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Clinical case
Reactive arthritis after COVID-19 infection
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  • Published on:
    Viral or Reactive Arthritis?
    • Simone Parisi, Rheumatologist Rheumatology Unit, Azienda Ospedaliero Universitaria Città Della Salute e della Scienza di Torino, Turin, Italy
    • Other Contributors:
      • Richard Borrelli, Physician
      • Maria Chiara Ditto, Rheumatologist
      • Enrico Fusaro, Rheumaotologist

    Dear Editor,
    We have read with interest the paper written by Dr. Keisuke Ono et al [1] whose title is “Reactive arthritis after COVID-19 infection” and we would like to share some medical thoughts we have concerning its content.
    In this paper, a male patient was admitted with COVID-19 pneumonia. On day 21, he developed an acute bilateral arthritis in his ankles, with mild enthesitis in his right Achilles tendon; given the circumstances and having excluded all the other plausible factors that might be related with this onset, the authors stated that such elements were given by a reactive arthritis whose primer was SARS-CoV-2.
    Regarding the definition of reactive arthritis (ReA), we would like to highlight some doubts and we belive that this element is contradicts the nature of ReA itself; first of all, as of today, ReA is to be given by bacterial infections only, should they be STDs-related or gastrointestinal. No viral agent has ever been either directly or indirectly linked to such element due to its pathogenesis. As Dr. Rebanta K. et al. properly stated in their papers, when ReA- associated invasive bacteria reach the systemic circulation, T lymphocytes are induced by bacterial fragments such as lipopolysaccharide and nucleic acids; These elements activate cytotoxic-T cells then attack the synovium and other self-antigens through molecular mimicry. It is believed that anti-bacterial cytokine response is also impaired in ReA, resulting in the decreased e...

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    Conflict of Interest:
    None declared.