Radiological images have shed more light on the effects of COVID-19 and have revealed that the virus is capable of making the body attack itself.

While muscle soreness and achy joints are common symptoms among COVID-19 patients, some individuals experience more severe and long-lasting conditions such as rheumatoid arthritis flares, autoimmune myositis or “COVID toes”, a dermatological condition in which patients’ toes become swollen and discolored, with blisters or pustules. Researchers at Northwestern Medicine say the radiological images confirm, for the first time, that the cause of these symptoms is the body itself.

“Mechanisms of musculoskeletal involvement in COVID-19 are not fully understood, but we now see evidence on imaging of immune-mediated damage,” corresponding author Dr. Swati Deshmukh, assistant professor of musculoskeletal radiology at Northwestern Memorial Hospital and Northwestern University, told HCB News.
The researchers conducted a retrospective review of data from patients who were at Northwestern Memorial Hospital between May and December in 2020.

Multimodality imaging such as MR and ultrasound, according to Deshmukh, allowed doctors to distinguish aches caused by COVID-19 from those caused by the flu or other diseases. It also enabled them to examine tissues inside the body to see which tissues were affected by the virus and how severely; including muscles, nerves, and joints, and even small peripheral nerves. They could then determine the potential mechanisms behind injuries and send patients to the right specialist for treatment, such as a rheumatologist or a dermatologist.

Some COVID-19 diagnoses based on musculoskeletal imaging were made for patients who were not even aware they'd contracted the virus. Deshmukh says that symptoms can include edema and inflammatory changes of the tissues such as fluid and swelling, hematoma, and gangrene. The types of musculoskeletal injuries, however, can differ, with some patients presenting injured nerves and others experiencing impaired blood flows.

“COVID-19 and mechanisms of injury are not yet fully understood,” she said. “The vaccine and virus variants add complexity. Further research is needed to optimize medical diagnosis, treatment, and hopefully one day, even prevention.”

The authors are now looking into surgical options and outcomes for patients who have not recovered on their own with conventional medical treatment. They are using imaging for preoperative and postoperative assessment of those who may require surgery.

The findings were published in Skeletal Radiology.

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