Fibromyalgia and Long-COVID: A Diagnostic Dilemma

Fibromyalgia, a chronic condition characterized by pain, fatigue, disordered sleep and cognitive impairment, has puzzled the medical community for decades. While it impacts a relatively large proportion of the population (6% of Americans), it remains notoriously difficult to define and diagnose. A fibromyalgia patient’s journey through the medical system can be long and frustrating, often taking years due to the lack of specific lab tests or imaging studies. 

The Murky Waters of Diagnosis 

The diagnostic criteria for fibromyalgia have shifted significantly over the past few decades. For instance, in the 1990’s, the American College of Rheumatology emphasized the importance of “tender spots” as a key piece of the diagnostic puzzle; they have since entirely retracted this idea from their framework. Instead, the current diagnostic criteria center around subjective symptoms such as widespread pain, cognitive issues, and unrefreshing sleep. As you can imagine, given this terribly broad array of symptoms, fibromyalgia is often confused with conditions such as rheumatoid arthritis, anemia, and multiple sclerosis, among many others. 

spike protein

Long-COVID: A New Piece of the Puzzle 

Fast forward to the post COVID-19 era. A new medical puzzle has emerged, complicating things even further: long-haul COVID, or Post-Acute Sequelae of SARS-CoV-2 infection (PASC). While prevalence estimates vary, one highly cited study in JAMA found that PASC affects about 30% of people infected with COVID-19.  

Characterized by a constellation of symptoms that persist for weeks, months or years after acute COVID infection has resolved, long-COVID shares a strikingly similar profile to fibromyalgia. According to a review paper published in Frontiers, the most common symptoms of long-COVID are fatigue, malaise, brain fog, insomnia, and muscle aches. While other symptoms are more unique (e.g. loss of smell), typical symptoms are nearly indistinguishable from fibromyalgia. 

Might Overlapping Symptoms Imply a Connection? 

Given the overlapping symptoms, one can't help but wonder: are some people suffering from long-COVID being diagnosed with fibromyalgia? While this is purely speculative question at this stage, it certainly warrants further exploration in the scientific literature, and consideration by patients and clinicians.  

The Importance of Awareness and Research 

On this Fibromyalgia Awareness Day, let us acknowledge that fibromyalgia, like long-COVID, is a real, debilitating condition. While its causes remain a mystery, and its diagnosis remains a challenge, one thing is clear: it takes a significant toll on everyone it afflicts. 

As we grapple with the aftermath of COVID-19, researchers, clinicians and patients alike ought to consider the potential connection between fibromyalgia and long-COVID. While we don’t have all the answers yet, we should all keep an open mind toward the potential overlap between these conditions, and the diagnostic and therapeutic challenges it poses. 

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[1] Srinivasan, S., Maloney, E., Wright, B., Kennedy, M., Kallail, K. J., Rasker, J. J., ... & Wolfe, F. (2019). The problematic nature of fibromyalgia diagnosis in the community. ACR open rheumatology1(1), 43-51.  

[2] Vincent, A., Lahr, B. D., Wolfe, F., Clauw, D. J., Whipple, M. O., Oh, T. H., ... & St. Sauver, J. (2013). Prevalence of fibromyalgia: a population‐based study in Olmsted County, Minnesota, utilizing the Rochester Epidemiology Project. Arthritis care & research65(5), 786-792. 

[3] Häuser, W., Ablin, J., Fitzcharles, M. A., Littlejohn, G., Luciano, J. V., Usui, C., & Walitt, B. (2015). Fibromyalgia. Nature reviews Disease primers1(1), 1-16. 

[4] Logue, J. K., Franko, N. M., McCulloch, D. J., McDonald, D., Magedson, A., Wolf, C. R., & Chu, H. Y. (2021). Sequelae in adults at 6 months after COVID-19 infection. JAMA network open4(2), e210830-e210830. 

[5] Proal, A. D., & VanElzakker, M. B. (2021). Long COVID or post-acute sequelae of COVID-19 (PASC): an overview of biological factors that may contribute to persistent symptoms. Frontiers in microbiology12, 1494. 


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