«Постковидный синдром»: в центре внимания скелетно-мышечная боль

Борьба с последствиями COVID-19 – заболевания, вызванного новой коронавирусной инфекцией SARSCoV-2, – является серьезной и весьма актуальной задачей, стоящей перед современной медициной. COVID19 нередко имеет тяжелое течение и сопровождается полиорганным поражением, системным иммунным воспалением, коагулопатией, нейроэндокринными и метаболическими нарушениями. Даже при относительно благоприятном течении последствиями инфекции SARS-CoV-2 могут стать дегенеративные изменения многих органов (легочный фиброз, кардиосклероз), различные функциональные и психоэмоциональные расстройства. Вследствие этого у 10–50% пациентов в течение длительного времени после стихания острых проявлений COVID-19 и элиминации вируса сохраняются различные неприятные симптомы. Данная патология обозначается как «постковидный синдром» (ПКС). Основными элементами ПКС являются хроническая боль, утомляемость и психоэмоциональные проблемы. Функциональные нарушения, аутоиммунные процессы и тяжелый психологический дистресс после перенесенного COVID-19 могут вызывать развитие и обострение заболеваний, характеризующихся хронической болью и утомляемостью, таких как фибромиалгия и синдром хронической усталости. Терапия и профилактика ПКС включают коррекцию функциональных нарушений, контроль боли, последовательную физическую, психологическую и социальную реабилитацию. 

1. Насонов ЕЛ. Коронавирусная болезнь 2019 (COVID-19): размышления ревматолога. Научно-практическая ревматология. 2020;58(2):123-132. doi: 10.14412/1995-4484-2020-123-132

2. Spreeuwenberg P, Kroneman M, Paget J. Reassessing the global mortality burden of the 1918 influenza pandemic. Am J Epidemiol. 2018;187(12):2561-2567. doi: 10.1093/aje/kwy191

3. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). URL: https://origin-coronavirus.jhu.edu/map.html. (Accessed: 18th April 2021) .

4. Darif D, Hammi I, Kihel A, El Idrissi Saik I, Guessous F, Akarid K. The pro-inflammatory cytokines in COVID-19 pathogenesis: What goes wrong? Microb Pathog. 2021;18(153):104799. doi: 10.1016/j.micpath.2021.104799

5. Capaccione KM, Yang H, West E, Patel H, Ma H, Patel S, et al. Pathophysiology and imaging findings of COVID-19 infection: An organ-system based review. Acad Radiol. 2021;28(5):595-607. doi: 10.1016/j.acra.2021.01.022

6. Oronsky B, Larson C, Hammond TC, Oronsky A, Kesari S, Lybeck M, et al. A review of persistent post-COVID syndrome (PPCS). Clin Rev Allergy Immunol. 2021;20:1-9. doi: 10.1007/s12016-021-08848-3

7. Summary of ICD coding for COVID-19. URL: http://www.whofic.org.za/SummaryICDcoding.pdf (Accessed: 18 April 2021).

8. McDonald LT. Healing after COVID-19: are survivors at risk for pulmonary fibrosis? Am J Physiol Lung Cell Mol Physiol. 2021;320(2):L257-L265. doi: 10.1152/ajplung.00238.2020

9. Zhang C, Wu Z, Li JW, Tan K, Yang W, Zhao H, et al. Discharge may not be the end of treatment: Pay attention to pulmonary fibrosis caused by severe COVID-19. J Med Virol. 2021;93(3):1378-1386. doi: 10.1002/jmv.26634

10. Budi EH, Schaub JR, Decaris M, Turner S, Derynck R. TGF-beta as a driver of fibrosis: Physiological roles and therapeutic opportunities. J Pathol. 2021;254(62). doi: 10.1002/path.5680

11. Shchendrygina A, Nagel E, Puntmann VO, Valbuena-Lopez S. COVID-19 myocarditis and prospective heart failure burden. Expert Rev Cardiovasc Ther. 2021;19(1):5-14. doi: 10.1080/14779072.2021.1844005

12. Ferrara F, Vitiello A. Scientific and pharmacological rationale for the treatment of cardiac damage caused by COVID-19. Discov Med. 2020;30(161):155-161.

13. Di Minno A, Ambrosino P, Calcaterra I, Di Minno MND. COVID-19 and venous thromboembolism: A meta-analysis of literature studies. Semin Thromb Hemost. 2020;46(7):763-771. doi: 10.1055/s-0040-1715456

14. Zuin M, Rigatelli G, Zuliani G, Roncon L. The risk of thrombosis after acute-COVID-19 infection. QJM. 2021;15:hcab054. doi: 10.1093/qjmed/hcab054

15. Higgins V, Sohaei D, Diamandis EP, Prassas I. COVID-19: from an acute to chronic disease? Potential long-term health consequences. Crit Rev Clin Lab Sci. 2020;21:1-23. doi: 10.1080/10408363.2020.1860895

16. Amann K, Boor P, Wiech T, Singh J, Vonbrunn E, Knöll A, et al. COVID-19 effects on the kidney. Pathologe. 2021;1:1-5. doi: 10.1007/s00292-020-00900-x

17. Askari H, Sanadgol N, Azarnezhad A, Tajbakhsh A, Rafiei H, Safarpour AR, et al. Kidney diseases and COVID-19 infection: causes and effect, supportive therapeutics and nutritional perspectives. Heliyon. 2021;7(1):e06008. doi: 10.1016/j.heliyon.2021.e06008

18. Lahiri D, Ardila A. COVID-19 pandemic: A neurological perspective. Cureus. 2020;29;12(4):e7889. doi: 10.7759/cureus.7889

19. Javed A. Neurological associations of SARS-CoV-2 infection: A systematic review. CNS Neurol Disord Drug Targets. 2021;16. doi: 10.2174/1871527320666210216121211

20. Bandeira IP, Schlindwein MAM, Breis LC, Peron JPS, Gonçalves MVM. Neurological complications of the COVID-19 pandemic: What have we got so far? Adv Exp Med Biol. 2021;1321:21-31. doi: 10.1007/978-3-030-59261-5_2

21. Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, FusarPoli P, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: A systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020;7(7):611-627. doi: 10.1016/S2215-0366(20)30203-0

22. Dani M, Dirksen A, Taraborrelli P, Torocastro M, Panagopoulos D, Sutton R, et al. Autonomic dysfunction in ‘long COVID’: Rationale, physiology and management strategies. Clin Med (Lond). 2021;21(1):e63-e67. doi: 10.7861/clinmed.2020-0896

23. Østergaard L. SARS CoV-2 related microvascular damage and symptoms during and after COVID-19: Consequences of capillary transit-time changes, tissue hypoxia and inflammation. Physiol Rep. 2021;9(3):e14726. doi: 10.14814/phy2.14726

24. De Giorgio MR, Di Noia S, Morciano C, Conte D. The impact of SARS-CoV-2 on skeletal muscles. Acta Myol. 2020;1;39(4):307-312. doi: 10.36185/2532-1900-034

25. Somasundaram NP, Ranathunga I, Ratnasamy V, Wijewickrama PSA, Dissanayake HA, Yogendranathan N, et al. The impact of SARS-CoV-2 virus infection on the endocrine system. J Endocr Soc. 2020;2;4(8):bvaa082. doi: 10.1210/jendso/bvaa082

26. Ehrenfeld M, Tincani A, Andreoli L, Cattalini M, Greenbaum A, Kanduc D, et al. Covid-19 and autoimmunity. Autoimmun Rev. 2020;19(8):102597. doi: 10.1016/j.autrev.2020.102597

27. Dotan A, Muller S, Kanduc D, David P, Halpert G, Shoenfeld Y. The SARS-CoV-2 as an instrumental trigger of autoimmunity. Autoimmun Rev. 2021;19:102792. doi: 10.1016/j.autrev.2021.102792

28. Weng LM, Su X, Wang XQ. Pain symptoms in patients with coronavirus disease (COVID-19): A literature review. J Pain Res. 2021;26;14:147-159. doi: 10.2147/JPR.S269206

29. Walitt B, Bartrum E. A clinical primer for the expected and potential post-COVID-19 syndromes. Pain Rep. 2021;16;6(1):e887. doi: 10.1097/PR9.0000000000000887

30. Marinangeli F, Giarratano A, Petrini F. Chronic pain and COVID-19: Pathophysiological, clinical and organizational issues. Minerva Anestesiol. 2020. doi: 10.23736/S0375-9393.20.15029-6

31. Kemp Н, Corner Е, Colvin L. Chronic pain after COVID-19: Implications for rehabilitation. Br J Anaesth. 2020;125(4):436-440. doi: 10.1016/j.bja.2020.05.021

32. Galal I, Mohamed Hussein A, Amin M, Saad MM, Zayan HEE, Abdelsayed MZ, et al. Determinants of persistent post-COVID-19 symptoms: Value of a novel COVID-19 symptom score. The Egyptian Journal of Bronchology. 2021;15:10. doi: 10.1186/s43168-020-00049-4

33. Carfì A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;11;324(6):603-605. doi: 10.1001/jama.2020.12603

34. Halpin S, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol. 2021;93(2):1013-1022. doi: 10.1002/jmv.26368

35. Jacobs L, Paleoudis E, Bari D, Nyirenda T, Friedman T, Gupta A, et al. Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection. PLoS One. 2020;11;15(12):e0243882. doi: 10.1371/journal.pone.0243882

36. Meyer-Frießem CH, Gierthmühlen J, Baron R, Sommer C, Üçeyler N, Enax-Krumova EK. Pain during and after COVID-19 in Germany and worldwide: A narrative review of current knowledge. Pain Rep. 2021;20;6(1):e893. doi: 10.1097/PR9.0000000000000893

37. Soares FHC, Kubota GT, Fernandes AM, Hojo B, Couras C, Costa BV, et al. Prevalence and characteristics of new-onset pain in COVID-19 survivors, a controlled study. Eur J Pain. 2021. doi: 10.1002/ejp.1755

38. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: A cohort study. Lancet. 2021;397(10270):220-232. doi: 10.1016/S0140-6736(20)32656-8

39. Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo P, Cuapio A, et al. More than 50 long-term effects of COVID-19: A systematic review and meta-analysis. Res Sq. 2021:rs.3.rs-266574. doi: 10.21203/rs.3.rs-266574/v1

40. Himmels JPW, Qureshi SA, Brurberg KG, Gravningen KM. COVID-19: Long-term effects of COVID-19. Rapid review. URL: https://www.fhi.no/en/publ/2021/Long-Term-Effects-ofCOVID-19 (Accessed: 18th April 2021).

41. Attal N, Martinez V, Bouhassira D. Potential for increased prevalence of neuropathic pain after the COVID-19 pandemic. Pain Rep. 2021;6(1):e884. doi: 10.1097/PR9.0000000000000884

42. Mohabbat AB, Mohabbat NML, Wight EC. Fibromyalgia and chronic fatigue syndrome in the age of COVID-19. Mayo Clin Proc Innov Qual Outcomes. 2020;4(6):764-766. doi: 10.1016/j.mayocpiqo.2020.08.002

43. Komaroff AL, Bateman L. Will COVID-19 lead to myalgic encephalomyelitis/chronic fatigue syndrome? Front Med (Lausanne). 2021;7:606824. doi: 10.3389/fmed.2020.606824

44. Wostyn P. COVID-19 and chronic fatigue syndrome: Is the worst yet to come? Med Hypotheses. 2021;146:110469. doi: 10.1016/j.mehy.2020.110469

45. Li Y, Scherer N, Felix L, Kuper H. Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis. PLoS One. 2021;16(3):e0246454. doi: 10.1371/journal.pone.0246454

46. Parisi S, Borrelli R, Bianchi S, Fusaro E. Viral arthritis and COVID-19. Lancet Rheumatol. 2020;2(11):e655-e657. doi: 10.1016/S2665-9913(20)30348-9

47. Gasparotto M, Framba V, Piovella C, Doria A, Iaccarino L. PostCOVID-19 arthritis: A case report and literature review. Clin Rheumatol. 2021:1-6. doi: 10.1007/s10067-020-05550-1

48. Nalbandian A, Sehgal K, Gupta A. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615. doi: 10.1038/s41591-021-01283-z

49. Chandrashekara S, Jaladhar P, Paramshetti S, Ramachandran V, Nizar SF, Kori D. Post COVID inflammation syndrome: Different manifestations caused by the virus. J Assoc Physicians India. 2020;68(12):33-34.

50. Wong AY, MacKenna B, Morton CE, Schultze A, Walker AJ, Bhaskaran K, et al. Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19: An OpenSAFELY cohort analysis based on two cohorts. Ann Rheum Dis. 2021 Jan 21. doi: 10.1136/annrheumdis-2020-219517

51. Demeco A, Marotta N, Barletta M, Pino I, Marinaro C, Petraroli A, et al. Rehabilitation of patients post-COVID-19 infection: A literature review. J Int Med Res. 2020;48(8):300060520948382. doi: 10.1177/0300060520948382

52. Candan SA, Elibol N, Abdullahi A. Consideration of prevention and management of long-term consequences of post-acute respiratory distress syndrome in patients with COVID-19. Physiother Theory Pract. 2020;36(6):663-668. doi: 10.1080/09593985.2020.1766181

53. Yang YC, Chou CL, Kao CL. Exercise, nutrition, and medication considerations in the light of the COVID pandemic, with specific focus on geriatric population: A literature review. J Chin Med Assoc. 2020;83(11):977-980. doi: 10.1097/JCMA.0000000000000393