Fibromyalgia and coronavirus: what patients should know

Fibromyalgia is not an autoimmune disease, so it does not make you immunosuppressed. But managing fibromyalgia has unique needs and concerns during the COVID-19 pandemic.

  • Fibromyalgia and arthritis pain

Living with fibromyalgia means dealing with a number of symptoms: generalized muscle pain (myalgia), extreme sensitivity in many areas of the body, sleep disorders, fatigue, headaches, and mood problems like depression and anxiety. But how does fibromyalgia affect your risk of COVID-19 and the ability to control these symptoms while staying home? This is what our experts want fibromyalgia patients to know about navigating the coronavirus pandemic.

  • Does fibromyalgia make you high risk for coronavirus?

The answer depends on whether you have primary or secondary fibromyalgia, says Petros Efithimiou, MD, FACR, a rheumatologist who practices in New York City.

Primary fibromyalgia, which is the most common form, is a chronic pain syndrome in which the body and brain process pain and stimuli differently, explains Dr. Efithimiou. Important: “There is no immunosuppression.”

Since fibromyalgia does not compromise your immune system, “there is no increased risk of acquiring COVID-19 and no increased risk of mortality from that disease,” says Frederick Wolfe, MD, a rheumatologist and fibromyalgia expert in Wichita, Kansas.

“People with a fibromyalgia diagnosis should follow medical authorities’ suggestions for ordinary citizens,” he says, including proper handwashing, practicing social distancing, and avoiding unnecessary travel and close contact with others if you need to go to work. or do an essential errand.

Secondary fibromyalgia, on the other hand, often occurs in patients with immune system disorders such as lupus, rheumatoid arthritis, and axial spondyloarthritis. In this case, your immune system can be suppressed and you would be considered high risk for COVID-19.

Knowing the difference is crucial.

“People might think that fibromyalgia is an autoimmune disease since rheumatologists often refer and treat them, and some of their symptoms may mimic those of lupus or other rheumatology patients,” says Nilanjana Bose, MD, MBA, rheumatologist at Rheumatology. Houston Center in Pearland, Texas.

But fibromyalgia is not an autoimmune disease, which occurs when the body’s immune system mistakenly attacks its own cells and tissues.

  • Do fibromyalgia medications suppress the immune system?

There is not necessarily a direct or universal way to treat fibromyalgia. Your medication options will depend on your most worrisome symptoms, as well as whether you have a concurrent condition. Medications used to treat primary fibromyalgia may include antidepressants, anticonvulsants, and nonsteroidal anti-inflammatory drugs (NSAIDs):

Antidepresivos tricíclicos: amitriptilina (Elavil), nortriptilina (Pamelor), ciclobenzaprina (Flexeril)Serotonin-norepinephrine reuptake inhibitors (SNRIs): duloxetine (Cymbalta) or milnacipran (Savella)

Selective serotonin reuptake inhibitors (SSRIs): fluoxetine (Prozac) or paroxetine (Paxil, Pexeva)

Antiseizure medications: gabapentin (Neurontin), pregabalin (Lyrica)

Non-steroidal anti-inflammatory drugs (NSAIDs): Advil or naproxen

If you develop symptoms of COVID-19, it is probably best to avoid NSAIDs such as ibuprofen (Advil) or naproxen (Aleve); you better take acetaminophen (Tylenol). According to a well-published article in the British Medical Journal, “Prolonged disease or complications of respiratory disease or complications of respiratory infections may be more common when using NSAIDs, both respiratory or septic complications [blood infection] and complications cardiovascular ”. said Paul Little, MD, a professor of primary care research at the University of Southhampton in the United Kingdom.

“Medications that patients take for pain and fibromyalgia, such as gabapentin (Neurontin) and pregabalin (Lyrica) do not lower the capacity of the immune system,” says Dr. Efithimiou.

Also, antidepressants don’t affect the immune system, says Dr. Bose, and “you should continue these medications to prevent flare-ups.” Before stopping a medication, contact your doctor by phone or use a telehealth system to make a plan.

  • Distinguish fibromyalgia symptoms from coronavirus symptoms

Many of the symptoms you may experience with fibromyalgia, including chest pain, body aches, fatigue, and general discomfort, can also be symptoms of COVID-19. But experts say you will be able to tell the difference.

“We tell our patients that if they experience drastic changes, such as shortness of breath or sharp chest pains, or feel different than the initial values, they should inform us,” says Dr. Efithimiou. “We ask them to assess the intensity and character of the symptoms. People are quite anxious, but they should stay away from the hospital. “

Anxiety and depression can cause physical symptoms, including body aches, fatigue, and chest pain. “The best way to distinguish between possible symptoms of COVID-19 and those of your chronic condition is to seek professional medical advice through an office visit or telehealth, which is available in many places,” says Brett Smith, DO, a rheumatologist with Blount Memorial Physicians Group in Alcoa, Tennessee.

  • Management of fibromyalgia symptoms in quarantine

Fibromyalgia symptoms such as pain and stiffness, fatigue, sleep disruption, anxiety and depression may feel intensified at this time. “It is a two-way street,” says Dr. Efithimiou. “The more anxiety can be controlled, the better the symptoms.”

We asked rheumatologist and psychologist John S. Fry, PhD, a former member of the National Fibromyalgia Association, what he can do to control these symptoms during the COVID-19 pandemic.

  1. Exercise

Many people find that exercise helps ease their fibromyalgia symptoms and their quality of life. The coronavirus should not stop you from moving. Take a walk, walk your dog, try online yoga classes, tai chi, or strength training. Take the rhythm and get plenty of rest between sessions.

     2.  Practice relaxation techniques

It is important that people with chronic pain and fatigue learn to relax their bodies by meditating, doing yoga, or practicing deep breathing or progressive muscle relaxation. While apps are available to guide you through these strategies, telemental health can help you hone these and other pain management skills, says Dr. Fry, who is licensed to practice in California.

    3. Lean on your loved ones

Dr. Fry believes that it should be called “spatial distancing” and not “social distancing,” especially since it is very important for people living with chronic illnesses to have the social support of friends and loved ones at this time. Be sure to take time out to connect with others, whether it’s calling a friend, FaceTiming or Skyping, or hosting a Zoom meeting with family and friends, says Dr. Fry. And take advantage of those loved ones who are around you 24 hours a day, 7 days a week; feel free to ask for a gentle massage or help with housework, he adds.

“Many fibrosis patients may have underlying depression and / or anxiety or a history of past trauma. It is important to expand your safety net during the pandemic, ”says Lenore Brancato, MD, a clinical assistant professor in NYU Langone Health’s rheumatology division in New York City. “With constant solemn news in the media and the necessary isolation from family and friends, it can fuel anxiety for everyone, especially fibro patients.”

     4. Create a schedule

Whether you plan a detailed schedule for your day or write down a to-do list every morning, creating a routine for yourself will help ease feelings of isolation and create some normalcy as you follow shelter-in-place orders. As you complete your tasks, “take a few seconds to savor the fact that you did it,” says Dr. Fry.

      5.  Change your internal dialogue

Internal dialogue can make a big difference in the way you handle your anxiety, which is probably causing you a catastrophe and thinking in black and white, explains Dr. Fry. Instead of saying something like: “The coronavirus is everywhere. I am trying to protect myself. I am scared. I will get it, and if I do, no one will be there for me, ”say something like,“ I could get the coronavirus, but I might not if I’m careful. ”

Remember that you are not alone. You probably have friends and family and communicating with them doesn’t make you a burden. Think back to the last time a friend called you for emotional support. After hanging up the phone, did you think it was a burden? Helping others is behavior that has been shown through research to make people happy, says Dr. Fry

    6. Find a healthy distraction

While you stay at home as much as possible, focus on hobbies and activities to help exacerbate feelings of anxiety and social isolation. Whether you paint, garden, color a scrapbook, or catch up on a Netflix series, it’s important to get into things that give you pleasure.

    7. Prioritize sleep

When you live with fibromyalgia, sleeping well is a struggle. Relentless pain can disrupt sleep, which can lead to increased pain and fatigue, creating a vicious circle. Coronavirus anxiety can make it even harder to fall asleep or fall asleep all night. Now is the time to go the extra mile to quench those concerns before closing your eyes and changing your perspective. “Before bed, write down three good things that happened, even if it’s been a horrible day,” says Dr. Fry. “Even if they are little things: my dog ​​licked my hand, I saw a cute hummingbird, a friend called me today. This too shall pass “.

“Facilitating restful sleep, which can be difficult during the best times for fibrosis patients, requires attention,” says Dr. Brancato. “Sleep hygiene and sleep rituals such as legs on the wall or simple inversions and meditation practice can be helpful. Daily exercises (including sitting biceps curls or leg lifts) can help reduce pain and relieve stress. Exercise can also promote better sleep. “

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