Musculoskeletal Manifestations in COVID-19 Patients at Paramilitary Hospital: A Cross-sectional Study

Introduction: Musculoskeletal symptoms are common in coronavirus disease 2019 (COVID-19) but are understudied in low-resource settings such as Nepal. This study aimed to assess the prevalence, spectrum, and severity of musculoskeletal manifestations in adults with acute COVID-19. Methods: We conducted a hospital-based, cross-sectional study at Nepal Armed Police Force Hospital, Kathmandu, from June to September 2023. Adults (≥18 years) with RT-PCR–confirmed COVID-19 were enrolled consecutively. Demographic, clinical, and laboratory data were collected. Musculoskeletal symptoms—myalgia, arthralgia, fatigue, low back pain, and paresthesia—were assessed using standardized questionnaires and severity scores (VAS/NRS). COVID-19 severity was classified per NIH criteria. Associations between symptom prevalence/severity and disease severity or viral load (Ct values) were analyzed using chi-square and ANOVA tests. Results: A total of 250 patients (47.6% male; mean age 49.8±18.1 years) were studied. Myalgia (70.0%), arthralgia (63.2%), and fatigue (61.2%) were the most frequent symptoms, followed by low back pain (44.0%) and paresthesia (4.4%). Symptom severity increased significantly with COVID-19 severity (p<0.001 for all). Myalgia, arthralgia, and fatigue had higher mean scores in moderate/ severe cases. There was a significant inverse association between RT-PCR Ct values and symptom severity, with higher viral loads correlating with more severe symptoms (p<0.001). Persistence of musculoskeletal symptoms at follow-up was observed exclusively in severe cases. Conclusions: Musculoskeletal symptoms, particularly myalgia, arthralgia, and fatigue, are highly prevalent and severe in COVID-19 patients in Nepal, with greater intensity in those with more severe disease and higher viral loads. Persistent symptoms after recovery highlight the need for integrated rheumatological and rehabilitative care in post-COVID management.