After almost two years of the pandemic of the new coronavirus covid-19, which today affects millions of people around the world, the attention of doctors and scientists is increasingly drawn to the condition of patients who have undergone covid and are faced with new painful symptoms – the so-called postcovid.
The term – post covid or post covid state appeared back in the spring of 2020, at the same time in social networks those who had had a mysterious infection began to unite into groups, such as “Atypical covid (post covid)” – one of the most popular communities on Russian Facebook today – to exchange rehabilitation experiences , mutual support, finding the right specialists. And the representative of the American community of patients, who suffered from debilitating symptoms of covid for 150 days, Hannah Davis even spoke at a meeting of the WHO, urging to pay close attention to the problems of people with “long covid”. Thanks to this “worldwide” activity of doctors and patients, postcoid syndrome was finally included as a separate condition in the International Classifier of Diseases.
“Today we see that the consequences of the disease – the so-called long covid – can last six to nine months or more,” he said recently Russian Minister of Health Mikhail Murashko…
According to the minister, symptoms that persist for such a long time may involve various body systems. Patients have neurological disorders, including cognitive disorders, memory problems, increased fatigue, various manifestations of the cardiovascular system, respiratory system, and musculoskeletal system.
– The defeat of the joints with covid most often proceeds according to the type of reactive arthritis, – said “SP” doctor – rheumatologist of the Medical Scientific and Educational Center of the Moscow State University named after M.V. Lomonosov Evgeny Borisov…
Trying to fight the virus, our immunity sometimes fails, begins to perceive the structures of our own body as alien and attack them. This can happen if, for example, a virus manages to change the structure of certain proteins – they become unrecognizable by the immune system, which leads to an autoimmune reaction. Defending itself, the system is capable of attacking almost any organ. In particular, redness, pain occurs in the joints, the joint is not bent well. The developing inflammation and tissue damage can provoke rheumatoid arthritis even in a previously healthy person.
“SP”: – How can doctors help such patients?
– For artificial suppression of immunity in case of a hyperimmune response, rheumatologists (and doctors of other specialties too) have a large set of so-called immunosuppressive drugs, glucocorticosteroids, etc. in the arsenal of rheumatologists on specific links of immunity. All of them are used in the treatment of the acute stage of the disease during covid infection. In the postcovid, a more gentle therapy is used.
Now there is evidence that articular lesions can occur even 4 weeks after the illness, when the patient seems to have completely recovered from covid. Sometimes, even up to six months, an increase in temperature to 37.2-37.5, exhausting fever can persist. What to do about it? Symptomatic treatment is selected individually – after all, in each specific case, it is necessary to find out which structures of the body were susceptible to secondary post-ovid lesions. Often, for this, different specialists have to come together, because several body systems at once (both the lungs, and the gastrointestinal tract, and joints) can be affected at the same time. At the same time, there are no established treatment regimens for this new disease yet; everything is invented on the go.
“SP”: – If, after covid, a patient fell ill with, for example, rheumatoid arthritis, does this mean that he had a predisposition to this disease before? Or can it even occur in an absolutely healthy person?
– Practice shows that covid can act as a trigger or trigger for the occurrence of autoimmune diseases (rheumatoid arthritis, vasculitis, systemic lupus erythematosus), which a person has never had before. But all these diseases are multifactorial, that is, they do not have one specific pathogen, as in pneumonia, for example. An example with atherosclerosis is more likely to be used here: whether it happens or not depends on the genetic predisposition, and on the lifestyle, bad habits, and the level of blood pressure. In the case of systemic diseases of the connective tissue, environmental factors, the place where a person lives, and the presence of foci of chronic infection in his body also play a role. Smoking also increases the likelihood of rheumatoid arthritis.… And if a person has at least 1-2 predisposing factors (heredity plus lifestyle plus smoking) and he falls ill with covid, this is the very trigger when the disease debuts. Although before that he was “healthy” and it is not yet known whether he would have been ill if not for the covid.
“SP”: – What kind of rehabilitation is needed for the affected joints? And how can the patient help himself?
– As you know, for any joint damage,not associated with autoimmune diseases, classical methods work well: physiotherapy, water therapy, remedial gymnastics. Even with age-related changes, physical activity is very important. A minimum of 60 – 90 minutes a day of walking, at a comfortable pace, without overstraining – it is desirable that the shoes have orthopedic insoles made under the arch of the foot. A visit to the pool, yoga, tai chi (these types of gymnastics are also included in the European recommendations for the treatment of osteoarthritis, they are also suitable for the rehabilitation of patients with postcoid syndrome).)
BUT! If the cause of the pain is autoimmune, all this cannot be done – neither do physiotherapy, nor overexert the joint. Therefore, for any pain in the joints, a person must first of all consult a doctor in order to determine the appropriateness, volume of a particular load and not harm.
Julia Manuylova, endocrinologist, Moscow State University Medical Research Center:
During the rehabilitation period of postcoid patients, we, endocrinologists, often have to deal with complications associated with overweight and diabetes mellitus decompensated in the process of covid-19 disease. The sharp increase in weight is especially striking. For example, some patients came to me with complaints that during self-isolation they gained up to 20 kilograms. This may be due to changes in lifestyle and eating behavior during illness, and in connection with the intake of certain medications (glucocorticosteroids, for example). Of course, we deal with each specific case individually, but in general, the classical approach is quite applicable to the treatment of post-obesity: reducing calories and increasing activity so that more calories are consumed than came with food.
Today, a large amount of data has already been accumulated confirming that with any chronic inflammatory disease, the risk of severe covid course increases and, accordingly, recovery is more difficult and longer. For example, people with diabetes are very hard to tolerate covid, which is also often accompanied by obesity (and in the process of treatment, patients, as you know, have to mostly lie on their stomach). All diabetics, in addition to the main treatment for coronavirus, need additional therapy, since even with ordinary acute respiratory viral infections, such patients have an increase in glucose levels, not to mention procovid. And during the rehabilitation period, the therapy that the patient is prescribed in connection with diabetes also has to be adjusted. So far, there is no reliable information that the number of complications associated with thyroid diseases is increasing in the postcovid. There was also no increase in the incidence of type 1 diabetes (as complications after covid-19). However, there is evidence that the covid virus acts on the pancreas, as a result of which the glucose level rises and signs of diabetes appear, which in the future, during the treatment of covid, may disappear on their own.