Long COVID and rheumatology: Clinical, diagnostic, and therapeutic implications 2022 Calabrese et al

[Andy]

Abstract

As of this writing, it is estimated that there have been nearly 600 million cases of coronavirus disease 2019 (COVID-19) around the world with over six million deaths. While shocking, these figures do not fully illustrate the morbidity associated with this disease. It is also estimated that between 10% and 30% of those who survive COVID-19 develop persistent symptoms after the acute infection has passed. These individuals, who most often experienced initial infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) considered mild to moderate in severity, often display a broad array of symptoms. Collectively, this disorder or syndrome is now referred to as Long COVID (among other designations), and it represents a national/international health crisis. The most frequently reported symptoms associated with Long COVID include chronic fatigue with post exertional features, neurocognitive dysfunction, breathlessness, and somatic pain. Long COVID can range in severity from mild to severely debilitating, with resultant loss of quality of life and productivity.

For now, there are many unanswered questions surrounding Long COVID: how can it be best defined, what is needed for accurate diagnosis, what is causing it, and how should it be best managed. How rheumatologists will engage in the Long COVID pandemic is another question; at the minimum, we will be called upon to evaluate and manage our own patients with immune-mediated inflammatory diseases who have developed it.

This review focuses on addressing the disease essentials, providing both declarative and procedural knowledge to prepare rheumatologists for how to address Long COVID: understanding its origins, its current case definitions, epidemiology, pathobiology and clinical manifestations. Finally, it will provide an outline on how to clinically approach patients with possible Long COVID and initiate treatment and/or guide them on how to best manage it.

Open access, https://www.sciencedirect.com/science/article/pii/S1521694222000535

 

[BrightCandle]

disorders that have been labeled as “psychosomatic” or in some way not real [3]. Such controversy merely adds to the clinical and interpersonal challenges facing both clinicians and patients who collectively so often feel compelled to find reasons and solutions for their suffering [6].

No mention of PEM despite it being the primary symptom, they are even misrepresenting the WHO.

diagnosis. They further assert that common symptoms include, but are not limited to, fatigue, shortness of breath, and cognitive dysfunction, and generally have an impact on everyday functioning; further, they recognize that the definition will likely change as knowledge increases. We believe that this is both an accurate and practical definition of Long COVID.

More Psychosomatic blaming nonsense.

COVID-19 disease at onset, increasing age, female sex, white ethnicity, poor pre-pandemic general and mental health, and other comorbidities (e.g., obesity and diabetes)

This is untrue, the vast majority of Long Covid patients came from mild infections.

It is clear that Long COVID also occurs after mild infection and, while likely less frequent, imposes a significant burden on afflicted patients

Its 1.15 billion and its 20,000 people datas collection, its not a trial.

such as the 1 billion dollar 40,000 person National Institutes of Health (NIH) sponsored trial

They get to PEM without giving it the usual name.

COVID patients is also affected by these domains but, in its most severe and chronic forms, has the dominant characteristic of postexertional exacerbation

and then get it wrong moments later

This postexertional flare of fatigue intensity...

On pain they are claiming no evidence of inflammation yet I have seen quite a few studies talking about high inflammation in Long Covid patients.

Presently, there is no compelling evidence of a widespread inflammatory basis for such pains

On treatment

Merely telling patients to push through their pain and discomfort rather than titrate their activities is often ill-advised and may lead to postexertional exacerbation and loss of trust in their rehabilitation program.

They are minimising it and saying most just get better

While there appears to be a small percentage of patients with Long COVID who have been observed to be profoundly and chronically debilitated even several years into their course, this is not the norm in terms of our understanding of the clinical course in the vast majority

Most of the paper is fine, it talks about some experimental treatments but misses a lot of what has been working for patients for over a year. It has some poor attention to detail in places and has a bit of somatic nonsense in it but as papers go its better than average on Long Covid and its consequences. Still IMO well below a reasonable bar and out of date already but would have been OK if it was published in early 2021. Nothing new or exciting in this and its a summary that misses the important details. Its not a wonder doctors are struggling.