Mary-Ann Fitzcharles, MD, FRCPC, MBChB
Credit: American College of Rheumatology
According to standard self-reported questionnaires completed at 5-year intervals, symptoms of fibromyalgia remained stable or improved during the COVID-19 pandemic. Although the results were unexpected, the investigators believed the results may be related to various influences, including a slower pace of life during the pandemic, resilience to prolonged stressors, and scoring significantly higher than healthy controls in all measures, which could mean that changes during the pandemic could represent regression to the mean. These data were presented to the American College of Rheumatology Convergence 2023 in San Diego, California.1
“Fibromyalgia symptoms fluctuate, with exacerbation usually associated with stressors,” wrote researcher Mary-Ann Fitzcharles, MD, FRCPC, MBChB, associate professor of medicine in the Division of Rheumatology at McGill University, QC, Canada, and colleagues. “The COVID-19 pandemic has been a cause of prolonged stress due to factors such as restricted medical care, social isolation, actual COVID infection, and changes in work activity or status. A worsening of the condition in fibromyalgia could be anticipated.
Investigators are using survey data to compare health status before the pandemic (2017) and in August 2022 among fibromyalgia patients and healthy controls to determine the impact of the pandemic on this patient population. Information collected included demographics, perception of change in health status, symptom characteristics, and emotional perceptions regarding the pandemic. Participants also completed the Fibromyalgia Impact Questionnaire (FIQ), Patient Health Questionnaire (PHQ) for Depression and Anxiety, Brief Pain Inventory (BPI), Self-Inventory administered on physical activity (AQAP) and the ED-5D-5L. Quality of life questionnaire. Pandemic-related emotions were assessed using the Perceived Stress Scale (PSS). Analyzes, including Fischer Exact test, Wilk-Shapiro test, and Kruskal-Wallis test, adjusted for variables.
A total of 32 women with fibromyalgia and 21 healthy control women completed the survey. Participants were predominantly white, although there were significant differences in body mass index, which was higher in the patient population, living alone, and employment status. About a third (34%) of fibromyalgia patients were infected with COVID-19, compared to 14% of healthy controls. The patient group reported more infection-related complications (9% vs. 0%, respectively), as well as changes in their work status (56% vs. 43%, respectively). Treatment adjustments tended to be non-pharmacological (47%) rather than pharmacological (25%).
While COVID-19-related emotions were comparable between cohorts, fibromyalgia patients reported perceived worsening of pain (53% vs. 5%, respectively). However, this remains unchanged compared to the questionnaire-based measurement. Interestingly, 16% of fibromyalgia patients reported improvement in their symptoms during the pandemic, compared to just 5% of controls.
Patients had greater perceived COVID-19 anxiety (3.8 vs. 2.5, respectively), although there was no difference for numbers testing positive for depression and anxiety on the PHQ .
Quality of life was significantly improved for the patient group compared to controls. Before the pandemic, patients’ average total FIQ score was 62.81, compared to 50.91 during the pandemic, representing a change of -11.91. Conversely, the total FIQ score for healthy controls was 7.63 before the pandemic, which increased to 25.04 during COVID-19, representing a change of 17.41. All other questionnaire measures remained unchanged for both cohorts.
Physical activity levels were maintained in the patient group but decreased in healthy controls. Clinical measures for fibromyalgia patients were related to function, affective state, and total FIQ, although they were not related to changes in pain or demographic variables. There were no significant correlations in the healthy control group.
The references
- SaharT, MinerbiA, VernerM, Mitrovic S et al. Effect of the COVID-19 pandemic on fibromyalgia health status. Presented at: American College of Rheumatology Convergence 2023. San Diego, California. November 10-15, 2023.
