Assessment of symptoms of the post-COVID-19 syndrome in patients with different rheumatic diseases

Abstract

Background: Patients with rheumatic diseases significantly suffer during and after infection with coronavirus disease (COVID-19). Post-COVID-19 syndrome (PCS) refers to signs and symptoms occurring during or following a COVID-19 infection that continue beyond 12 weeks. The study aimed to assess PCS symptoms in rheumatic disease patients compared to a control group not suffering from a rheumatic disease or any other chronic illness. Results: The prevalence of PCS symptoms was significantly higher in rheumatic disease patients compared to the control group: fatigue (69.1% vs. 41.25%), myalgia (73.5% vs. 37.5%), attention deficits (57.4% vs. 40%), and muscle weakness (33.8% vs. 13.8%). Objectively, the study group had significantly higher scores for the Fatigue Severity Scale (FSS) (35.46 ± 13.146 vs. 25.1 ± 7.587), Short-form McGill Pain Questionnaire (SF-MPQ-2) (21.66 ± 10.3 vs. 11.6 ± 3.433), and higher grades of functional disability in the Post-COVID-19 Functional Status scale (PCFS). Rheumatic disease patients had significantly higher frequencies of anxiety and depression, as assessed by the Hospital Anxiety and Depression Scale (HADS), and cognitive impairment, as assessed by the Mini-Mental State Examination (MMSE), than the controls (P = 0.023, P = 0.003, P = 0.0001, respectively). Moreover, SLE patients had the most symptoms and the highest FSS, SF-MPQ-2, PCFS, and HADS scores, as well as the lowest MMSE scores (P = 0.0001 for all except cough (P = 0.043), weakness (P = 0.015), paresthesia (P = 0.027), and anosmia (P = 0.039)). Lower disease duration, hospitalization during acute COVID-19, steroid use, smoking, and biologics non-use were significantly associated with higher PCS symptoms. Smoking was a significant risk factor (P = 0.048), and biologics use was protective (P = 0.03). Rheumatic disease patients who received two doses of the COVID-19 vaccinations had better scores on the FSS, HADS for anxiety and depression, and MMSE than those who received a single dose (P = 0.005, P = 0.001, P = 0.009, P = 0.01). Conclusion: Rheumatic disease patients have a higher prevalence and risk of PCS, so strict follow-up, avoiding smoking, controlling disease activity, and COVID-19 vaccinations are essential for decreasing the morbidity of PCS.