Abstract Long COVID is a diagnostic label currently given to those suffering from a poorly understood state of incomplete recovery or who have development of a myriad of medically unexplained symptoms occurring in the wake of infection with SARS CoV-2 that is both poorly understood and controversial. Many of the features of one of the most common clinical endotypes of Long COVID are shared by a condition well familiar to all rheumatologists and one with a large body of epidemiologic, clinical and basic research accrued over many decades namely the syndrome of fibromyalgia. Some have recently suggested that Long COVID may merely be a new name for fibromyalgia and that this diagnosis is indeed the condition that many or most may be suffering from as a post infectious sequela. In this Viewpoint we argue that while the parallels between the clinical syndrome experienced by many of those currently labeled as Long COVID and fibromyalgia are strong we should be not too quick to rename the disorder. We further argue that relabeling Long COVID as fibromyalgia is clinically reductionistic and any such relabeling may be attended by harm in both the design and execution of a future research agenda as well to patients who may be inadvertently and unfortunately pejoritised by such labeling. We further explore the parallels and differences between Long COVID and fibromyalgia and outline areas of needed future research and care. Paywall, https://ard.bmj.com/content/early/2023/11/20/ard-2023-224844
Discussing content from Calabrese previously: Biologic and Nonbiologic Interventions for Fatigue in Rheumatoid Arthritis (2019). Calabrese. Long COVID: defining the role of rheumatology in care and research (2022) Calabrese et Calabrese Rheumatology and Long COVID: lessons from the study of fibromyalgia 2023,Calabrese
If a label of fibromyalgia is pejorative, and it often is, that illustrates a whole other problem. There's the same issue with labelling some people with Long Covid with ME/CFS. Running away from existing labels largely due to the stigma they create doesn't help move the understanding of these conditions forward. It's perfectly possible to keep cohorts separate in research studies but recognise when people meet diagnostic criteria e.g. Covid-19 associated ME/CFS versus pre-Covid-19 ME/CFS.
It's too soon to throw in the towel due to impatience or irritation and refuse to distinguish between known symptoms clusters of: FM symptom clusters vs ME symptom clusters vs LC symptom clusters. If symptom clusters are at the moment all that can be detected in most cases of LC, so be it, for now. Just as clinical experts distinguish between FM and ME, based on symptoms,so, after adequate study, LC will be mapped out and perhaps/perhaps not lumped in the ME predominant side. or less "severe" into the FM predominant camp. Opinions are not necessarily expert, nor are they necessarily scientific.
Referencing Long COVID: major findings, mechanisms and recommendations (2023, Nature Reviews Microbiology) and The immunology of long COVID (2023, Nature Reviews Immunology)
Big duh here. But I guess it has to be said. It turns out that when you invent a bunch of horseshit, you end up with a bunch of horseshit. And when you do that in medicine to millions of people, it's about as bad as it sounds when you say it out loud. Although the original essay about Long Covid being fibromyalgia was just so profoundly ignorant that it didn't really merit a response, but I guess it's better than not. But obviously decades have been thoroughly wasted on delusional fantasies about the magical powers of the mind to cause illness just because it's hard to figure out. It's pretty absurd that such flowery language has to be used when in fact most of the profession is in dire need of a slap to the face over this, and then probably as many as it takes for them to stop just straight up ruining lives while disrespecting them as much as is humanly possible. This has a weird feel of concentration camps after a war with people dithering around wondering if it would be fair to let them out because, uh, reasons, I guess? Like it would be insulting to those who made the decisions, or whatever? Because you still have to work with them? Tens of millions of lives have been ruined by an insane ideology, and the strongest commentary that can be mustered up is some "golly gee maybe we shouldn't have done it quite so harshly just saying don't judge me oh please don't lose respect for me for saying you did something a bit wrong when actually you pretty much condemned tens of millions to needless suffering and early death while actually regressing not just this profession but scientific discovery". But I guess we should feel grateful for that "golly gee bit of a pickle we did here" since it's basically the most physicians are willing to give. Good grief. Just thinking about how loud this has all been, how thoroughly Long Covid should have debunked this whole insane circus. It's like ignoring a giant blaring alarm going on right in your face with the power of a dozen jet engines and a light more blinding than staring right at the noon Sun.
It is increasingly recognised that a significant proportion of patients who experience chronic inflammatory conditions, chronic pain conditions, other chronic illnesses, chronic stressful experiences such as war, as well as patients with more short-term illnesses including viral diseases, will experience the phenomenon of centrally sensitised nociplastic pain along with other symptoms such as fatigue and cognitive dysfunction, in combination with nociceptive pain and inflammation. When speculation becomes 'facts', via the magic of sophistry and arbitrary attribution.
Or re-writing to: "It is increasingly recognised that a significant proportion of patients who experience chronic inflammatory conditions, chronic pain conditions, other chronic illnesses, chronic stressful experiences such as war, as well as patients with more short-term illnesses including viral diseases, DO NOT GO ON TO experience the phenomenon of centrally sensitised nociplastic pain along with other symptoms such as fatigue and cognitive dysfunction, in combination with nociceptive pain and inflammation." The vast majority never do - otherwise pretty much everybody would have this. And they don't. THE END
It's really something that in speaking of being careful about useless speculation, the main argument here is still based on... useless speculation. Central sensitization and nociplastic pain are useless concepts invented to give credibility to the old psychosomatic beliefs. It's really frustrating that even after it's all been debunked, it just keeps going precisely because it was built to sound pseudoscientific. So the only change we'd get here is to move away from the old fairy tales, and onto... the new pseudoscientific fairy tales. So a lateral movement that comes back to its origin. The emperor may not be wearing a sumptuous golden robe, but he is still wearing a sumptuous golden, uh, garment. Yes, yes, that's it, it's not a robe, it's a garment. Problem solved.
