Rheumatology and Long COVID: lessons from the study of fibromyalgia

Abstract

Rheumatology, such as other subspecialties, has both a unique perspective to offer as well as an evolving role to play in the global COVID-19 pandemic. Our field has already contributed meaningfully to the development and repurposing of many of the immune-based therapeutics which are now standard treatments for severe forms of the disease as well as to the understanding of the epidemiology, risk factors and natural history of COVID-19 in immune-mediated inflammatory diseases. Still in evolution is our potential to contribute to burgeoning research efforts in the next phase of the pandemic: the syndrome of postacute sequelae of COVID-19 or Long COVID. While our field brings many assets to the study of Long COVID including our expertise in the investigation of chronic inflammation and autoimmunity, our Viewpoint focuses on the strong similarities between fibromyalgia (FM) and Long COVID. While one can speculate on how embracing and confident practising rheumatologists already are regarding these interrelationships, we assert that in the emerging field of Long COVID the potential lessons from the field of fibromyalgia care and research have been underappreciated and marginalised and most importantly now deserve a critical appraisal.

Keywords: Covid-19; Epidemiology; Fibromyalgia.

Figure 1

The figure depicts the partial relationships among a number of defined conditions with overlapping symptoms with the most common clinical endotype observed in Long COVID (ie, fatigue, pain, brain fog and sleep disturbances). Fibromyalgia and ME/CFS are displayed most prominently to reflect the centrality of the represented symptoms in these disorders. While each entity is represented by a discreet circle virtually all may have overlap with each either singly or in combination and cannot readily be displayed. ME/CFS, myalgic encephalomyelitis or chronic fatigue syndrome.