Rheumatologists debate link between fibromyalgia and long COVID


By Emma Wilkinson

28 Jan 2024

Similarities in the presentation of fibromyalgia and long COVID may mean rheumatologists will be faced with increasing numbers of patients whom they are “powerless to help”, experts have warned. 

In a series of letters debating the resemblance of long COVID symptoms to fibromyalgia, rheumatologists have questioned what role the profession should play in managing patients and whether they should form part of a multi-disciplinary team with psychologists, chronic pain and rehabilitation specialists.

It comes in response to a paper published last year in the Annals of the Rheumatic Diseases which argued that with long COVID, medicine is repeating mistakes that were made in trying to define the pathophysiology of fibromyalgia while ignoring psychosomatic factors.

To address this, Professor Xavier Mariette from Université Paris-Saclay, France, suggested renaming long COVID as fibromyalgia-like post-COVID syndrome.

A response from Professor Robert Landewe from the Amsterdam Rheumatology Center in the Netherlands published in the same journal noted that rheumatologists are still “relatively powerless” in managing patients with fibromyalgia who may face long waits to be seen.

Agreeing with the similarities between fibromyalgia and long COVID, he added that recognising this problem does not solve the practical problems and challenges it raises for rheumatologists.

In fact, considering both as “ill-defined psychosomatic disorders with one ‘final common pathway’”, that can be triggered by different causes including common viruses, “bears the danger of putting the rheumatologist in the forefront of the societal long-COVID problem”, he said. 

“Patients with long-COVID will consult us (even) more often and ask for solutions that we cannot offer. 

“Society may expect us, immuno-rheumatologists, to find pathophysiological explanations for a problem that we see as psychosomatic rather than immunological or infectious,” he said.

Professor Mariette agreed that “naming a problem” will not be sufficient but more attention was needed on the psychosomatic aspects of long Covid and it was important to start the debate.

“I was well aware that aligning ‘long COVID’ to fibromyalgia was a rather provocative approach,” he replied in a follow up letter. “However, I wanted to highlight the fact that the psychosomatic aspects of post-COVID symptoms were not sufficiently highlighted in previous works.” 

More research is needed to unpick psychosomatic, immunometabolic and neurological aspects of long-COVID and the current evidence showing an increased risk of the condition in those pre-existing psychological factors, he added.

But for now, “if we accept the fact that the psychological aspects of the disease are important, we have to involve psychologists, psychiatrists, pain and rehabilitation specialists for the treatment of these patients”, Professor Mariette wrote. 

“Especially, since these specialists have more experience in helping and guiding their patients to recognise that their symptoms might be linked with a reaction to an event considered as traumatic and not to the persistence of the viral infection or to an abnormal immune reaction.” 

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