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      Arthralgia as an initial presentation of COVID-19: observation

      , 1 , 2

      Rheumatology International

      Springer Berlin Heidelberg

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          Dear Editor, Arthralgia is an important clinical complaint seen in many virus infections. For a new emerging disease from China, COVID-19 [1], the data on the rheumatic manifestation are limited. In a clinical epidemiology report published in Lancet, no data on joint complaint of the patients are mentioned [2, 3]. Here, the authors would like to share observation from Thailand, the second country where the disease exists [4]. In Thailand, at present (28 February 2020), there are 40 patients. Of these 40 patients, at least one patient (2.5%) presented with joint pain complaint. The case is a female patient who initially presented with high fever and low platelet count was observed. The patient further developed respiratory difficulty and pneumonia was detected. The diagnosis of the test is by molecular diagnosis for COVID-19. This case was primarily miss diagnosed as dengue in a local hospital and the patient was referred to tertiary care hospital after COVID-19 was confirmed. The patient was managed by the standard respiratory supportive care and full recovered. This report can imply the importance of rheumatic complaint in COVID-19. In the setting where viral arthropod borne disease is common, the COVID-19 with arthralgia might be easily missed.

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          Most cited references 4

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          Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

          Summary Background In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding National Key R&D Program of China.
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            Emerging new coronavirus infection in Wuhan, China: Situation in early 2020

             W Hsia (2020)
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              Food for Thought: The Role of Undernutrition and Diabetes in India’s TB Epidemic


                Author and article information

                Rheumatol Int
                Rheumatol. Int
                Rheumatology International
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                28 March 2020
                : 1
                [1 ]Sanitation1 Medical Academic Center, Bangkok, Thailand
                [2 ]GRID grid.440681.f, Dr DY Patil University, ; Pune, India
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.




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