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HomeAnswersRheumatologycovid-19How to treat my leg numbness and pain after COVID infection?

What are the complications of post COVID infection?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At November 29, 2022
Reviewed AtOctober 11, 2023

Patient's Query

Hello,

I suffered from COVID-19. Two weeks later, I suffered tingling and numbness in my feet, pain in my legs, and general malaise. This was continued for another two to three weeks with pain in the buttocks while sitting and hip pain at night. I had an MRI of the SI joint, which showed some inflammation on the left side. Hlab 27 test was negative, and CRP is 7. The doctor thinks it is either AS or a post-COVID arthritis type condition. Last few weeks, I have had pain in both knees which is quite bad. I am 63 years old with a previous history of knee OA, which required one surgery but was fine until a few weeks ago. Feeling pretty low and concerned, I had slightly similar symptoms after a terrible reaction to a modern vaccine 16 months ago, but that abated. It seems to be a strong link with spike protein. Can you give me your thoughts?

Hello,

Welcome to icliniq.com.

Thank you for your query. This is obviously a post covid viral arthritis caused by the infection that you had, and it gives the same presentation as sacroiliitis and other autoimmune diseases. We call it reactive arthritis, and it takes time to heal. We can give a short course of steroids like Prednisone. However, that will be prescribed by your general physician. Until osteoarthritis will get better due to this infection. However, it shall go back to its baseline after the virus is out of your body, which might take up to six months if no treatment is given. Another possible treatment is an anti-inflammatory like Naproxen for two to three weeks.

Thank you.

Patient's Query

Hi doctor,

Thanks for your prompt reply. I forgot to mention I have some minor back stiffness also in the mornings but not much pain in that region. It has all come post COVID. I did have a previous episode of pelvic pain about four years ago, but that was linked at the time to a possible prostate issue and cleared up over a few weeks. I was playing football twice a week for the past year with no problem other than occasional Achilles tendon niggles. That has been a small problem over the past 35 years or so. But never too bad. You sound pretty confident it is not likely to be late onset AS. Possibly I have read too much about the condition online and convinced myself that I have it. If you do not mind me asking, are you hearing of other instances of these types of issues post covid infection? Is still playing football at 63 regularly great? I am hoping to get back to sports again at some point. These symptoms all came quickly after what seemed like a mild covid infection. I had read Achilles issues can be associated with AS, which fed my worry a bit. But they are only a few with long intervals and only as a result of playing football nonstop most of my life and not resting when I got injured. Like any football-crazy guy, I have had a few injuries over the years. I did try some Prednisone for a few days. I think 20 mg or less for five days but did not notice much change. They also did a lumbar spine MRI which showed a few nonspecific minor changes, possibly ‘suggestive’ of AS, but certainly not definitive.

Hi,

Welcome back to icliniq.com.

So as you mentioned, I am seeing a lot of facts in the clinic with COVID or post-viral infection called reactive arthritis which usually responds to anti-inflammatories and or Prednisone we prescribe. The best treatment is exercise. So you play football, I suggest you to go back to it. Achilles tendinitis is related to sacroiliitis. However, sacroiliitis after the age of 40 is less likely. The change that you had most likely is an infection, and we will resolve it within a few months with the anti-inflammatory treatment.

Thank you.

Patient's Query

Hi doctor,

Thanks for the reply. Perhaps I will try a two-week course of NSAIDS to try to dampen down the inflammation, you are seeing a few cases of this type of COVID reaction by sacroiliitis or you also mean spondylitis?

Hi,

Welcome back to icliniq.com.

Exactly, these tests are against sacroiliitis or spondylitis (same disease). Take Naproxen 500 mg twice daily for two weeks and see.

Patient's Query

Hi doctor,

Thank you for the reply. CRP was 1.1 mg/L, and ESR was 2 mm/hr. So you still believe in reactive arthritis? Do you still believe this will settle down in a few months?

Hi,

Welcome back to icliniq.com.

Yes, even if the markers are low, they can still be active. It will definitely settle down.

Patient's Query

Hi doctor,

Thank you for the reply. What about the high interleukin 6? Is that the major sign of reactive arthritis? My level is rather elevated. It is linked to inflammatory arthritis, as you know. Will this IL-6 serum rate decrease in time as reactive arthritis inflammation goes down? Please let me know your thoughts. I am worried IL-6 is already damaging my joints, especially with this knee pain.

Hi,

Welcome back to icliniq.com.

This IL-6 is not very specific, and do not worry as it is not damaging your joints. It is just a marker of inflammation and will go down eventually. I am surprised that they advised it because we do not usually screen for it.

Patient's Query

Hi doctor,

Thanks for your reply.

It just seems I need to take these medications and be patient.

Hi,

Welcome back to icliniq.com.

Yes, unfortunately, it takes time.

Patient's Query

Hi doctor,

Thank you for the reply,

What do you think is the trigger? Is massive inflammation caused by the immune system's reaction to the virus?

Hi,

Welcome back to icliniq.com.

Yes exactly. The virus caused a cascade of events causing massive inflammation.

Patient's Query

Hi doctor,

Thank you for the reply,

After our recent conversations about my post COVID issues, I have attached a couple of MRI reports.

You stated my condition is most probably reactive arthritis since it occurred in the weeks following COVID.

Please give me your view on the attached reports as soon as possible. I am still very anxious and worried and mentally struggling with all this.

Hi,

Welcome back to icliniq.com.

The findings on the MRI (magnetic resonance imaging) suggest sacroiliitis and spondylitis in the spine with the formation of chronic calcifications. This can be due to previous inflammation that has been ongoing or to the new onset reactive arthritis (less likely). In all cases, the treatment is a prolonged anti-inflammatory course for a month, like the Naproxen I gave you.

If the problem persists, we might consider new drugs such as biological therapy but not now.

Patient's Query

Hi doctor,

Thank you for the reply,

So it could still be reactive arthritis that will subside with time?

Hi,

Welcome back to icliniq.com.

Yes, but the findings are chronic. So I think you had sacroiliitis before, and then you have reactive now, and anyway, the treatment is the same for now.

Patient's Query

Hi doctor,

Thank you for the reply,

But can it still possibly settle down over the course of some months and not become a long-term issue of ongoing pain?

Hi,

Welcome back to icliniq.com.

Yes, for the active sacroiliitis. But the old findings in the spine are inactive and chronic and will not go away.

I think the active sacroiliac inflammation will go down and disappear.

Patient's Query

Hi doctor,

Thank you for the reply,

That is encouraging. So this does not seem to you a case of ankylosing spondylitis in terms of ongoing degeneration and inflammation? The main problem at the moment is bilateral knee pain, sore hips at night and buttocks when seated too long. There is back and abdominal stiffness in the morning but no real pain. You are not just saying all this to be kind?

Hi,

Welcome back to icliniq.com.

It might be, I do not deny, but less likely. Ankylosing spondylitis will usually subside with age.

Patient's Query

Hi doctor,

Thank you for the reply,

Is it right to say you believe that issues with my SI joint and knees will slowly go away with the NSAIDs over a period of time, and the spine changes are likely to be inactive? So I should not worry too much?

Hi,

Welcome back to icliniq.com.

Yes, do not worry. As I said, even if it is full-blown ankylosing spondylitis, the treatment is NSAIDs (nonsteroidal anti-inflammatory drugs). So you are completely covered and safe.

Patient's Query

Hi doctor,

Thank you for the reply,

Perhaps I have had low-grade AS over recent years without any real symptoms, and COVID has stirred everything up, and it could return to baseline in time. I have pain in my knees that signals the destruction of the cartilage. Is that possible after six weeks or so after the symptoms began?

Hi,

Welcome back to icliniq.com.

Perhaps. I am not worried about your knees, though. It can happen after six weeks, but NSAIDS (non-steroidal antiinflammatory drugs) will take care of it.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Mohamad Ali Rida
Dr. Mohamad Ali Rida

Rheumatology

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