Patients with RA, Long COVID Significantly More Likely to Have Concomitant Fibromyalgia


Fibromyalgia was 3 times more common among patients with rheumatoid arthritis and Long COVID.

RA, Long COVID Significantly More Likely to Have Concomitant Fibromyalgia

Kaleb Michaud, PhD

Credit: American College of Rheumatology

Patients with rheumatoid arthritis (RA) and Long COVID were approximately 3 times more likely to be diagnosed with fibromyalgia, according to data presented at the American College of Rheumatology’s 2023 Convergence in San Diego, California. Results also revealed these patients had increased disease severity, psychosocial distress, and reported many symptoms of Long COVID pre-COVID infection. Investigators hypothesized a Long COVID diagnosis may be indicative of a preexisting illness.

Long COVID is defined as the development of persistent or new symptoms which can last for weeks or longer in patients who have previously recovered from COVID-19 infection. Common symptoms include cough, fatigue, breathlessness, chest tightness, palpitations, myalgia, and difficulty concentrating. It is estimated 30% of those diagnosed with COVID-19 could experience Long COVID and 10% of patients remain positive after 6 months post-infection.

“Recent studies showed increased odds of Long COVID in RA though uncertainty remains on whether this was due to a direct response to infection or the natural RA symptom course,” wrote lead investigator Kaleb Michaud, PhD, director of Forward, The National Databank for Rheumatic Diseases, and lead of the University of Nebraska Medical Center’s RAIN clinical database, and colleagues. “We set out to examine if characteristics and symptoms of those receiving Long COVID diagnosis appeared before COVID infection.”

Investigators used comprehensive questionnaires obtained from participants with clinician-diagnosed RA and self-reported COVID-19 infections at 6-month intervals, collected in FORWARD, The National Databank for Rheumatic Diseases. Eligible patients responded to the question, “Have you EVER been told by a healthcare provider that you have Long COVID?” which was added in July 2022. The survey closest to pre- infection or, if no prior COVID-19 infection was reported, prior to the initial Long COVID diagnosis was used as the baseline.

Participants self-reported health information including their symptoms, treatments, hospitalizations, and socioeconomic status. Patient-reported outcomes (PROs) included the Health Assessment Questionnaire (HAQ), Fatigue, Pain, Health Satisfaction, Sleep Problem, Widespread Pain Index (WPI), Symptom Severity Scale (SSS), and the 2016 American College of Rheumatology Fibromyalgia Criteria. Patients also included any depressive symptoms, as measured by the Patient Health Questionnaire-8 (PHQ-8), and anxiety, evaluated using the Generalized Anxiety Disorder 2-item (GAD-2). PROs were assessed at baseline according to future Long COVID status and a Lasso approach helped to select variables in a multivariate logistic model using Long COVID as the outcome.
A total of 667 patients with RA and COVID-19 responded to the Long COVID item and were included in the study. Of these participants, 15% were Long COVID positive.

Compared with Long COVID negative patients, those with Long COVID were older (68.2 vs 65.4, respectively), less likely to be White (88.7% vs 94.7%, respectively), had more comorbidities (2.6 vs 1.7, respectively), and had lower socioeconomic status. These patients were more likely to have depression (6.8% vs 3.9%, respectively) and worse RA PROs, although there were no differences in disease-modifying antirheumatic drug (DMARD) use.

Additionally, subjects with Long COVID were more likely to meet the criteria for fibromyalgia and the condition was 3 times more common among this population (41% vs 13%, respectively). During initial infection, Long COVID+ patients had more severe infections (23% vs 9%, respectively) and hospitalizations (18% vs 5%).

Investigators noted the self-reported data coupled with the lack of official criteria for Long COVID may have limited the study. However, future research will determine how well the recent criteria were able to identify Long COVID in the cohort, including patients without COVID-19, as well as the rates of Long COVID diagnosis termination.


  1. MichaudK, PedroS, Kamlesh GandhiS, Wolfe F. Persons with Rheumatoid Arthritis and Long COVID Had Worse Pre-COVID RA Symptoms and Worse Non-RA Symptoms, as Well as Higher Rates of Fibromyalgia Compared with COVID Infected Long COVID Negative. Presented at: American College of Rheumatology Convergence 2023. San Diego, CA. November 10-15, 2023.
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