Post-COVID Joint Pain: Symptoms and Seeking Early Diagnosis

Q: Post-COVID Joint Pain: Symptoms and Seeking Early Diagnosis

Hello, thank you for your inquiry. <br>Here are my responses：<br>1. <br>Since the joint discomfort clearly occurred after the blood draw, could it be that the inflammatory markers, ANA, and other indices had not yet shown abnormal trends at that time, and only now can we detect a

Joint pain after a confirmed COVID-19 infection?

Hello Doctor, I apologize for the lengthy message.
I started feeling unwell on November 11th (muscle aches, fever, fatigue, red rashes on limbs, dry eyes, dry mouth).
I was diagnosed with COVID-19 on November 13th.
On November 16th, someone noticed that my fingers were turning white, and I subsequently began to experience joint stiffness, a sensation of tightness, and mild pain (starting from the finger joints, then the right elbow, both knee joints, and both shoulder joints).
The discomfort is most pronounced and affects my daily life the most right after I wake up.
After about five minutes of activity, I feel much better, but the stiffness and tightness persist almost all day.
I find myself subconsciously bending my fingers.
After researching online, I suspect it could be an autoimmune disease (as I tend to develop rashes when under significant stress).
On November 18th, I visited a rheumatology and immunology department for blood tests, and the results are as follows (the paper data was manually entered, so there may be errors in the test items): C3: 161.9 mg/dl, C4: 31.4 mg/dl, HGB (Hemoglobin): 15.9 g/dl, Lymphocyte: 39.4%, Eosinophil: 2%, Platelet (Platelet count): 275 x 10^3/µl, WBC (White blood cell count): 6.93 x 10^3/µl, Neutrophil: 54.2%, Monocyte: 4%, Basophil: 0.4%, D-Dimer: <0.16 mg/L, IgE: 21.6 IU/ml, Anti-B2-GP1 IgE: 0.7 Negative, ANA: Negative (<1:80), Anti-Cardiolipin IgE: 2.5 Negative GPL-U/ml, ESR (Erythrocyte sedimentation rate): 7 mm/hr, RF (Rheumatoid factor): <10.0 IU/ml, eGFR (MDRD): >60, Creatinine: 1.06 mg/dl, ALT (Alanine aminotransferase): 30 U/L, CRP (C-reactive protein): 0.237 mg/dl.

From November 20th to 26th, most of my COVID-19 symptoms disappeared, but my dry eyes and joint discomfort became more pronounced, with increased pain and stiffness in the joints.
However, after my follow-up appointment on November 27th, the doctor stated that all blood tests were normal, so there were no concerns about autoimmune diseases, and prescribed me some non-steroidal anti-inflammatory pain relievers.
Based on the above situation, I would like to ask the following questions:
1.
Since the joint discomfort became apparent after the blood test, could it be that the inflammatory markers and ANA were not yet showing abnormal trends at that time, and would only be detectable now?
2.
Related to the previous question, could it be that the blood tests need to show significant symptoms to detect abnormalities? Are there any early (or highly sensitive) tests available that can be conducted? The diagnosing doctor mentioned that I should return for a check-up if there are obvious deformities in the joints, but I hope to diagnose or prevent issues early, rather than waiting for irreversible problems to arise before seeking examination.
3.
I continuously suspect an autoimmune disease based on information I found online, as arthritis is often associated with autoimmune conditions.
Given that my blood tests are currently normal, what other non-rheumatic diseases could potentially cause joint pain?
These are my questions.
Thank you for your responses, Doctor!

Aki, 20~29 year old female. Ask Date: 2023/11/27

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
Here are my responses:
1.
Since the joint discomfort clearly occurred after the blood draw, could it be that the inflammatory markers, ANA, and other indices had not yet shown abnormal trends at that time, and only now can we detect abnormalities? --> No, if clinical symptoms such as rashes have already begun, there would be some detectable signs in the tests if it were indeed related to an autoimmune disease.
2.
Related to the previous question, will the blood tests only reveal abnormalities when there are significant symptoms present? Are there any early (or highly sensitive) tests that can be conducted? The diagnosing physician mentioned that I should return for testing only if there are noticeable joint deformities, but I hope to diagnose or prevent issues early rather than waiting for irreversible problems to arise.
--> It is advisable not to wait for joint deformities to return for a check-up.
If joint pain is persistent and not alleviating, you can return for an earlier consultation.
The tests you have undergone are already quite comprehensive, and the testing standards between medical centers and regional hospitals are not significantly different, so there is no need for concern.
3.
I have been continuously suspicious of having an autoimmune disease based on information found online, as arthritis is almost always an autoimmune condition.
Given that my blood tests are currently normal, what other non-rheumatic diseases could be causing joint pain? --> First, the tests we arrange may change over time, so if your symptoms worsen, you should return for further testing.
Additionally, some joint pains may not cause abnormal test results, such as osteoarthritis, fibromyalgia, or other autoimmune diseases.
These need to be evaluated by your attending physician, who will conduct a detailed examination of your joints and other parts of the body in addition to blood tests for a more accurate diagnosis.
Ministry of Health and Welfare Changhua Hospital, Allergy, Immunology, and Rheumatology Department is concerned about you.

Reply Date: 2023/11/27

More Info

Post-COVID joint pain is a growing concern among individuals who have recovered from COVID-19. Your symptoms, including joint stiffness, pain, and the feeling of discomfort, particularly upon waking, are not uncommon in the context of post-viral syndromes. The fact that you experienced muscle aches, fever, and other systemic symptoms prior to your COVID-19 diagnosis suggests that your body was under significant stress, which could contribute to the development of joint pain.

1. Understanding Inflammatory Markers: You asked whether inflammatory markers such as ANA (Antinuclear Antibody) and others might not have shown abnormalities at the time of your blood test. It is indeed possible for inflammatory markers to fluctuate over time, and some autoimmune conditions may not present with elevated markers until the disease has progressed. However, your blood test results, which showed normal levels for various inflammatory markers, suggest that there is currently no active autoimmune process. If your symptoms persist or worsen, it may be beneficial to repeat these tests or consider additional tests that could provide more insight into your immune status.

2. Early Detection of Autoimmune Conditions: Regarding your concern about whether blood tests need to show clear abnormalities to diagnose an autoimmune disease, the answer is nuanced. Some autoimmune diseases can be difficult to diagnose early, as they may not always present with clear laboratory findings. Tests such as anti-citrullinated protein antibodies (ACPA) or specific tests for conditions like lupus or Sjögren's syndrome may be helpful if your symptoms continue. Additionally, a thorough clinical evaluation by a rheumatologist is crucial, as they can assess your symptoms in the context of your medical history and perform a physical examination to identify any signs of joint inflammation or damage.

3. Exploring Other Causes of Joint Pain: You expressed concern about the possibility of non-rheumatic causes of joint pain. Indeed, joint pain can arise from various conditions beyond autoimmune disorders. For example, osteoarthritis, which is a degenerative joint disease, can cause stiffness and pain, particularly in weight-bearing joints. Fibromyalgia is another condition that can lead to widespread pain and stiffness without clear inflammatory markers. Additionally, post-viral arthritis has been documented following infections, including COVID-19, where joint pain may occur without the presence of an autoimmune disease.

In conclusion, while your blood tests currently do not indicate an autoimmune disease, it is essential to continue monitoring your symptoms. If your joint pain persists or worsens, consider seeking a referral to a rheumatologist for a comprehensive evaluation. They may recommend further testing or imaging studies to assess your joints and provide a more definitive diagnosis. In the meantime, managing your symptoms with NSAIDs (non-steroidal anti-inflammatory drugs) as prescribed can help alleviate discomfort. Staying active within your limits and engaging in gentle stretching or physical therapy may also be beneficial in maintaining joint function and reducing stiffness.
Lastly, remember that the post-COVID landscape is still being studied, and ongoing research may provide more insights into the long-term effects of the virus on joint health and immune function. Stay proactive about your health and communicate openly with your healthcare providers about any changes in your symptoms.

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