Table 2.

Anti-SARS-CoV-2 drugs and its rheumatic musculoskeletal adverse effects

Drugs	Antiviral mechanisms	Rheumatic musculoskeletal adverse events	Refs.
Chloroquine and hydroxychloroquine	Inhibit pH-dependent internalization and fusion of the virus with lysosomes	Myopathy and neuromyopathy	[33]
Favipiravir	Inhibit viral RNA-dependent RNA polymerase	Hyperuricemia	[34]
Remdesivir		Not reported
EIDD-2801		Not reported
Lopinavir-ritonavir	Protease inhibitor	Hyperuricemia (≤ 5%), musculoskeletal pain (6%), arthralgia (< 2%), osteonecrosis, vasculitis, SJS-TEN	[35]
Umifenovir	Block the virus-cell membrane fusion as well as virus-endosome fusion	Not reported
Galidesivir	Antiviral adenosine nucleoside analog	Not reported
Ribavirin	Interfere with polymerases, RNA capping, and inosine monophosphate dehydrogenase	Arthralgia (> 10%), musculoskeletal pain (> 10%), backache (1–10%), gout (< 1%), myositis (< 1%), Exacerbation of sarcoidosis (higher incidence in combination with interferon α)	[36]
Camostat mesylate	Serine protease inhibitor	Not reported
Interferon α and β	Inhibit replication	Interferon α2b: Myalgia (16–75%), musculoskeletal pain (1–21%), arthralgia (3–19%), backache (1–19%), amyotrophy (< 5%), Arthritis (< 5%) including RA, Other autoimmune disease (< 1%) including sarcoidosis, myositis, rhabdomyolysis, SJS, SLE, vasculitis Interferon β1a and β1b: Myalgia (25–29%), Backache (23–25%), Autoimmune hepatitis, Immune thrombocytopenia, SLE, osteonecrosis, Sjogren syndrome	[37]
Convalescent plasma		Chance of transfusion-related adverse events: urticaria, anaphylaxis, transfusion-related acute lung injury Latent risk of hyperimmune attacks: Possibly via antibody-dependent enhancement of tissue damage and blunting of endogenous immunity to the virus

RNA ribonucleic acid, SJS-TEN Steven Johnson syndrome-toxic epidermal necrolysis, SLE systemic lupus erythematosus