Fibromyalgia Symptoms Unimpacted by COVID-19 Pandemic

Mary-Ann Fitzcharles, MD, FRCPC, MBChB

Credit: American College of Rheumatology

According to standard self-reported questionnaires completed 5 years apart, the symptoms of fibromyalgia remained stable or improved during the COVID-19 pandemic. Although results were unexpected, investigators believed the findings may be related to a variety of influences including a slower life pace during the pandemic, resilience to extended stressors, and scoring significantly higher than healthy controls in all measures, which may mean changes during the pandemic could represent a regression to the mean. This data was presented at the American College of Rheumatology’s 2023 Convergence in San Diego, California.¹

“Fibromyalgia symptoms fluctuate, with exacerbation commonly associated with stressors,” wrote investigator 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 was a cause of prolonged stress due to factors such as restricted medical care, social isolation, actual COVID infection, and changes in activity or work status. Worsening of health status in fibromyalgia could be anticipated.

Investigators using survey data to compare health status pre-pandemic (2017) and in August 2022 among patients with fibromyalgia and healthy controls to determine the impact the pandemic had on this patient population. Information collected included demographics, perception of health status change, symptom characteristics, and emotional perceptions regarding the pandemic. Participants also filled out the Fibromyalgia Impact Questionnaire (FIQ), the Patient Health Questionnaire (PHQ) for depression and anxiety, the Brief Pain Inventory (BPI), the Physical Activity Self-Administered Questionnaire (AQAP), and the ED-5D-5L Quality of Life Questionnaire. Emotions related to the pandemic were assessed using the Perceived Stress Scale (PSS). Analyses, including the Fischer Exact test, Wilk-Shapiro test, and Kruskal-Wallis test, adjusted for variables.

A total of 32 women with fibromyalgia and 21 healthy female controls completed the survey. Participants were predominantly White, although there were significant differences regarding body mass index, which was higher in the patient population, living alone, and work status. Approximately one third (34%) of patients with fibromyalgia experienced COVID-19 infection compared with 14% of healthy controls. The patient group reported more infection-related complications (9% vs 0%, respectively), as well as changes in work status (56% vs 43%, respectively). Adjustments in treatment tended to be non-pharmacological (47%) than pharmacological (25%).

While emotions related to COVID-19 were comparable between cohorts, patients with fibromyalgia reported a perceived worsening of pain (53% vs 5%, respectively). However, this was without change on the questionnaire-based measurement. Interestingly, 16% of patients with fibromyalgia reported an improvement in symptoms during the pandemic, compared with only 5% of controls.

Patients had greater COVID-19 perceived anxiety (3.8 vs 2.5, respectively), although there were no differences for numbers screened positive for depression and anxiety on the PHQ.

Quality of life was significantly improved for the patient group compared with controls. Prior to the pandemic, the average total FIQ score for patients was 62.81 compared with 50.91 during the pandemic, representing a -11.91 change. Conversely, the total FIQ score for healthy controls was 7.63 pre-pandemic, which increased to 25.04 during COVID-19, representing a 17.41 change. All other questionnaire measures were unchanged for both cohorts.

Physical activity levels were maintained in the patient group but decreased in healthy controls. Clinical measures for patients with fibromyalgia were linked to function, affective status 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.

References

1. ^{SaharT, MinerbiA, VernerM, Mitrovic S, et al. Effect of the COVID-19 Pandemic on Health Status of Fibromyalgia. Presented at: American College of Rheumatology Convergence 2023. San Diego, CA. November 10-15, 2023.}