Arthritis and Long COVID: A Double Whammy

“Long COVID” lays a particularly heavy burden on people with pre-existing arthritis, a Canadian survey study indicated.

Worsened pain and greater functional limitations relative to their status prior to COVID-19 infection were reported by most individuals in Laval, Quebec, who had some type of arthritis and developed post-acute COVID symptoms following initial infection, according to Debbie Ehrmann Feldman, PhD, of the University of Montreal, and Barbara Mazer, PhD, of McGill University, also in Montreal.

Just over half of these patients said they had experienced moderately to severely increased susceptibility to fatigue, and 42% complained of markedly more breathlessness when climbing stairs, the pair reported in Arthritis Care & Research. Some 37% indicated they now had moderately or severely increased pain.

While fewer than 20% of respondents graded pre-COVID mobility and activity status as poor, about half did so for their current abilities:

• Mobility: pre-COVID 18.5% poor, with long COVID 45.7% poor
• Usual activities: pre-COVID 9.3% poor, with long COVID 52.5% poor

Furthermore, the unemployment rate among respondents with long COVID doubled after infection (14.5% pre-COVID vs 28% with long COVID). For context, among respondents without long COVID, their rate of unemployment rose from 13.8% pre-COVID to 19.0% at the time of the survey.

“Prevention of COVID is key for persons with arthritis. However, for those who are infected with COVID and develop long COVID, there is a need to implement timely and effective interventions to improve functional status,” Feldman and Mazer wrote.

The researchers said they undertook the study to get a better grasp of how long COVID affects people with arthritis, who already have to cope with pain and difficulties with daily activities.

Feldman and Mazer worked with public health authorities in Laval, a large (population about 450,000) suburb of Montreal, to identify long COVID patients with pre-existing arthritis. Officials provided email addresses for some 41,000 city residents who had confirmed COVID-19 (i.e., symptoms plus positive SARS-CoV-2 test).

A survey comprising two questionnaires was sent to these addresses in mid-2022, with 2,764 responses received. Of those, 171 said they had some type of arthritis (the researchers did not ask about specific types), with 91 also indicating they had lingering COVID-type symptoms.

Mean age for the 171 reporting an arthritis history was 56 and 78% were women. Median time from positive COVID test to survey completion was 410 days (range 95-1,040). Some 10% had been hospitalized for COVID-19.

Risk factors for developing long COVID in the arthritis group included female sex (OR 3.42, 95% CI 1.24-9.44), one or more comorbidities (OR 2.77, 95% CI 1.23-6.22), and hospitalization for COVID (OR 6.08, 95% CI 1.00-36.9).

The survey asked about 21 types of health and functional issues, ranging from fatigue and respiratory symptoms to walking ability, mental status, and sensory abilities. For each item, participants indicated whether they had experienced small, moderate, or severe changes following COVID-19 infection.

Only a few participants indicated that they had experienced worsening gastrointestinal function, speech, or hearing. However, in line with the roughly 50% who reported long COVID, substantial worsening of symptoms typical of that condition (cognitive difficulties, fatigue, breathing problems) were endorsed by 35%-50% of respondents.

Many others said they had relatively minor worsening of problems. Only 12% of participants said they had no increase at all in susceptibility to fatigue, and just 30% did not complain of any worsened pain or discomfort.

Self-described overall health status also got a lot worse for those with long COVID. Among those respondents, 78% graded their pre-COVID global health level as good; with long COVID, only 31% did so. Pre-COVID “poor” ratings were given by 3%, which increased to 24% at the time of survey completion.

To some extent, these results indicate that people with arthritis are at greater risk for long COVID, and suffer greater burdens from it, relative to the general population with post-acute symptoms, Feldman and Mazer noted. While the prevalence of long COVID was 38% in the entire set of 2,764 responses, it was 54% for those reporting pre-existing arthritis. The greater burden was exemplified by the differences in unemployment status between those with arthritis (28%) and those without (19%) after experiencing long COVID.

Limitations to the analysis included the geographic restriction to one Canadian city and its reliance on self-reports of health status and medical history. The survey response rate of less than 10% was another limitation, such that results might best be considered to represent individuals motivated to share their experiences.

Also, since the survey was completed long after contracting COVID, participants’ recollections of their pre-pandemic status may have been colored by their current condition. Finally, the relatively small number of respondents with both arthritis history and long COVID meant the statistical correlations came with wide confidence intervals.