Infectious Disease

To understand long COVID’s pathogenesis, consider fibromyalgia

Source/Disclosures

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sources:

Calabrese L. The epidemic long COVID-19: Questions, implications for rheumatology. Presented at: Biologic Therapies Summit X; May 11-13, 2023 (hybrid meeting).

Disclosures:
Calabrese reports financial disclosures with AbbVie, Amgen, AstraZeneca, BMS, Galvani, Genentech, GlaxoSmithKline, Janssen, Novartis, Sanofi-Regeneron and UCB.

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The current understanding of long COVID’s pathogenesis may be better served by looking to other diseases and syndromes, particularly fibromyalgia, according to a speaker at the 2023 Biologic Therapies Summit.

“Rheumatologists need to talk about this,” Leonard Calabrese, DO, RJ Fasenmyer chair of clinical immunology at the Cleveland Clinic, and chief medical editor of Healio Rheumatology, told attendees at the hybrid meeting. “The field of long COVID needs to understand that there is an extraordinarily strong relationship between [it and] fibromyalgia.”

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“There is no doubt, unequivocally, that after COVID-19 there is an anti-self response with numerous autoantibodies,” Leonard Calabrese, DO, said. “These are just the things at the top of the list.” Image: Adobe Stock

Leonard Calabrese

The relative closeness of long COVID symptoms and fibromyalgia spans multiple areas, Calabrese said, beginning with their potential origins as post-infectious sequelae.

“Fibromyalgia as a post-infectious sequela has long been described — studies show that it can arise from viruses such as Ross River and from other non-viral pathogens as well,” Calabrese said. “If you think of fibromyalgia, it is characterized as fatigue, pain, sleep disturbances and neurocognition.”

However, despite the apparent connections, Calabrese reported that over the course of two separate conferences with long COVID as a focal point, fibromyalgia as a subject did not come up at all.

“I have been to two major long COVID conferences where this word was never uttered, not one time,” he said.

Regarding the specific pathogenesis of long COVID, Calabrese noted that there has been much progress toward discerning its true nature.

In many patients, persistent viral infections accompany long COVID.

“Everyone is aware that there are data that, in some patients, show evidence of persistent viral infections,” Calabrese said. “Whether it comes from post-mortem studies or finding a spike in the serum or finding virus in the GI tract up to a year later, it is not found in all patients — and in actuality it is found in the vast minority.”

The presence of persistent viral infections, Calabrese said, is boosting the rationale for the pursuit of testing antiviral therapies in these patients. In addition to persistent infections, the undeniable anti-self response should be investigated, he added.

“There is no doubt, unequivocally, that after COVID-19 there is an anti-self response with numerous autoantibodies,” Calabrese said. “These are just the things at the top of the list.”

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