Lifting the Mask on Musculoskeletal Manifestations of COVID-19: Results of an Interview-Based Study

Figures & data

Table 1 Demographic, Clinical Data of the Study Patients According to Musculoskeletal Manifestations

Variables	All Patients (n=110)	Without MSK Manifestations (n=10)	With MSK Manifestations (n=100)	P
Demographic Characteristics
Gender, n (%)
Female	80 (72.7)	7 (70)	73 (73)	1
Male	23 (27.3)	3 (30)	27 (27)
Age (years), mean ± SD	37.7±12.9	36.1±12.46	38.5±13.01	0.693
Marital status, n (%)
Single/divorced/widowed	38 (34.5)	4 (40)	34 (34)	0.735
Married	72 (65.5)	6 (60)	66 (66)
Occupation
Not employed	17 (15.5)	0 (0)	17 (17)	0.512
Employed	66 (60)	8 (80)	58 (58)
Retired	7 (6.4)	0 (0)	7 (7)
Not able to work	1 (0.9)	0 (0)	1 (1)
Student	19 (17.3)	2 (20)	17 (17)
Residence, n (%)
Urban	93 (84.5)	8 (80)	85 (85)	0.651
Rural	17 (15.5)	2 (20)	15 (15)
Education, n (%)
Middle school	3 (2.7)	0 (0)	3 (3)	0.732
High school	6 (5.5)	0 (0)	6 (6)
College degree	85 (77.3)	9 (90)	76 (76)
Post-graduate	16 (14.5)	1 (10)	15 (15)
Smoking habit, n (%)
Current smoker	9 (8.2)	0 (0)	9 (9)	0.341
Nonsmoker	92 (83.6)	10 (100)	82 (82)
Ex-smoker	9 (8.2)	0 (0)	9 (9)
Family income, n (%)
Not enough	6 (5.5)	0 (0)	6 (6)	0.719
Enough but no saving	60 (54.5)	6 (60)	54 (54)
Enough and saving	44 (40)	4 (40)	40 (40)
Socioeconomic status, n (%)
Low	6 (5.5)	1 (10)	5 (5)	0.588
Average	90 (81.8)	7 (70)	83 (83)
High	14 (12.7)	2 (20)	12 (12)
Active lifestyle, n (%)	74 (67.3)	9 (90)	65 (65)	0.108
Clinical data
Weight (Kg), mean ± SD	80.33±18.21	71.45 ±19.3	81.25 ±17.95	0.106
Height (Cm), mean ± SD	165.63±26.41	165.1 ±9.72	165.68 ±9.42	0.853
Body mass index (Kg/m^2), mean ± SD	29.07±5.41	26.08±6.1	29.39±5.27	0.065
Comorbidities, n (%)
Any comorbidity	31 (28.2)	2 (20)	29 (29)	0.722
Diabetes mellitus	9 (8.2)	0	9 (9)	1
Hypertension	14 (12.7)	2 (20)	12 (12)	0.613
Chronic kidney disease	2 (1.8)	0	2 (2)	1
Chronic lung disease	6 (5.5)	0	6 (6)	1

Table 2 Musculoskeletal and Rheumatic Manifestations Associated with COVID-19 Infection

Variables	Study Group (n=110)
Onset from the first day of COVID-19 infection (days), median (min-max)	2 (0–45)
Duration of musculoskeletal /rheumatic manifestations (days), median (min-max)	7 (0–210)
Musculoskeletal manifestations, n (%)
Arthralgia	90 (81.8)
Myalgia	94 (85.5)
Muscle weakness	45 (40.9)
Facial muscle pain	8 (7.3)
Swollen joints	9 (8.2)
Widespread musculoskeletal pain	66 (60)
Infectious arthritis	0
Mucocutaneous manifestations, n (%)
Persistent dryness of the mouth	21 (19.1)
Persistent dryness of the eyes	37 (33.6)
Skin rash	8 (7.3)
Severity of COVID-19 related arthralgia, n (%)
No	20 (18.2)
Mild	20 (18.2)
Moderate	36 (32.7)
Severe	26 (23.6)
Very severe	8 (7.3)
Severity of COVID-19 infection related myalgia, n (%)
No	16 (14.5)
Mild	28 (25.5)
Moderate	37 (33.6)
Severe	23 (20.9)
Very severe	6 (5.5)
The maximum musculoskeletal pain score, median (min-max)	7 (0–10)

Figure 1 Distribution of MSK manifestations (pain, discomfort, numbness) associated with COVID-19 infection.

Table 3 COVID-19 Infection Data According to Musculoskeletal Manifestations

Variables	All Patients (n=110)	Without MSK Manifestations (n=10)	With MSK Manifestations (n=100)	P
Contact to a symptomatic case in 14 days, n (%)	73 (66.4)	6 (60)	67 (67)	0.730
Severity of COVID-19 infection, n (%)
Mild	26 (23.6)	8 (80)	18 (18)	<0.001*
Moderate	52 (47.3)	1 (10)	51 (51)
Severe	32 (29.1)	1 (10)	31 (31)
Presenting manifestations, n (%)
Shortness of breath	58 (52.7)	1 (10)	57 (57)	0.006*
Loss of taste	59 (53.6)	0 (0)	59 (59)	<0.001*
Cough	60 (54.5)	3 (30)	57 (57)	0.181
Loss of smell	68 (61.8)	1 (10)	67 (67)	0.001*
Loss of appetite	52 (47.3)	0 (0)	52 (52)	0.001*
Headache	83 (75.5)	1 (10)	82 (82)	<0.001*
Sore throat	48 (43.6)	0 (0)	48 (48)	0.005*
Diarrhea	37 (33.6)	0 (0)	37 (37)	0.016*
Dizziness	58 (52.7)	0 (0)	58 (58)	<0.001*
Fever	67 (60.9)	2 (20)	56 (56)	0.013*
Pneumonia	23 (20.9)	2 (20)	21 (21)	1
Investigations done to confirm the diagnosis of COVID-19 infection, n (%)
X-Ray chest	15 (13.6)	0 (0)	15 (15)	0.352
HRCT chest	20 (18.2)	2 (20)	18 (18)	1
PCR-COVID-19	110 (100)	10 (10)	100 (100)	1
Antibodies for COVID-19	12 (10.9)	0 (0)	12 (12)	0.597
Complete blood count	37 (33.6)	2 (20)	35 (35)	0.49
O2 requirement, n (%)	11 (10)	1 (10)	10 (10)	1
Hospital admission, n (%)	10 (9.1)	1 (10)	9 (9)	1
Duration of COVID-19 symptoms (from the first day until symptoms resolved) (days), median (min-max)	10 (1–150)	2.5 (1–17)	12 (1–150)	<0.001*
Outcome of COVID-19 infection in the first 2 weeks, n (%)
Improvement	84 (76.4)	10 (100)	74 (74)	0.113
Deterioration	26 (23.6)	0 (0)	26 (26)
Mucocutaneous manifestations, n (%)
Persistent dryness of the mouth	21 (19.1)	1 (10)	20 (20)	0.684
Persistent dryness of the eyes	37 (33.6)	0 (0)	37 (37)	0.016*
Skin rash	8 (7.3)	0 (0)	8 (8)	1
Severity of COVID-19 infection related fatigue, n (%)
No	11 (10)	8 (80)	3 (3)	<0.001*
Mild	14 (12.7)	1 (10)	13 (13)
Moderate	37 (33.6)	1 (10)	36 (36)
Severe	31 (28.2)	0 (0)	31 (31)
Very severe	17 (15.5)	0 (0)	17 (17)

Note: *p<0.05.