Post Covid-19 complications: Skin issues, joint pain becoming increasingly common, say experts

People should seek good rehabilitative care, exercise every day, maintain good posture, and follow a healthy diet to manage joint and muscle pain

Authors: By: Lifestyle Desk | New Delhi |

The list of post-Covid complications seems to be only increasing with doctors now saying that there has also been an increase in skin conditions like herpes, and joint pains in patients

What is causing joint issues?

There is about four-five per cent increase in arthritis cases post Covid-19 infection, said Dr Narendra Vaidya, joint replacement surgeon and managing director, Lokmanya Hospital Pune.

“During Covid, inflammatory molecules break muscle protein and decrease its synthesis causing muscle fatigue; this also damages cartilage, causing arthritis. Arthritis can also arise as sequele of steroid and antiviral drugs used to treat Covid-19. Musculoskeletal symptoms like stiffness of joints, muscle pain are commonly seen in post-Covid patients along with decreased muscle strength. Many people complain of joint and muscle pain, and have also come with new onset of autoimmune arthritis,” he said.

According to Dr Vaidya, patients complain of joint pain or arthralgia, muscle pain or myalgia, extreme fatigue, reactive arthritis, and vasculitis (inflammation of the blood vessels). “Joint pain can be temporary or continue for months,” he said.

One more reason to develop joint pain could be the overdose of steroids or a faster. This might develop osteonecrosis of bones, leading to faster degeneration and joint pains, said Dr Richa Kulkarni, chief consulting physiotherapist, KINESIS – Sports Rehab and Physiotherapy Clinic, Pune.

How to prevent and treat the condition?

People should seek good rehabilitative care, exercise every day, maintain good posture, and follow a healthy diet to manage joint and muscle pain, said Dr Vaidya.

What are the skin conditions?

Covid has induced many autoimmune and dormant infections in people with low immunity, such as herpes and warts. “Treatment with monoclonal anti–TNF alpha antibodies can cause herpes. Since the beginning of the pandemic, many people reported herpes, joint pain, and even warts. These problems are commonly seen in females when compared to males. People come with complaints like skin rash, redness, shingles around eyes nose, lips. These infections are common among senior citizens, and pregnant women. Herpes and other skin complications are getting triggered in patients who have a previous history. Do not ignore any signs like rashes, redness of the skin, and patches, seek immediate medical attention,” said Dr Vishwajeet Chavan, orthopedic surgeon, Apollo Spectra Pune.

Dr Saurabh Shah, dermatologist at Bhatia Hospital Mumbai has been seeing about one case of herpes zoster (covid related) every week. “The reason could be low immunity since  Covid attacks the immune system of the body. Herpes Zoster (also known as shingles) virus (Varicella Zoster virus) is present in the body of almost every individual. When our immunity gets compromised or jeopardised, herpes zoster, which lies dormant in the body (dorsal nerve root ganglion), becomes active and flares up. Usually this skin infection is seen in patients with poorly controlled diabetes, patients with chronic renal failure, patients on chemotherapy, post medical and surgical illness and other diseases that compromise our immunity,” he explained.

There is also an uncanny increase in the incidence of urticaria in a lot of patients, said Dr Shah. “These rashes appear as itchy, red, evanescent raised areas on most parts of the body, usually after an infection (post-Covid). These invariably disappear in a few hours,” Dr Shah told indianexpress.com.

By: Lifestyle Desk | New Delhi |
Updated: February 21, 2022 4:22:15 pm

Indiana University researchers study long-term effects of COVID-19 on bone growth

Authors: Caitlin VanOverberghe 

SARS-CoV-2 can cause quick and significant bone loss—even when infections of the virus that causes COVID-19 appear to be mild.

Researchers in the Department of Orthopaedic Surgery at Indiana University School of Medicine discovered that mouse models infected with the novel coronavirus lost approximately 25% of their bone mass within two weeks of contagion. They also found mouse models with a 63% increase in osteoclasts, the cells that cause bone to break down.

These changes were observed even in mice with mild and asymptomatic infections.

The study is part of ongoing coronavirus-related research being conducted by the Kacena Lab in Indianapolis, led by Melissa Kacena, PhD, the Vice Chair of Research for the Department of Orthopaedic Surgery. Findings will be published in the medical journal BONE.

The study raises questions about the lasting implications of the pandemic and the virus’s effects on the musculoskeletal system. The discovery will likely inspire further research into the potential bone loss experienced by people of all ages who contract COVID-19.

Decreased bone mass, or osteoporosis, can lead to brittle bones that are prone to breaks.

Elderly people have always been the most at-risk group for complications due to osteoporosis, because they are least likely to naturally regenerate lost bone matter. Because the elderly are also at a higher risk of contracting COVID-19, Kacena is studying if those who overcome the virus will now be even more likely to suffer broken bones.

And with more children contracting the Delta variant, further questions are raised about whether young people can develop adequate bones after contracting the virus. Humans don’t reach peak bone mass until about age 25, Kacena said, and COVID-19 could be impacting normal bone development.

Kacena diverted her work to SARS-CoV-2 after several studies from across the country revealed that those dying from the coronavirus had high numbers of megakaryocytes built up in various organs, which causes significant issues.

Megakaryocytes are among Kacena’s areas of expertise; she studies their relation to bone regeneration and fracture healing.

The Kacena Lab began using transgenic mouse models to further study the coronavirus and its relation to megakaryocytes and bone health. It was the first lab in Indiana and only one of a handful of labs in the United States to start conducting coronavirus-related experiments at this level.

Megakaryocytes are large bone marrow cells that produce platelets needed for blood clotting. The autopsies of those who died from COVID-19 have revealed significant megakaryocyte build-ups in the heart, lungs and brain. The lab’s goal was to discover whether regulating megakaryocytes could change the severity of COVID-19 and decrease its morbidity and mortality.

From there, Kacena’s researchers began questioning the other effects COVID-19 might be having on the body, particularly the musculoskeletal system. These inquiries ultimately led to the discovery of decreased bone matter in the coronavirus-infected mice.

Researchers found a 24.4% decrease in trabecular bone volume fraction; a 19.0% decrease in trabecular number; a 6.2% decrease in trabecular thickness; and a 9.8% increase in trabecular separation

Researchers at all levels assist with work done in the Kacena Lab.

The lead author on the study published in BONE is Olatundun Awosanya, who began working in the Kacena Lab as an undergraduate in 2018 when she was assigned to work in the lab after being accepted into IUPUI’s Life-Health Science Internship (LHSI) program.

LHSI places 75 undergraduate students in immersive experiences around the Indianapolis campus, encouraging them to explore career goals while gaining important professional skills.

In her senior year at IUPUI, Awosanya was named College Intern of the Year by the Indiana Chamber of Commerce for her work in the Kacena Lab. Now, Awosanya is working toward a doctoral degree under Kacena’s mentorship.

The work was made possible by grant funding from the Cooperative Center of Excellence in Hematology (CCEH) at IU School of Medicine and the Indiana Clinical and Translational Sciences Institute (CTSI).

This work was also supported in part by VA Merit Review Award #BX003751 from the United States (U.S.) Department of Veterans Affairs Rehabilitation Research and Development Service. The contents do not represent the views of the U.S. Department of Veterans Affairs, the National Institutes of Health, or the United States Government.

Long COVID’s daunting toll seen in study of pandemic’s earliest patients

Authors: Melissa Healy   6 hrs ago

COVID-19 patients in Wuhan were among the pandemic’s first victims, and a comprehensive new study finds that a year after shaking the coronavirus, survivors were more likely than their uninfected peers to suffer from mobility problems, pain or discomfort, anxiety and depression.

detailed accounting of 1,276 people hospitalized for COVID-19 in the pandemic’s opening months reveals that a full year later, almost half continued to report at least one lingering health problem that is now considered a symptom of “long COVID.”

One out of five said they had continued fatigue and/or muscle weakness, and 17% said they were still experiencing sleep difficulties. Just over one in four said they were suffering anxiety or depression in the wake of their bout with the SARS-CoV-2 virus.

For the growing number of patients who identify themselves as COVID “long haulers,” the new accounting offers cause for optimism — and concern. The period from six to 12 months after infection brought improvement for many. But most patients struggling with symptoms at the six-month mark were not yet well six months later.

The findings, catalogued by a team of Chinese researchers, were published late Thursday in the medical journal Lancet.

“This is not good news,” said David Putrino, a rehabilitation specialist who works with COVID long haulers at Mount Sinai Hospital in New York. “If you run the numbers here, about one-third of the group that had persistent symptoms are getting better after 12 months, while two-thirds are not.”

Putrino also called the findings a “wake-up call” to public health officials that even when the pandemic is over — a distant enough prospect in the midst of a fourth wave of infections — its downstream consequences will not be.

“We’re going to need resources for many years to come to deal with these patients,” he said.

There will be a lot of them. More than 87,000 COVID-19 patients are being hospitalized each day in the United States, and 2.7 million have receiving hospital care in the past year alone.

The half who contend with persistent symptoms will show up in doctors’ offices with clusters of vague and perplexing complaints including brain fog, heart palpitations, pain and exhaustion. And despite emerging evidence that time and specialized treatment can help many to improve, few will have the wherewithal to spend months in intensive rehabilitation for their symptoms, Putrino said.

An editorial published alongside the new study noted that only 0.4% of COVID long haulers are receiving rehabilitative treatment for their symptoms.

Even as scientists puzzle over the common biological mechanisms of long COVID’s diverse symptoms, healthcare providers “must acknowledge and validate the toll of the persistent symptoms of long COVID on patients, and health systems need to be prepared to meet individualised, patient-oriented goals, with an appropriately trained workforce,” Lancet’s editors wrote.

The new research also offered some glimmers of hope.

When the study’s COVID-19 patients were examined at six months, 68% said they had at least one of 15 symptoms considered hallmarks of long COVID, which is also known as Post-Acute Sequelae of COVID, or PASC. At one year, 49% were still afflicted by at least one of those symptoms.

The proportion of patients with ongoing muscle weakness and fatigue dropped from 52% to 20% during that time. Patients experiencing loss of smell dropped from 11% to 4%, and those afflicted with sleep problems fell from 27% to 17%. The 22% who reported hair loss at six months dwindled to 11% a full year out.

At the same time, the numbers of patients reporting breathing difficulties saw a slight increase, rising from 26% at six months to 30% after a year. Likewise, patients who reported new depression or anxiety increased from 23% to 26% during that period.

Study co-author Xiaoying Gu from the China-Japan Friendship Hospital in Beijing said the slight uptick in anxiety and depression was, like all of long COVID’s symptoms, hard to explain.

The psychiatric symptoms “could be caused by a biological process linked to the virus infection itself, or the body’s immune response to it,” he said. “Or they could be linked to reduced social contact, loneliness, incomplete recovery of physical health or loss of employment associated with illness.”

Patients who required mechanical ventilation were more likely than those with less severe illness to have measurable lung impairment and abnormal chest X-rays at both six and 12 months.

But in the tally of more subjective long COVID symptoms, the difference between the most severely ill and those who required no supplemental oxygen at all was very small.

That finding underscores the fact that even patients who are only mildly ill are at risk of developing a range of persistent symptoms.

Of the study population’s 479 patients who held jobs when the pandemic struck, 88% had returned to work a year after their illness. Most of the 57 who did not return said they either could not or were unwilling to do the tasks required of them.

The findings from the Wuhan patients also tracked with the widespread observation that persistent post-COVID infection symptoms are more common in women than in men. Women who had been hospitalized for COVID-19 were twice as likely as their male counterparts to report depression or anxiety 12 months later. In addition, they were close to three times as likely to show evidence of impaired lung function, and 43% more likely to report symptoms of fatigue and muscle weakness.

All of the study’s participants were treated at a single hospital in Wuhan, where reports of a mysterious new form of pneumonia first surfaced in December 2019. The researchers followed a large group of patients sickened in the first five months that the outbreak.

That makes the Lancet report one of the earliest and largest accounts of lingering COVID-19 symptoms to be tallied and vetted by other researchers, and the only one to compare such patients to a group of uninfected peers matched on a wide range of demographic and health attributes.

One thing is already clear, the journal editors noted: “Long COVID is a modern medical challenge of the first order.”

This story originally appeared in Los Angeles Times.