FibroCOVID: Or Fibromyalgia As A Result Of A SARS-CoV-2 Variant Infection


A new Italian study led by the Rizzoli Orthopedic Institute and the University of Bologna that also involved researchers from the University of Catanzaro, University of Turin, Università Campus Bio-Medico di Roma and the University of Ferrara has alarming found that there is now a growing prevalence of the medical condition known as fibromyalgia among so called recovered COVID-19 patients who had been previously been infected with the various SARS-CoV-2 variants.

The study found that mostly males and those that were obese were prone to this new Long COVID manifestation or post-acute COVID-19 syndrome (PACS).

Fibromyalgia (FM) is a medical condition characterized by chronic widespread pain. Other symptoms include tiredness to a degree that normal activities are affected, sleep problems, and cognitive dysfunctions. Some individuals also report restless legs syndrome, bowel or bladder problems, numbness and tingling and sensitivity to noise, lights or temperature. Patients with fibromyalgia are more likely to suffer from depression, anxiety and posttraumatic stress disorder.

The researchers are terming the new condition in recovered COVID-19 patients experiencing Fibromyalgia (FM) as “FibroCOVID”.

Out of a sample size of 616 individuals (77.4% women) who filled in a questionnaire 6±3 months after the COVID-19 diagnosis, 189 (30.7%) satisfied the ACR survey criteria for FM (56.6% women). A multivariate logistic regression model including demographic and clinical factors showed that male gender (OR: 9.95, 95% CI 6.02 to 16.43, p<0.0001) and obesity (OR: 41.20, 95% CI 18.00 to 98.88, p<0.0001) were the strongest predictors of being classified as having post-COVID-19 FM. Hospital admission rate was significantly higher in men (15.8% vs 9.2%, p=0.001) and obese (19.2 vs 10.8%, p=0.016) respondents.

The study findings suggest that clinical features of FM are common in patients who recovered from COVID-19 and that obesity and male gender affect the risk of developing post-COVID-19 FM.

The study findings were published in the peer reviewed BMJ journal: Rheumatic and Musculoskeletal Diseases.

The COVID-19 disease, which is caused by the SARS-CoV-2 coronavirus, may cause post-acute COVID-19 syndrome (PACS). PACS is characterized by a large array of manifestations including fatigue, cognitive problems, sleep disturbances, and musculoskeletal complaints.

The Italian study team aimed to investigate the prevalence and predictors of fibromyalgia (FM) in patients who recovered from COVID-19. To this end, the authors of the current study found that clinical features of FM are common in patients who recovered from COVID-19. Males and those who are obese are at a higher risk of developing post-COVID-19 fibromyalgia.

Fibromyalgia or FM is a chronic condition that widespread musculoskeletal pain, as well as sleep problems, general fatigue, areas of tenderness, and cognitive disturbances. Individuals with FM may be more sensitive to pain as compared to those without the condition.

Prior to the COVID-19 pandemic, FM affects about 4 million adults in the United States, which is about 2% of the adult population. However considering that more than 40 million Americans have been infected with the SARS-CoV-2 virus so far with almost half infected with the various variants that emerged, the prevalence of fibromyalgia is now expected to be extremely high.

Certain individuals who recover from COVID-19 may experience persistent symptoms. Apart from the clinical manifestations of acute COVID-19, the long-term effects are emerging as a new and overwhelming challenge for healthcare systems.

Now known as PACS, this condition is now being recognized as a long-term consequence of COVID-19.

Alarmingly, musculoskeletal pain, which is the cardinal symptom of FM, has been reported in one-third of patients with acute COVID-19.

Thus as a result, this persistent pain is a hallmark symptom of PACS, along with cardiovascular, pulmonary, renal, dermatological, gastroenteric, and endocrine sequelae.

So far the pathogenesis of FM has yet to be fully understood. Scientists believe that pain misperception appears to be tied to neuromorphological modifications and an imbalance between pronociceptive and antinociceptive pathways. These modifications may be developed as a result of stressful life events, genetic predisposition, neuroinflammation, and psychological characteristics, among other causes.

Web-based or internet-based surveys have gained growing popularity in medical and health research. These can reach a large pool of potential participants quickly, involving those who may be geographically dispersed or difficult to access. The COVID-19 pandemic has emphasized the use of web-based surveys, and there are now over 2,000 records that can be obtained on PubMed.

The Italian study team utilized web-based survey to investigate the prevalence of FM after symptomatic COVID-19. The authors of the current study also wanted to determine the predictive factors of post-COVID-19 FM syndrome development.

In order to arrive at the study findings, the team collected data between April 5 and 18, 2021 through an online form created using the Googles Forms platform, a free survey administration tool. Further, the team defined the presence of FM in the participants using the American College of Rheumatology (ACR) survey criteria, along with a Fibromyalgianess Scale or Fibromyalgia Symptom Scale (FS).

The online survey containsed 28 questions that gather the demographic information, features, and duration of acute COVID-19, underlying health conditions, and other valuable attributes like height and weight.

A total of 616 individuals of which 77.4% of whom were women, filled out the form.

The study demonstrated that self-reported clinical features of FM are common after patients recovered from symptomatic COVID-19. The team estimates the prevalence at 31%, which is comparable to the 30% that was recently reported for PACS.

Interestingly the respondents with FM showed features suggestive of a more serious COVID-19 form, especially those who had been hospitalized or required oxygen support. The study design, however, did not allow an accurate definition of COVID-19’s severity.

The study team also revealed that males and those who are obese are at an increased risk of a severe clinical course because of COVID-19.

Corresponding author Professor Dr Francesco Ursine from the Rizzoli Orthopedic Institute told Thailand Medical News, “Our study data suggest that clinical features of FM are common in patients who recovered from COVID-19 and that obesity and male gender affect the risk of developing post-COVID-19 FM.”

The study team stressed that due to the increasing number of COVID-19 cases, physicians and rheumatologists might face an exponential increase in cases of a new health condition which they termed as “FibroCOVID”.

Thailand Medical News would like to further add that it should be noted that there is no cure for fibromyalgia (FM). However the usage of certain drugs like Pregabalin and Milnacipran can help to alleviate the symptoms associated with the condition such as persistent pain. Other drugs include:

-Pain relievers. OTC (Over-the-counter) pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. However opioid medications are not recommended as they can lead to significant side effects and dependence and will worsen the pain over time.

-Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your physician may prescribe amitriptyline or the muscle relaxant cyclobenzaprine to help promote sleep.

-Anti-seizure drugs. Drugs designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the U.S.Food and Drug Administration to treat fibromyalgia.

Like most countries in the world, France has been affected by the COVID-19 pandemic (or severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) declared by the World Health Organization since March 11, 2020 (WHO, 2020). In November 2020, given the alarming figures of the second epidemic wave of SARS-CoV-2, the French government announced a new lockdown for a period of at least 1 month.

This lockdown situation was experienced for the first time from March to May 2020 and disrupted everyone’s lifestyle: non-essential businesses and structures were closed; and travel was allowed only for work, food, care, and individual physical activity within 1 km from home (Decree n ° 2020-260, 2020).

If a lockdown can reduce the virus contamination rate and limit the hospital overcrowding, it is not devoid of consequences. Several authors underlined deleterious effects on mental health, e.g., emotional disturbances, stress, anxiety, exhaustion, and depression (Brooks et al., 2020).

In a qualitative analysis, people expressed a depressed mood during the period of isolation and sometimes felt the need for professional mental health support after only 2 weeks of lockdown (Williams et al., 2020). Lockdown affects the usual sleep rhythm for more than a third of adults who had not been infected with the virus (Wang et al., 2020; Zhao et al., 2021), characterized by more time spent in bed but with a lower quality of sleep (Cellini et al., 2020). All the studies have been unanimous about the significant impact of lockdown, with an increased risk for women, people who lack family support, and those who have a poor quality of sleep, psychological history and/or fear of getting infected with the virus (Jeong et al., 2016; Tang et al., 2020; Wang et al., 2020).

Most of these risk factors are found in fibromyalgia patients, predominantly females (Vincent et al., 2013). Indeed, clinical manifestations of this syndrome are mainly characterized by the triad of pain, fatigue and sleep disturbances, affecting quality of life (Abeles et al., 2007; Häuser et al., 2010). The syndrome is the result of the interplay between many predisposing, triggering, and sustaining factors that fuel the vicious cycles of fibromyalgia.

Thus, the term fibromyalgia syndrome is used as a common final pathway of multiple somatic, psychological and social contributions, specific to each patient (Ferrari, 2000; Littlejohn and Walker, 2002; Turk and Adams, 2016). Among the recurrent psychosocial manifestations of this syndrome, studies found mental disorders in nearly 97% of fibromyalgia patients (Miki et al., 2018), anxiety and depressive disorders (13–64% and 20–80%, respectively, Fietta et al., 2007), often supported by previous experiences of burnout, trauma and/or difficult life stories.

In addition, sleep disorders were present in 90% of cases (Osorio et al., 2006). These sleep difficulties caused increased fatigue and modified painful perceptions by altering descending pain-inhibition pathways (Choy, 2015). These constraints led to a reduction in physical, professional and social activities and disrupted the different temporalities of life. In sociology, we differentiate four types of temporalities in daily life: biological time; economic time (working time); familial and cultural time; and personal time (Chesneaux, 1997). With chronic disease, these times become upsetting, imposing significant coping skills for patients (Grimaldi, 2006). Generally, this situation promotes social isolation and gradually leads to a decline in physical and functional capacities, deconditioning and fatigability, promoted by pain, fatigue, fear of movement and feeling of incapacity (Nijs et al., 2013; Turk and Adams, 2016). Patients gradually switch to physical inactivity and an increase in sedentary behavior in daily life.

In the absence of a curative drug treatment, scientists promote physical activity in all its forms in order to relieve symptoms (Figueroa et al., 2008; Häuser et al., 2010; Busch et al., 2011; Menzies et al., 2014; Bidonde et al., 2019). Actually, for this syndrome, adapted physical activity is recommended as a first-line treatment, as it is the only “strong for” therapy-based recommendation in the EULAR guidelines (Macfarlane et al., 2017). With lockdown, engaging and/or maintaining a regular practice of an adapted physical activity is difficult because of the closure of structures and trips restrictions limited to 1 km around the home, reducing the possibilities to exercise and promoting social isolation (Goethals et al., 2020).

Thus, during lockdown we observe a break in rhythms that is imposed not only on the practice of physical activity, but also on all spheres of life (work, family, leisure, etc.), requiring a restructuring of scheduling. Fibromyalgia patients are not spared from the multiple consequences of lockdown, which will add to the existing symptoms (Mohabbat and Mohabbat NML, 2020). Given the pre-existing weaknesses in terms of mental health and sleep, which are already very serious symptoms in fibromyalgia, and knowing that these patients accumulate several risk factors for developing symptoms related to lockdown (sex, sleep, psychological history, etc.), the fibromyalgia population could be particularly affected by the lockdown constraints (Batres-Marroquín et al., 2020; Cavalli et al., 2021). The purpose of the present study was to investigate the impact of COVID-19 lockdown on fibromyalgia patients in order to understand their experiences given the changes in everyday life and temporalities.

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