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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Case Series
Full Version
Joint Manifestations Following COVID-19 Infection- A Case Series of Six Patients
Correspondence Address :
Thomas George,
Amrita Nagar, Edappally, Kochi, Kerala, India.
E-mail: thomasg@aims.amrita.edu
A rare subset of Coronavirus Disease-2019 (COVID-19) positive patients has musculoskeletal manifestations including arthritis, arthralgia, myalgia and non specific bodyaches. Moreover, postviral Reactive Arthritis (ReA) has been reported following COVID-19 infection. This article reports the characteristic joint manifestations of Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) infection in 6 out of 211 consecutive patients with laboratory-confirmed diagnosis of COVID-19 and treated at dedicated hospital. One 49-year-old female patient developed arthritis while having active COVID-19 infection, one 54-year-old male had post COVID-19 ReA, and one 48-year-old female was found to have undifferentiated arthritis. One 58-year-old female patient was initially thought to have ReA the diagnosis was reconsidered later when her symptoms resolved without any disease modifying agents. Two patients 37-year-old male and 63-year-old female, developed arthralgia following COVID-19 infection. Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and steroids were found to be beneficial in the series of patients. The key point to be noted is that not all arthritis or arthralgia following COVID-19 is ReA.
Coronavirus disease-2019, Postviral arthritis, Severe acute respiratory syndrome-coronavirus-2
The ongoing pandemic of COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has affected more than thirty two crore cases across the world till mid-January 2022. Most common symptoms include fever, cough, fatigue, breathing difficulties, and loss of smell and taste (1). At least a third of the patients remain asymptomatic.
The ReA belongs to a group of diseases called spondyloarthropathies typically causing monoarthritis or oligoarthritis that usually involves the lower limbs (ankles and knees). It is commonly preceded by a gastrointestinal (Campylobacter, Salmonella and Shigella) or urogenital (Chlamydia) infection (2),(3). A rare subset of COVID-19 patients has musculoskeletal manifestations including arthritis, arthralgia and non specific bodyache (3). Moreover, few case reports of postviral ReA have been reported following COVID-19 infection (4),(5),(7). This article compiles a series of six patients with muskuloskeletal manifestations following COVID-19 infection.
All the patients reported between September 1, 2020 to December 31, 2020 at a tertiary centre in Kerala, India. Overall, 211 consecutive patients with a history of COVID-19 infection were analysed for musculoskeletal manifestations during active infection and following it. Only those cases confirmed by a positive result to real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) assay for COVID-19 from throat swab specimens were included in the series (8). All patients with history of rheumatological diseases or joint disorders were excluded. Out of 211, 6 patients had muskulosteletal manifestations. The clinico biochemical parameters of the patients in present study are mentioned in (Table/Fig 1).
Case 1
A 49-year-old female had oligoarthritis with early morning stiffness involving left knee and left ankle on the second day of admission for COVID-19 infection. Inflammatory markers were high (ESR-92 mm/hr, CRP-204 mg/dL). Rheumatoid Factor (RF), Anti Cyclic Citrullinated Peptide (anti-CCP) and antinuclear antibody by Immunofluorescence-ANA (IFA) were negative. X-rays of ankles and knees were normal. A possibility of acute viral arthritis was made. Along with the ongoing Dexamethasone i.v. 6 mg once daily for active COVID-19 infection, colchicine was also added. Steroids were later converted to oral on discharge after he turned seronegative (14th day) and tapered and stopped over two weeks. Oral colchicine was continued for a total of three weeks, following which patient became completely asymptomatic, and the drug was stopped.
Case 2
A 54-year-old male with background history of hypertension developed right knee pain and swelling with early morning stiffness lasting more than 30 minutes, 3 weeks following detection of COVID-19 infection (patient was in isolation at home). Laboratory parameters showed raised Erythrocytes Sedimentation Rate (ESR) (64 mm/hr) and CRP (146 mg/dL). X-rays of knees, RF, Anti CCP and ANA were normal. A provisional diagnosis of post COVID-19 ReA was made. Synovial fluid aspiration and local steroid injection was not attempted, as patient didn’t gave consent. Stat dose of i.v. Dexamethasone 4 mg was given and patient was advised to take oral etoricoxib 60 mg twice daily, daily calcium and weekly Vitamin D 60000 units. The symptoms improved significantly on a two week follow-up and was advised to continue etoricoxib 90 mg once daily. On review after four weeks he was asymptomatic and inflammatory markers normalised (ESR 22 mm/hr, CRP- 0.9 mg/dL).
Case 3
A 58-year-old female presented with mild left knee arthritis with early morning stiffness lasting less than 30 minutes for three days duration, two weeks after recovery from COVID-19. Patient was admitted at the present facility during COVID-19 infection. Knee radiographic examinations were normal. Inflammatory markers were mildly raised (ESR - 32 mm/hr, CRP-12 mg/dL). Possibility of ReA was considered. RF and CCP were normal. Synovial fluid study couldn’t be done as patient did not consent. She was given stat oral etorcoxib 60 mg and topical preparations thereafter in view of five year history of type 2 Diabetes Mellitus and high normal creatinine values (0.9 mg/dL). Two weeks later on her review visit, she was completely asymptomatic. As she became completely asymptomatic without any active intervention, the possibility of ReA was considered unlikely at this stage.
Case 4
A 48-year-old female presented a week after recov-ering from COVID-19 infection with arthralgia involving bilateral elbows and knees with generalised bodyache. Laboratory parameters showed normal inflammatory markers (ESR-13 mm/hr, CRP 4.5 mg/dL). X-rays showed early osteoarthritic changes in bilateral knees. She was reassured and was sent home on oral calcium and vitamin supplements. She was asymptomatic on her 1-month revisit.
Case 5
A 37-year-old male, known diabetic with nephropathy, developed bilateral knee and right ankle arthritis three months after COVID-19 infection. He had high ESR of 67 mm/hr with normal CRP, normal knee and ankle X-rays. The Computed Tomography (CT) Chest showing bilateral ground glass opacities probably sequela of
COVID-19, ANA 2+ speckled pattern with normal complements. The RF (8 IU/mL) and anti CCP (5 U/mL) were normal and coombs test was negative. A provisional diagnosis of undifferentiated arthritis, probably triggered by COVID-19 was made and was initiated on oral prednisolone (0.5 mg/kg/day) and hydroxychloroquine 300 mg. He is assumed to return for his follow-up visit before long and is yet to be reviewed.
Case 6
A 63-old-year female, had non specific generalised joint pains involving small and large joints with no objective evidence of arthritis, 2two weeks following COVID-19 infection. Her inflammatory markers and X-rays were normal. She was reassured and was asked to review in case of persistent symptoms. She remained asymptomatic on follow-up after a month.
Molecular mimicry is one among the proposed mechanisms of pathogenesis of viral associated arthritis (9). Examples of molecular mimicry concerning SARS-CoV-2 are reported and this mechanism is hypothetically involved in the pathogenesis of both the acute systemic infection and the postinfective viral related immunological consequences (10),(11),(12). Studies demonstrate that coronaviruses share molecular epitopes with human proteins (e.g., spike glycoprotein S) (13).
Out of 211 patients with history of SARS-CoV-2 infection, six patients developed joint manifestations. Out of six, only one patient developed ReA. One patient had arthritis during active COVID-19 infection. Two developed arthralgia following COVID-19 infection. One was diagnosed with undifferentiated connective tissue disease. Lower limb predominant oligoarticular involvement was observed to be the most common pattern of disease. None of them developed any extra-articular manifestations of ReA.
The most frequent presentation of ReA is oligoarthritis (14). It can affect any peripheral joint, but the knee is considered to be the most involved. Axial manifestations may go under-recognised (15). The diagnosis of ReA is established on the association of clinical and microbiological criteria (16). Since, the emergence of COVID-19, only a few cases of post COVID-19 ReA has been published. Honge BL et al., describes about post COVID-19 reactive monoarthritis involving right knee in a 53-year-old male (4). He was hospitalised for 12 days due to COVID-19. Few days following discharge, he developed severe right knee monoarthritis restricting his mobility. Synovial fluid analysis revealed numerous polymorphonuclear cells with sterile cultures with elevated CRP (279 mg/L). His RF, Anti CCP, HLA B-27 was negative. He was treated with NSAIDs (Ibuprufen 400 mg thrice daily) and short course of steroids (prednisolone 25 mg) for 10 days following which he became asymptomatic.
Mukarram IG et al., describes about post COVID-19 ReA involving right knee in a 34-year-old male patient 10 days after testing positive for COVID-19 (5). The MRI of knees showed mild joint effusion and had elevated levels of CRP and ferritin. Treatment with intra-articular steroids and 10 days with NSAIDs made him asymptomatic.
Ono K et al., reports on a 50-year-old male patient who was admitted for COVID-19 pneumonia and developed bilateral ankle arthritis and right achilles tendinitis (6). Synovial fluid was inflammatory in nature with no growth of any organism. The RF, Anti CCP, HLA B-27 all were negative. He was diagnosed with ReA; NSAIDs and intraarticular corticosteroid injection resulted in moderate improvement.
A 73-year-old man with diabetes mellitus, hypertension, and coronary heart disease as reported by Saricaoglu EM et al., developed swelling, redness, pain, and tenderness in the left first metatarsophalangeal, proximal and distal interphalangeal joints and right second proximal and distal interphalangeal joints two weeks following onset of symptoms of COVID-19 (7). The CRP and ferritin were markedly elevated. The RF, Anti CCP and serum uric acid levels were normal. Arthritis symptoms resolved completely with one week NSAIDs.
In the current study group and previous published case reports, post COVID-19 ReA was reported in males. The ReA patient had right knee monoarthritis as in the other two reports (4),(5). Lower limb predominant oligo or monoarthritis involving large joints was the common pattern observed except in Saricaoglu EM et al., case (7). Inflammatory markers were elevated in all cases like in present case (CRP -146 mg/dL, ESR- 64 mm/hr). Synovial fluid study revealed inflammatory picture with negative culture in the published case reports and the authors couldn’t attempt the same due to lack of consent. The RF, Anti CCP and X-rays of affected joints were normal in all the cases as in present case.
The treatment of choice for ReA caused by other pathogens is NSAIDs and glucocorticoids. In present case series, and previously reported cases (4),(5),(6),(7), NSAIDs were employed and patients became clinically better although Mukarram IG et al., and Ono K et al., employed intra-articular steroids while Honge BL et al., used oral steroids in addition to NSAIDs (4),(5),(6). As in present case, all patients became asymptomatic or clinically better within one to two weeks following treatment.
The course of ReA varies considerably, probably depending upon the triggering pathogen and the genetic background of the host (17). The typical disease duration is three to five months. Most patients either remit completely or have little active disease within 6-12 months after presentation, but 15-20% may experience more chronic persistent arthritis (18). All of our patients improved clinically and biochemical parameters also improved during our follow-up after one month. One of our patients is yet to follow-up. Currently, five out of the six patients described above are asymptomatic and not on any medications now. Considering the current scenario, the prognosis of these patients is expected to be good. This series is limited by the lack of synovial fluid analysis and HLAB27 gene testing as the patients did not consent for the same.
All joint pains following COVID-19 may not be due to ReA. Out of six patients having muskuloskeletal manifestations from our 211 post COVID-19 patients, only one had ReA. He was successfully treated with parenteral steroids and oral NSAIDs. As increasing number of COVID-19 related arthritis reports are coming, further study is warranted.
DOI: 10.7860/JCDR/2022/51552.16192
Date of Submission: Jul 24, 2021
Date of Peer Review: Sep 14, 2021
Date of Acceptance: Feb 07, 2022
Date of Publishing: Apr 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 11, 2021
• Manual Googling: Jan 28, 2022
• iThenticate Software: Feb 05, 2022 (15%)
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