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.
Rob Volansky, Healio
Extracts
“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.
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.
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.
Dr Charles Shepherd Comments
Good to see these rheumatologists recognising the importance of post exertional malaise (PEM) being an important diagnostic feature of both Long Covid and ME/CFS.
However, by stating that PEM is “worsening of fatigue and other fatigue related symptoms after exertion” suggests that they don't really understand that PEM is different to activity induced fatigue and involves a DELAY in symptom exacerbation.
The NICE guideline on ME/CFS summarises the difference between these two key diagnostic symptoms:
- Debilitating fatigue is worsened by activity, is not caused by excessive cognitive, physical, emotional or social exertion, and is not significantly relieved by rest.
- Post exertional malaise follows activity in which there is a worsening of symptoms that is often delayed in onset by hours or days; is disproportionate to the activity and has a prolonged recovery time that may last hours, days, weeks or longer.
Dr Charles Shepherd,
Trustee and Hon. Medical Adviser to the ME Association,
Member of the 2018-2021 NICE guideline on ME/CFS committee,
Member of the 2002 Chief Medical Officer's Working Group on ME/CFS
