The British Journal of General Practice has published an article entitled ‘Muscle weakness post-COVID: a practical guide for primary care‘ which discusses assessing patients with Long Covid in a primary care setting.
by Rebecca Payne, Tabitha Pring, Molly Hey, Gareth Payne and Trisha Greenhalgh (2024)
Introduction
- What could be behind a patient’s muscle symptoms?
- What should the GP look for on clinical assessment? And will they find anything?
- Case studies
- Who should the GP investigate?
- Initial investigations for patients with muscle symptoms post-COVID
- How should the GP manage patients with significant muscle weakness post-COVID?
Conclusion
COVID is known to cause muscle, nerve, and metabolic damage. Many patients presenting with post-COVID weakness, exertional symptoms, or fatigue will have identifiable defects on neurophysiological examination. When managing these patients, excluding treatable conditions such as myasthenia gravis, managing concomitant problems such as vitamin D deficiency, and explaining that improvement is likely over a period of 2–3 years can support the patient while nature heals what medicine can not.
MEA Comment
This is a useful short review of the possible causes of muscle weakness and fatigue in people with Long Covid along with how to assess this symptom and make sure that it is not being caused by post Covid conditions such as myasthenia gravis and polymyalgia.
Some of this information on possible causation, especially mitochondrial dysfunction, is also applicable to muscle weakness and fatigue in ME/CFS.
It is good to see that graded exercise therapy is not recommended and accompanied by an appropriate reference:
However, the information and guidance on activity management and pacing was far too brief and failed to direct people to useful sources of patient information on activity management such that the NICE guideline on ME/CFS and ME Association's guidance on Pacing: Activity and Energy Management.
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
