Table 7 Musculoskeletal Manifestation of SARS-CoV, MERS-CoV and COVID-19.
SARS (only studies with large study population included)
Study Lee et al (2003)N = 138, confirmed casesRetrospective study Donnelly et al (2003)N = 1425, confirmed casesRetrospective study Choi et al (2003)N = 267 (227 confirmed cases)Retrospective study Chen et al (2005)N = 67, confirmed casesRetrospective study Leung et al (2005)N = 8, probableClinicopathologic study Yu et al (2006)N = 121, confirmed casesRetrospective study
Clinical features Myalgia: 60.9% Myalgia: 50.8% Myalgia: 50% Myalgia/arthralgia: 13.4% N/A Myalgia: 71%
Key findings on investigations ↑ CK (32.1%) N/A N/A ↑ CK (20.9%) ↑ CK ↑CK (26%)
Histopathology N/A N/A N/A N/A • Focal myofiber coagulative necrosis
• Myofiber atrophy in patients who received steroids
• No virus detected or cultured N/A
Key study findings and message High peak CK predictive of ICU admission and death (univariate, P = 0.04)(Association with CK on admission had P = 0.06) Myalgia commonly reported No significant difference in CK levels in probable and confirmed patients No difference in reporting of myalgia/arthralgia in patients with ARDS vs. without • Higher CK associated with more myofiber necrosis
• Myopathy possibly immune mediated, possible component of steroid and critical illness myopathy • ↑CK likely due to myositis as cardiac enzymes normal
MERS
Study Omrani et al (2013)N = 3, confirmed casesRetrospective study Saad et al (2014)N = 70, confirmed casesRetrospective study Kim et al (2017)N = 23, confirmed casesRetrospective study Alsaad et al (2017)N = 1,Clinicopathologic
Signs and symptoms Myalgia or arthralgia: 20% Myalgia or arthralgia: 26.9% N/A
Labs ↑ CK N/A Electromyogram in 1 normal N/A
Histopathology N/A N/A N/A • Atrophic and myopathic changes
• Inflammatory changes in perimysium and endomysium, more in areas of atrophy
• Viral particles detected in macrophages infiltrating muscles
Key study findings and message Mild/asymptomatic cases may contribute to spread more than recognised Myalgia/arthralgia common nonrespiratory symptom Neuromuscular complications during MERS treatment may be underdiagnosed • Muscle atrophy and inflammation
• Viral particles in muscle
COVID-19
Study Huang et al (2020)N = 41, confirmed casesRetrospective study Chen et al (2020)N = 99, confirmed casesRetrospective Wang et al (2020)N = 138, confirmed cases, Retrospective study Guan et al (2020)N = 1099, confirmed casesRetrospective study Li et al (2020)N = 1994, confirmed casesMeta-analysis, 10 studies Zhang et al (2020)N = 645, confirmed casesRetrospective study
Clinical features Myalgia or fatigue: 44% Myalgia: 11% Myalgia: 34.8% Myalgia or arthralgia: 14.9% Myalgia or fatigue: 35.8% (11-50%) Myalgia:11%
Key findings on investigations ↑ CK (33%) ↑ CK (13%) (associated with ↑ myocardial enzymes) ↑CK ↑ CK> = 200 U/mL: 13.7% ↑ CK: 13-33% ↑ CK
Key study findings and message No difference in level of CK in ICU and non-ICU patients Muscle ache less commonly reported Higher CK in ICU patients (P = 0.08) Muscle ache less commonly reported • Myalgia or fatigue more commonly reported
• 5% case fatality rate overall • Muscle ache at admission associated with more severe/critical disease (P = 0.002)
• Higher CK in patients with abnormal imaging (P < 0.05)
ARDS, acute respiratory distress syndrome; CK, creatine kinase; ICU, intensive care unit; MERS-CoV, middle east respiratory syndrome coronavirus; SARS-COV, severe acute respiratory syndrome coronavirus.