corona virus-Covid19

Some COVID-19 Patients Present with Aches and Pains, Not Respiratory Symptoms Interview with:

Dr Caroline Wei Shan Hoong, MBBS, MRCP Associate Consultant Endocrinologist Department of General Medicine Woodlands Health Campus National Healthcare Group, Singapore

Dr. Wei Shan Hoong

Dr Caroline Wei Shan Hoong, MBBS, MRCP
Associate Consultant Endocrinologist
Department of General Medicine
Woodlands Health Campus
National Healthcare Group, Singapore What is the background for this study?

Response: In the course of our clinical work, we have noticed a predominance of musculoskeletal complaints among some of COVID-19 patients who are otherwise clinically well, and a small subset of them who develop a viral arthralgia (joint pains) sometimes occurring separately from the onset of acute respiratory symptoms. Besides a few isolated case reports, there was not much described about COVID-19 associated viral arthralgia in the literature.

Clinicians are well aware of the need to test for COVID-19 when patients present with cough or shortness of breath. However, when they present as joint pains without any respiratory symptoms, a diagnosis of COVID-19 could easily be missed. Due to overlapping clinical features like low platelet count and elevated liver enzymes, they could easily be misdiagnosed as having other vector-borne infections such as dengue fever, if clinicians do not have a high clinical suspicion of COVID-19. Hence we decided to describe the epidemiology and various presentations of musculoskeletal manifestations of COVID-19 in our cohort of patients. What are the main findings?

Response: Musculoskeletal symptoms occur in up to 30% of COVID-19 patients. Majority of them have generalised muscle aches and other non-localising body aches which are usually short-lived lasting a couple of days, often coinciding with the occurrence of fever and respiratory symptoms. This is not unusual for a viral infection, and often represents an acute cytokine response as part of the infective process.

A minority of patients (2% of our cohort) had prominent joint aches which could sometimes occur many days before and many days after the occurrence of fever or respiratory symptoms. The pain could occur in various joints – some patients several large joints in the arms/legs, in others small joints in the hands. They were often more severe and could last from days to weeks.

Fortunately, the presence of musculoskeletal symptoms was not associated with the risk of developing a pneumonia or severe COVID-19. What should readers take away from your report?

Response: It is important to recognise that COVID-19 can sometimes present as new onset aches and pains, even if patients do not have any respiratory symptoms or fever at the time of presentation. A delay in diagnosis could potentially be a public health hazard if COVID-19 is not tested for and managed appropriately.

As the joint pains were often protracted, this could form part of the “long COVID” syndrome recently described in the literature, adding to the increasing morbidity and multi-systemic nature of COVID-19 illness that patients suffer from. What recommendations do you have for future research as a result of this work? 

Response: Future research should study the mechanisms behind viral arthralgia, whether there is direct viral invasion into the joints, immune complex deposition or whether it is perhaps just a reactive process within the joints. In addition, if longer follow-up is available, it would be useful to see if the joint pains recur and whether there is any longer term damage to the joints.


Citation: Hoong CWS, Amin MNME, Tan TC, Lee JE. Viral arthralgia a new manifestation of COVID-19 infection? A cohort study of COVID-19-associated musculoskeletal symptoms. Int J Infect Dis, 2021 Jan 18.



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Last Updated on January 20, 2021 by Marie Benz MD FAAD