This is important for our readers who treat chronic pain patients.
Author: Denise Baez
Muscle involvement and peripheral nerve affection are common problems after infection with coronavirus disease 2019 (COVID-19), even among individuals who were asymptomatic, according to a study published in International Journal of Rheumatic Diseases.
The study, which included 400 patients with a history of COVID-19 infection with (n = 210) or without (n = 190) symptoms, found that the overall prevalence of peripheral neuropathy and myopathy after COVID-19 infection was 56.3%. Among symptomatic patients, the prevalence was 81%, and among asymptomatic patients, the prevalence was 28.8%.
In the symptomatic group, about 57.2% had neuropathy, and 24% had myopathy, compared with 21% and 7.8%, respectively, in the asymptomatic group.
“To the best of our knowledge, this is the first study conducted on a large sample of patients with variable durations after infection with COVID-19, and the first to document sensorimotor axonal and demyelinating neuropathy and myopathy even among asymptomatic post-COVID-19 patients, with clarification of the risk factors of developing neuromuscular affection among them,” wrote Dalia Salah Saif, MD, Shebin El-Kom, Menoufia, Egypt, and colleagues.
Risk factors for developing myopathy and neuropathy that were significantly higher in the symptomatic group included hospitalisation (42.8% of symptomatic patients were hospitalised vs 6.3% in the asymptomatic group), long-lasting respiratory symptoms (15.2% vs 2.6%), and severe respiratory symptoms (22.3% vs 3.7%).
Univariate analysis of the suggested risk factors for post-COVID-19 neuromuscular affection included hospitalisation (odds ratio [OR] = 9.7; 95% confidence interval [CI], 1.5-23.8), long-lasting respiratory symptoms of more than 2 weeks (OR = 8.9; 95% CI, 2.7-10.6), and the presence of severe respiratory symptoms during infection (OR = 10.4; 95% CI, 3.2-21.4). Multivariate regression analysis showed that the presence of long-lasting, and severe respiratory symptoms were independent risk factors for the occurrence of post-COVID-19 neuromuscular complications (OR = 6.2, 95% CI, 1.7-9.5 and OR = 7.5, 95% CI, 1.1-12.4).
The study also included 30 gender- and age-matched healthy controls for comparison. There were significant differences between the COVID-19 group and the control group in regards to serum creatine phosphokinase (CPK) levels, clinical signs, and electrophysiologic findings of neuropathy and myopathy, with more prominent features among patients who were symptomatic.
Serum CPK was 754 ± 120 μg/mL in the symptomatic group, 221 ± 65 μg/mL in the asymptomatic group, and 93 ± 7.9 μg/mL in the control group. Rates of decreased/absent ankle reflexes were 22%, 5%, and 0%, respectively. Impaired pinprick sensation of feet/toes occurred in 26%, 4.7%, and 0%, respectively. Impaired vibration of toes occurred in 32%, 5.8%, and 0%, respectively.
The findings suggest that “neuromuscular involvement is a common complication after COVID-19 infection, even in asymptomatic patients, and the different degrees of affection and functional impairment in different studies can be explained according to the severity of COVID-19 infection and the presence of other risk factors in those patients,” the authors wrote. “Thus, in order to improve management and prevent a worsening of the patients’ outcomes, we must be aware of the presence of any neurologic symptoms in patients after COVID-19 infection.”