I have recently seen some posts about reactive arthritis following COVID-19 and would like to share a case with you. A 68 year old woman with a history of gout presented with pain and stiffness in her shoulders and hips 6 weeks after COVID-19 infection (the symptoms appeared 2 weeks after testing positive). She had a raised ESR and CRP and was treated with steroids for polymyalgia rheumatica. Despite prompt treatment, she soon developed temporal artery tenderness, headaches and blurry vision. She had to be admitted to hospital for IV methylprednisolone for giant cell arteritis. 

Although rheumatological conditions after COVID-19 seems to be not so uncommon, it is important to remember to follow-up these patients for ongoing development. Have you seen similar cases? 

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Mamootil D.

Link to publication

Mamootil D (July 16, 2023) New-Onset Polymyalgia Rheumatica Complicated by Giant Cell Arteritis Following COVID-19 Infection. Cureus 15(7): e41951. doi:10.7759/cureus.41951

Copyright © 2023 Mamootil D

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

I want to know if anyone has noticed chronic changes in chest x-rays or CT scans after COVID-19 infections. I have noticed that pulmonary fibrosis is quite common after severe COVID-19. Recently, I also saw cavitary lesions 8 weeks on CT scan following a patient's acute infection. In this case, he also had pulmonary embolism secondary to the infection. Has anyone else seen this?

Three and a half years after the virus behind COVID-19 began its rampage around the world — eventually killing tens of thousands of Canadians — a group of top medical experts is calling on federal officials to launch a full national inquiry into Canada's pandemic response.In a sweeping set of editorials and analysis papers published today in the British Medical Journal (BMJ), more than a dozen physicians and health advocates are shining a spotlight on what they've dubbed the country's "major pandemic failures," from the devastation in long-term care homes, to vaccine hoarding, to higher death rates among lower-income communities. Those shortcomings all played out against the backdrop of the country's complex, fragmented health-care system. That decentralized approach, the authors argue, led to dramatic differences in how each province handled the spread of SARS-CoV-2, the virus first reported in Canada in Jan. 2020.

When compared with the "shambolic" U.K. response and the "chaos and divisiveness" of the U.S., Canada appeared to rise to the occasion when COVID hit, wrote several authors in an introductory editorial, including Dr. Jocalyn Clark, a Canadian physician who is currently the BMJ's international editor. Yet the reality, the papers explain, remains far more nuanced, with the full scope of successes and failures still unclear. "We wouldn't know because no pandemic inquiry has been established by its federal government," the group continued. "This is a mistake."

The most important reason for an inquiry, the group stated, is accountability for the losses of the pandemic, after more than 50,000 direct deaths, millions of additional infections that "devastated families" across Canada, and a lasting legacy of Long COVID patients...Read more

How important is an inquiry like this in your opinion?

MONDAY, July 24, 2023 (HealthDay News) -- Amygdala and insula retraining (AIR), a neuroplasticity program, may be a viable means of reducing fatigue and increasing energy among patients with long COVID, according to a study published online July 17 in the Evidence-Based Complementary and Alternative Medicine Journal.

Loren L. Toussaint, Ph.D., from Luther College in Decorah, Iowa, and Alexandra J. Bratty, M.B.A., Ph.D., from AB Research Consulting in Las Vegas, randomly assigned 100 participants (aged 21 to 65 years) with postviral symptoms at least three months after an acute COVID-19 infection to AIR or control.

The researchers found a significant decrease in participants' fatigue and a significant increase in their energy after the three-month AIR intervention. Fatigue reduction was nearly four times higher in the AIR group versus the control group, while the absolute reduction in mean scores for the AIR group was more than double that of the control group. Similarly, the effect size in energy enhancement among AIR participants was twice that of the control group, and the absolute increase in energy mean scores for the AIR group was almost double that of the control group.

"These findings are both timely and pertinent, as so little is known about how to treat long COVID and so many patients suffer from it after the acute infection of COVID-19," the authors write.

Bratty is the CEO of AB Research Consulting, which provides consulting services to The Gupta Program, the commercial version of the AIR intervention; Bratty's company was compensated for this work by independent donors.

Abstract/Full Text

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BMC

Primary care services are key to population health and for the efficient and equitable organisation of national health systems. This is why they are often financed through public funds. Primary care doctors are instrumental for the delivery of preventive services, continuity of care, and for the referral of patients through the system. These cadres are also the single largest health expenditure at the core of such services. Although recruitment and retention of primary care doctors have always been challenging, shortages are now exacerbated by higher demand for services from aging populations, increased burden of chronic diseases, backlogs from the COVID-19 pandemic, and patient expectations. At the same time, the supply of primary care physicians is constrained by rising retirement rates, internal and external migration, worsening working conditions, budget cuts, and increased burnout. Misalignment between national education sectors and labour markets is becoming apparent, compounding staff shortages and maldistribution.

With their predominantly publicly funded health systems and in the aftermath of COVID-19, countries of the European region appear to be now on the cusp of a multi-layered, slow-burning primary care crisis, with almost every country reporting long waiting lists for doctor appointments, shortages of physicians, unfilled vacancies, and consequently, added pressures on hospitals’ Accident and Emergency services. This articles collection aims at pulling together the evidence from countries of the European Region on root causes of such workforce crisis, impacts, and effectiveness of existing policies to mitigate it. 

Recruiting and retaining PHC doctors has historically been complex, as general practice is by some considered less attractive than other medical specialties. It often entails rural deployment and worse working conditions, higher burn-out rates, comparatively lower pay and prestige. However, new demand as well as supply-side factors seem to be rocking the medical labour market in Europe, particularly in the aftermath of the COVID-19 pandemic...Read more

Is this a problem that has no solution?