Background/Purpose: Since its discovery in Wuhan, China, severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) has ravaged the globe on an unprecedented scale. While coronavirus disease (COVID-19) was initially thought to be an acute disease only, protracted symptomatology led to the characterisation of post-acute COVID-19 syndrome (PACS). PACS is now recognised as a bonafide array of multi-systemic clinical manifestations 12 weeks beyond the onset of acute symptoms that is not attributable to alternative pre-covid diagnoses. The prevalence of musculoskeletal (MSK) manifestations in PACS has been demonstrated in different populations with Fibromyalgia (FM) in post-acute COVID-19 being identified as a new facet of PACS. MSK manifestations have decreased the quality of life (QoL) of patients affecting their self-care, mental health, work ethic and livelihood.
Our study set out to determine the prevalence of MSK manifestations in post-acute COVID-19 syndrome patients and their quality of life at Kenyatta National Hospital (KNH). We also set out to determine the prevalence of Fibromyalgia as a rheumatological diagnosis of interest in PACS.

Methods: A descriptive cross-sectional study conducted at KNH, a tertiary (Level 6) regional referral hospital in Nairobi, Kenya. We recruited 101 patients, randomly sampled from the inpatient COVID-19 database. Following screening for eligibility, contact via phone was established and patients who consented verbally were scheduled for physical participation where written consent was taken. A chart review was done prior to the PI-participant physical encounter. Study tools were filled by participants and a musculoskeletal examination was conducted by the Principal Investigator (PI). MSK manifestations were recorded accordingly. Diagnosis of Fibromyalgia was done using the American College of Rheumatology (ACR) criteria and assessment of QoL was done using the 36-item short form (SF 36) questionnaire.

Results: The prevalence of MSK manifestations in PACS was 57.4% (95% CI 47.5% – 66.3%), the most common being fatigue (65.5%), arthralgia (58.6%) and myalgia (53.4%). The prevalence of Fibromyalgia was documented at 10.9% (95% CI 5.9% – 17.8%). Patients with MSK manifestations were 6.8 times more likely to have poor QoL than those without MSK manifestations. All the 8 domains of the SF 36 were adversely impaired among PACS patients with MSK manifestations; physical health (mean score 5.3+/-4.5 SD) and emotional wellness (mean score 10.4+/-5.8 SD) being the most affected categories. PACS patients with MSK manifestations were more likely to be female, who had a high BMI and long duration of hospital stay where they were treated with steroids in the acute phase of COVID-19. Smokers were also more likely to develop MSK manifestations. We did not elicit presence of comorbidity, older age and positive vaccination status as independent associated factors.

Conclusion: MSK manifestations in PACS are significant clinical features affecting 57.4% of COVID-19 survivors, who are about 7 times more likely to have poor QoL, adversely influencing their productivity for work and livelihood.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-musculoskeletal-manifestations-in-post-acute-covid-19-patients-and-their-quality-of-life-at-kenyatta-national-hospital/