Post-exertional malaise assessment ‘becoming more important’ for long COVID in rheum care
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WASHINGTON — Approximately 20% of patients meeting the 2016 fibromyalgia criteria report post-exertional malaise, which itself may be key to understanding both long COVID and fatigue in patients with rheumatic diseases, according to data.
“Post-exertional malaise is the worsening of fatigue and other fatigue-related symptoms after exertion,” Kaleb Michaud, MD, of the University of Nebraska Medical Center, told attendees at ACR Convergence 2024.
He stressed that chronic fatigue is the dominant symptom among patients with long COVID.
Moreover, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an important symptom among patients with rheumatic and autoimmune diseases.
“Understanding the nature and interrelationship of the fatigue among these disorders is important for both epidemiologic understanding and clinical management,” Michaud said.
To examine the prevalence of post-exertional malaise among patients across various rheumatic diseases, as well as its association with COVID-19 infection, Michaud and colleagues surveyed adults enrolled in the Forward Databank. The analysis included 1,158 participants who completed the post-exertional malaise subscale of the DePaul Symptom Questionnaire between January and June 2024.
Participants were categorized by diagnosis of rheumatoid arthritis, osteoarthritis, fibromyalgia or system lupus erythematosus, and assessed using the American College of Rheumatology’s 2016 fibromyalgia criteria. Stratification also included whether participants had COVID-19 infection, and when that infection occurred in relationship to post-exertional malaise.
According to the researchers, 7.5% of participants overall reported post-exertional malaise, with the incidence ranging from 4.4% among patients with OA to 14% in those with fibromyalgia. The highest incidence rate was 20%, which occurred among individuals meeting the ACR’s 2016 fibromyalgia criteria.
In addition, any prior COVID-19 infection was associated with positivity for post-exertional malaise. However, severity of acute COVID-19 may impact the development of post-exertional malaise, according to Michaud.
“If you were hospitalized, it was a much higher proportion of those meeting post-exertional malaise criteria,” he said.
Meanwhile, post-exertional malaise was worse among individuals reporting outcomes such as depression and widespread pain.
“Post-exertional malaise assessment is becoming more important in those with long COVID, as we are assisting those with long durations of this condition,” Michaud said. “Estimating post-exertional malaise prevalence is a first step. This is the first study that we know of presenting post-exertional malaise rates in a population of patients with rheumatic and autoimmune diseases.”
Michaud described the associations between post-exertional malaise, disease activity and COVID-19 as “important,” but said further research is needed.
“They require additional understanding,” he said.
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Michaud K. Abstract #0795. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
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