Evidence map›Paper›PMID 41821578›Full record

ArticleCase reports in infectious diseases2026

From Viral Recovery to Autoimmunity: A Case Report of Rheumatoid Arthritis Emergence After COVID-19.

Tatsuki Tsuruga, Hajime Fujimoto, Toshiyuki Ito, Atsushi Tomaru, Haruko Saiki, Taro Yasuma, Corina N D'Alessandro-Gabazza, Esteban C Gabazza, Tetsu Kobayashi

Abstract read
In one paragraph

Article in Case reports in infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Tatsuki TsurugaDepartment of Pulmonary and Critical Care Medicine, Faculty and Graduate School of Medicine, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan, mie-u.ac.jp.
Hajime FujimotoDepartment of Pulmonary and Critical Care Medicine, Faculty and Graduate School of Medicine, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan, mie-u.ac.jp.
Toshiyuki ItoDepartment of Pulmonary and Critical Care Medicine, Faculty and Graduate School of Medicine, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan, mie-u.ac.jp.
Atsushi TomaruDepartment of Pulmonary and Critical Care Medicine, Faculty and Graduate School of Medicine, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan, mie-u.ac.jp.
Haruko SaikiDepartment of Pulmonary and Critical Care Medicine, Faculty and Graduate School of Medicine, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan, mie-u.ac.jp.
Taro YasumaDepartment of Immunology, Faculty and Graduate School of Medicine, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan, mie-u.ac.jp.
Corina N D'Alessandro-GabazzaDepartment of Immunology, Faculty and Graduate School of Medicine, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan, mie-u.ac.jp.
Esteban C GabazzaDepartment of Pulmonary and Critical Care Medicine, Faculty and Graduate School of Medicine, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan, mie-u.ac.jp.ORCID https://orcid.org/0000-0001-5748-1499
Tetsu KobayashiDepartment of Pulmonary and Critical Care Medicine, Faculty and Graduate School of Medicine, Mie University, Edobashi 2-174, Tsu, Mie, 514-8507, Japan, mie-u.ac.jp.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

A woman in her 50s contracted Coronavirus disease 2019 (COVID-19), initially presenting with mild symptoms, and managed conservatively. However, she developed a persistent low-grade fever and insidious joint pain for 1 month, prompting further evaluation. Chest computed tomography revealed bilateral pulmonary infiltrates, leading to hospitalization for COVID-19-associated pneumonia. Despite a 2-week course of ceftriaxone and azithromycin, her condition remained unchanged. Postadmission testing revealed elevated rheumatoid factor, anti-cyclic citrullinated peptide (CCP) antibodies, and matrix metalloproteinase-3, suggesting an inflammatory or autoimmune process. Given concerns for immune-mediated inflammation, she was treated with high-dose methylprednisolone. With pneumonia improvement, she was discharged on oral prednisolone (PSL) (20 mg/day) with a planned taper. Her joint symptoms resolved, and anti-CCP antibody levels normalized during steroid therapy. However, upon PSL tapering and discontinuation, her joint pain recurred, and anti-CCP antibodies became positive again. A rheumatology consultation confirmed rheumatoid arthritis (RA). This case provides rare longitudinal documentation of dynamic anti-CCP antibody changes that paralleled clinical disease activity, illustrating the progression from postviral reactive arthritis to classifiable RA. It underscores COVID-19's potential to trigger autoimmune dysregulation and highlights the need for long-term follow-up with serial autoantibody monitoring in patients with persistent musculoskeletal symptoms after infection.

Indexed as

autoimmune diseaseCOVID-19hyperinflammatory responserheumatoid arthritis

Identifiers

PMID41821578
PMCPMC12976139

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.