SUMMARY

“New-onset OCD and juvenile enthesitis related arthritis after COVID-19” describes three pediatric patients who developed juvenile enthesitis-related arthritis (ERA) and abrupt onset neuropsychiatric symptoms, including OCD, following COVID-19 infection. These cases were evaluated at the Stanford Immune Behavioral Health Clinic and provide insight into a potential link between SARS-CoV-2, immune activation, and neuropsychiatric symptoms.

Each patient demonstrated a unique timeline of psychiatric deterioration, with abrupt or subacute onset of OCD symptoms alongside imaging-confirmed arthritis—despite often minimal joint complaints during flare and recovery periods. Notably, the patients improved following immunomodulatory therapies including nonsteroidal anti-inflammatory drugs (NSAIDs) and, in more persistent or severe cases, disease-modifying antirheumatic drugs (DMARDs). Importantly, imaging such as musculoskeletal ultrasound was used proactively, even in the absence of joint pain, revealing evidence of joint inflammation that informed earlier therapeutic intervention.

These findings support the mounting evidence linking COVID-19 to neuropsychiatric deteriorations such as OCD, anxiety, depression, and psychosis as a result of systemic inflammation, triggered by the COVID-19 infection. Moreover, it highlights the diagnostic and therapeutic value of evaluating peripheral inflammation in cases of abrupt onset neuropsychiatric symptoms such as OCD. This study adds to growing evidence that neuroimmune mechanisms, particularly post-infectious immune dysregulation, may underlie certain pediatric-onset psychiatric disorders.

LINK TO PAPER: https://karger.com/dne/article-pdf/doi/10.1159/000545137/4361454/000545137.pdf