MRI Evaluation of Sacroiliac Joint Affection in Post-COVID Patients

Abstract Background SARS-CoV-2 has been a worldwide pandemic, which caused a great health burden to many countries and societies, both for the acute presentation, and the sequalae. The fact that the virus targets specific receptors that are shared between lung tissue and other body tissues led to the phenomenon of post-COVID manifestations outside the lungs, including but not exclusive to the joints, causing the emergence of a new entity of diseases, known as post-COVID arthritis. Aim of the Work to evaluate the sacroiliac inflammatory involvement in patients who have suffered from COVID-19 using magnetic resonance imaging (MRI) Patients and Methods All eligible Post COVID patients referred from orthopaedics or rheumatology clinics to MRI unit for MRI of the sacroiliac joint in the previous year and the proceeding six months -set date: February 2023- and who met the inclusion and exclusion criteria (at least 30 patients) were included in the study in order to evaluate the sacroiliac inflammatory involvement in post-COVID patients. Results the first cross-sectional study with MRI in post-COVID19 sacroiliitis. our patients complained of typical inflammatory lower back pain after the resolution of infectious symptoms, with clinical features of acute sacroiliitis (insidious onset, night pain, morning stiffness, improvement with exercise and NSAIDs, radiation to buttocks), as described after different infections or in the context of reactive arthritis or seronegative spondyloarthritis. that most of the patients were in the third and fourth decades, with more females (63.3%) than males (36.7%). Among those patients, 83.3% showed bilateral affection of the sacroiliac joints, while those presenting with unilateral sacroiliitis represented 16.7% with more cases having right sided affection compared to those with left sided affection. Most of the patients were on Non-steroidal anti-inflammatory drugs, and almost all patients had complete recovery of symptoms. In few cases treatment required the intake of steroids. Only three cases required intra-articular steroid injection. Conclusion magnetic resonance imaging of the sacroiliac joints in post-COVID patients who suffered from low back pain few days to weeks after the infection with the virus, showed the joint affection to be in the form of bilateral sacroiliitis in most cases, with few cases presenting with unilateral affection mainly on the right side. We also found that the majority of these patients responded well and fully recovered from the symptoms on NSAIDs.