; Naveen Jeyaraman; Prajwal Gollahalli Shivashankar; Sathish Muthu

doi:10.1016/j.jor.2022.07.011

Assessment of risk factors in post- COVID-19 patients and its associated musculoskeletal manifestations: A cross-sectional study in India

J Orthop. 2022 Sep-Oct:33:131-136. doi: 10.1016/j.jor.2022.07.011. Epub 2022 Jul 21.

Authors

Madhan Jeyaraman^{1

2

3}, Preethi Selvaraj^{2

4}, Naveen Jeyaraman^{2

5}, Prajwal Gollahalli Shivashankar^{2

6}, Sathish Muthu^{2

7}

Affiliations

¹ Department of Orthopaedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, India.
² Orthopaedic Research Group, Coimbatore, Tamil Nadu, India.
³ South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX, 78045, USA.
⁴ Department of Community Medicine, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Chengalpattu, Tamil Nadu, India.
⁵ Department of Orthopaedics, Atlas Hospitals, Tiruchirappalli, Tamil Nadu, India.
⁶ Department of Orthopaedics, Mallika Spine Centre, Guntur, Andhra Pradesh, India.
⁷ Department of Orthopaedics, Government Medical College and Hospital, Dindigul, Tamil Nadu, India.

Abstract

Introduction: Musculoskeletal manifestations of COVID-19, post COVID-19, and post COVID-19 vaccination include arthralgia, myalgia, new-onset backache, fatigue, inflammatory arthritis either symmetrical or polyarticular, reactive arthritis, osteoporosis, osteonecrosis of the femoral head, neuropathies, myositis, and myopathies. Almost 15% and 44% of post-COVID-19 patients reported arthralgia and myalgia. We aim to analyze the musculoskeletal manifestations of COVID-19 infection and the factors determining their severity.

Methodology: This is a retrospective multicentric cross-sectional study conducted from all the four regions (northern, southern, eastern, and western regions) in India. The recruitment period was from June 1st, 2021, to September 30th, 2021. All patients with COVID-19 positivity in the past were classified into three groups (mild, moderate, and severe). The primary outcome is to find the correlation of musculoskeletal symptoms with disease positivity, severity, and demographic variables. We focused at clinical characteristics and symptoms at the time of admission, as well as comorbidities, laboratory findings, immunological findings, treatments, and outcomes.

Results: The study was conducted among 2334 subjects across all the regions of India. Out of which 719 were COVID-19 positive individuals. Non-vaccinated were about 62.6% compared to 37.4% vaccinated among COVID-19 positive individuals. The total average musculoskeletal scores calculated were about 15.94 ± 54.86. MSK scores were significantly higher (p < 0.001) among males, uneducated, those with co-morbidities, and non-vaccinated individuals. Multivariate regression analysis showed a 1.63 times higher risk of having COVID-19 infection among smokers, those who don't exercise regularly are 1.25 times at risk of having COVID-19 infection. Similarly, those who have comorbidities are 1.93 times at risk of having COVID-19 infection. Non-vaccinated individuals were 2.33 times at risk of having COVID-19 infection.

Conclusion: Factors such as male sex, non-vaccination, and associated co-morbidities increased the risk of developing severe MSK manifestations upon infection with COVID-19 and needs extended monitoring to control the morbidity due to the same.

Keywords: COVID-19; Complications; MSK; Musculoskeletal manifestations; Risk factors; SARS-CoV-2; Vaccination.