Fibromyalgia may occur post-COVID

In a recent study published in the journal PLoS ONE, researchers investigate the incidence of fibromyalgia (FM) syndrome among individuals hospitalized due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Study: The possible onset of fibromyalgia following acute COVID-19 infection. Image Credit: Stokkete / Shutterstock.com

Background

FM syndrome refers to chronic and extensive musculoskeletal pain frequently accompanied by sleep and fatigue, as well as mood and cognitive disturbances. The precise FM pathogenesis is unclear; however, several infections, such as those due to hepatitis C virus (HCV) and human immunodeficiency virus (HIV), as well as Lyme disease, have been implicated in FM development in the post-acute phase.

Post-acute coronavirus disease 2019 (COVID-19) syndrome, often referred to as long COVID, is characterized by persistent or novel COVID-19 symptoms that continue for at least four weeks after COVID-19 symptom onset. The most commonly reported long COVID symptoms include weakness, fatigue, arthralgia, myalgia, cognitive decline, sleep difficulties, depression, and anxiety.

An investigation into the onset of post-COVID FM could guide policymaking and strategy development to customize treatments and improve the standard of care for affected individuals.

About the study

In the present study, researchers investigated the development of post-COVID FM among COVID-19 convalescents hospitalized due to COVID-19 and identified associated predisposing factors.

The study comprised adults hospitalized due to SARS-CoV-2 infection and discharged from SARS-CoV-2 infection wards of the Sheba Medical Center infection wards in Israel between July 15, 2020 and November 15, 2020.

Upon hospital admission, the initial COVID-19 diagnosis was confirmed using the reverse transcription-polymerase chain reaction (PCR) assay. Patients were discharged based on improvement in clinical signs and symptoms.

SARS-CoV-2 infection severity was documented according to the United States National Institutes of Health (NIH) criteria.

The team excluded individuals discharged to health facilities or nursing homes and individuals with cognitive impairments before SARS-CoV-2 infection. In addition, individuals with active psychotic disorders, active malignancies, previously diagnosed with FM, or who died before study completion were excluded from the analysis.

Telephone interviews were conducted between January 19, 2021, and April 5, 2021, using questionnaires such as the FM survey diagnostic criteria questionnaire, subjective traumatic outlook (STO) questionnaire to evaluate the psychological effects of trauma, and the sense of coherence (SOC) questionnaire to assess resilience. The minimum duration between hospital discharge and the interviews was 90 days.

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Post-acute COVID-19 FM incidence was determined, multivariate logistic regression modeling was performed, and odds ratios (OR) were calculated. In addition, data on demographic variables, medical disease history, and COVID-19-associated hospitalization, including SARS-CoV-2 infection severity, prescribed medications, and respiratory assistance, were obtained from electronic medical records.

Results

A total of 531 hospitalized COVID-19 patients were discharged from the facility, 216 of whom were excluded, and 101 individuals were unwilling to participate. Furthermore, language barriers were present for 16 individuals.

As a result, 198 individuals were considered for the final analysis. The median participant age was 64 years, whereas the mean follow-up duration was five months. About 37% of the participants were female.

The most commonly observed comorbidities were hypertension, dyslipidemia, diabetes, obesity, and congestive cardiac failure, which were observed in 48%, 35%, 33%, 22%, and 19% of the study participants. COVID-19 severity was mild, moderate, and severe among 31%, 10%, and 59% of participants. The post-COVID FM incidence was 15%, with 87% of participants experiencing at least one FM-associated symptom.

The female sex was significantly associated with the development of FM in the post-acute COVID-19 period, with an OR of 3.7. Additionally, low SOC and high STO scores were significantly associated with the development of FM in the post-acute COVID-19 phase.

The most commonly observed FM-associated symptoms were fatigue, sleep difficulties, cognitive impairments, and muscle and joint pains, which were observed in 57%, 56%, 54%, and 42% of patients, respectively.

A median STO score of 8.0 was observed. However, 73% of individuals with FM had STO scores greater than or equal to 13.0 compared to 22% among the non-FM group.

After five months of COVID-19-associated hospitalization, 15% of individuals and 26% of women were diagnosed with FM, which was nearly five-fold greater than the proportion of FM patients identified among the general public of Israel.

Conclusions

The study findings are in accordance with prior studies investigating long-term post-acute COVID-19 symptoms and showed that most hospitalized COVID-19 patients experience at least one FM-associated symptom, such as fatigue, myalgia, sleep disturbances, concentration difficulties, and depression/anxiety for three months to one year post-acute COVID-19.

Overall, the study findings indicate that the prevalence of FM was greater among COVID-19 convalescents than among the general public. In addition, a significant subjective traumatic experience, low resilience, and female sex were significantly associated with the occurrence of FM in the post-acute COVID-19 period.

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.