The ClinicianThe ClinicianКлиницист1818-83382412-8775Publishing House ABV Press47210.17650/1818-8338-2021-15-1-4-K650REVIEWОБЗОРMusculoskeletal manifectations of the new coronavirus infection: focus on arthralgia and myalgiaСкелетно-мышечные проявления новой коронавирусной инфекции: фокус на артралгии и миалгииhttps://orcid.org/0000-0003-4669-1006ShostakN. A.ШостакН. А.
Russian Federation

1 Ostrovityanova St., Moscow 117997, Russia

Россия, 117997 Москва, ул. Островитянова, 1

https://orcid.org/0000-0002-7410-9784KlimenkoA. A.КлименкоА. А.
Russian Federation

1 Ostrovityanova St., Moscow 117997, Russia

Россия, 117997 Москва, ул. Островитянова, 1

https://orcid.org/0000-0001-6890-8777DemidovaN. A.ДемидоваН. А.
Russian Federation

Natalia Aleksandrovna Demidova

1 Ostrovityanova St., Moscow 117997, Russia

Наталья Александровна Демидова

Россия, 117997 Москва, ул. Островитянова, 1

ndemidova03@gmail.comKondrashovA. A.КондрашовА. А.
Russian Federation

1 Ostrovityanova St., Moscow 117997, Russia

Россия, 117997 Москва, ул. Островитянова, 1

https://orcid.org/0000-0001-8266-6022AndryashkinaD. Yu.АндрияшкинаД. Ю.
Russian Federation

1 Ostrovityanova St., Moscow 117997, Russia

Россия, 117997 Москва, ул. Островитянова, 1

https://orcid.org/0000-0002-0457-8921SaakyanYu. M.СаакянЮ. М.
Russian Federation

1 Ostrovityanova St., Moscow 117997, Russia

Россия, 117997 Москва, ул. Островитянова, 1

https://orcid.org/0000-0002-7932-6323VaraksinG. A.ВараксинГ. А.
Russian Federation

1 Ostrovityanova St., Moscow 117997, Russia

Россия, 117997 Москва, ул. Островитянова, 1

https://orcid.org/0000-0001-6528-9093TarantinaA. Yu.ТарантинаА. Ю.
Russian Federation

1 Ostrovityanova St., Moscow 117997, Russia

Россия, 117997 Москва, ул. Островитянова, 1

Pirogov Russian National Research Medical University, Ministry of Health of RussiaФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава России15102021151-431410503202205032022Copyright ©; 2021, Shostak N.A., Klimenko A.A., Demidova N.A., Kondrashov A.A., Andryashkina D.Y., Saakyan Y.M., Varaksin G.A., Tarantina A.Y.Copyright ©; 2021, Шостак Н.А., Клименко А.А., Демидова Н.А., Кондрашов А.А., Андрияшкина Д.Ю., Саакян Ю.М., Вараксин Г.А., Тарантина А.Ю.2021Shostak N.A., Klimenko A.A., Demidova N.A., Kondrashov A.A., Andryashkina D.Y., Saakyan Y.M., Varaksin G.A., Tarantina A.Y.Шостак Н.А., Клименко А.А., Демидова Н.А., Кондрашов А.А., Андрияшкина Д.Ю., Саакян Ю.М., Вараксин Г.А., Тарантина А.Ю.https://creativecommons.org/licenses/by/4.0https://klinitsist.abvpress.ru/Klin/article/view/472

The new coronavirus infection (COVID-19) is associated with a wide spectrum of various clinical manifestations including involvement of the musculoskeletal system which can persist for a long time after the infection. Supposedly, pathogenesis of musculoskeletal manifestations of COVID-19 is primarily caused by systemic inflammation accompanied by cytokine hyperexpression (interferon γ, interleukins 1β, 6, 8, 17, tumor necrosis factor α), as well as hypoxia leading to overproduction of inflammatory cytokines, activation of bone reabsorption by osteoclasts and subsequent decrease of mineral bone density and osteonecrosis in some cases. Additionally, some drugs prescribed to patients with COVID-19 (some antiviral drugs and glucocorticoids) should also be taken into account as they can lead to development of musculoskeletal pathology. In the acute period of COVID-19, myalgias are common, but in rare cases myositis with proximal muscular weakness and increased levels of creatine phosphokinase, lactate dehydrogenase can occur. Arthralgias in the acute period of COVID-19 are rarer than myalgias. In the studies of clinical manifestation of COVID-19, frequency of arthralgias and myalgias in the acute period is between 15.5 and 50 %. After COVID-19, frequency of arthralgias and myalgias gradually decreases, however there are cases of long-term joint and muscle pains, as well as post-viral arthritis, development of arthritis in the context of various autoimmune disorders. Myalgias and arthralgias during COVID-19 usually regress spontaneously and in most patients do not require prescription of antipain medications, but in some cases pain management is necessary. Use of non-steroid anti-inflammatory drugs and vitamin D during COVID-19 is a safe and effective method of pain management, including myalgia and arthralgia. Rehabilitation programs play an important role in improvement of functional state and patient recovery after moderate and severe COVID-19.

При новой коронавирусной инфекции (COVID-19) возможен большой спектр различных клинических проявлений, в том числе поражения скелетно-мышечной системы, зачастую длительно сохраняющихся после перенесенной инфекции. Предполагается, что в патогенезе мышечно-суставных проявлений COVID-19 основную роль играет системное воспаление, сопровождающееся гиперэкспрессией цитокинов (интерферон γ, интерлейкины 1β, 6, 8, 17, фактор некроза опухоли α), а также гипоксия, вызывающая перепроизводство воспалительных цитокинов, активацию резорбции кости остеокластами, что приводит к снижению минеральной плотности костной ткани и в некоторых случаях – к развитию остеонекроза. Также следует учитывать возможность развития патологии скелетно-мышечной системы вследствие воздействия лекарственных препаратов, которые назначаются пациенту с COVID-19 (некоторые противовирусные препараты и глюкокортикоиды). В остром периоде COVID-19 наиболее часто наблюдаются миалгии, однако в редких случаях может возникать миозит с развитием проксимальной мышечной слабости и повышением уровня креатинфосфокиназы, лактатдегидрогеназы. Артралгии в остром периоде COVID-19 наблюдаются реже, чем миалгии. В исследованиях, посвященных клиническим проявлениям COVID-19, частота артралгий и миалгий в остром периоде составляет от 15,5 до 50 %. После перенесенного COVID-19 их частота постепенно снижается, однако описаны случаи длительных болей в суставах и мышцах, а также случаи поствирусного артрита, развитие артритов в рамках различных аутоиммунных заболеваний. Миалгии и артралгии при COVID-19, как правило, регрессируют самостоятельно и у большинства больных не требуют назначения обезболивающих препаратов, однако в некоторых случаях необходимо купирование болевого синдрома. Применение нестероидных противовоспалительных препаратов и витамина D при COVID-19 безопасно и эффективно для купирования боли, в частности, миалгии и артралгии. Большое значение имеют программы реабилитации для улучшения функционального состояния и восстановления пациентов, перенесших умеренное и тяжелое течение COVID-19.

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