Background/Purpose: Many patients with SLE experience symptoms of chronic pain and fatigue, often meeting criteria for fibromyalgia (FM). In this study, we sought to examine whether FM symptoms improved or worsened following the outset of the COVID-19 pandemic.

Methods: On Maya 6, 2020, 287 patients in the Duke Lupus Registry (DLR) were emailed an invitation to take a survey about the impact of the COVID-19 pandemic. Responses to the ACR 2016 FM diagnostic criteria questions (defined as post-pandemic responses) were compared to the 53 patients’ responses to the same questions collected at their most recent clinic visit prior to March 18, 2020 (defined as pre-pandemic responses). Significant clinical improvement was defined as a 3+ decrease in fibromyalgia severity score (FSS), a patient reported outcome scored as 0-31; significant clinical worsening was defined as 3+ increase in FSS. A two-tailed student t-test was used to performed a paired analysis of pre-pandemic FSS to post-pandemic FSS. Finally, the polysymptomatic distress scale (PDS) was used to characterize symptoms as mild (0-3), moderate (4-7), or severe (12-19).

Results: Survey responses were received from 53/287 (18%) of the Duke Lupus Registry participants, 92.5% of whom were women, 34% Black, and 60% Caucasian, compared to 93.4%, 53.8%, and 39.4%, respectively, in the registry as a whole. The mean pre-pandemic FSS for these patients was 7.5 ± 0.8 (SEM), compared to 8.7 ± 0.7 (SEM), post-pandemic (p=0.05). Pre-pandemic, 15 patients (28%) met criteria for mild polysymptomatic distress, 12 (23%) moderate, and 7 (13%) severe; post-pandemic, 21 patients (40%) met criteria for mild polysymptomatic distress, 15 (28%) moderate, and 8 (15%) severe (see Figure 1). Of the 53 survey respondents, 8 (15%) demonstrated significant clinical improvement during the pandemic, whereas 14 (26%) experienced significant clinical worsening. Of the 14 patients with worsened FSS, 12 (86%) did not identify any specific pandemic-related stressors or challenges in the domains of physical health, mental health, or personal life (work, family, and finances); the other 2 patients only mentioned worsening symptoms (pain, anxiety, and depression) as challenges. In contrast, of the 8 patients with improving FSS, 4 (50%) did not describe specific challenges, whereas the other 4 patients described symptoms in addition to articulating themes of isolation, missing extended family and family events, struggling with job loss, working to find opportunities for exercise, and grappling with balancing childcare and work responsibilities.

Conclusion: The experience of the COVID-19 pandemic is heterogeneous for SLE patients. In average, patient’s FM symptoms worsened following the onset of the pandemic, with 14 patients experiencing significant clinical worsening and only 8 patients experiencing significant clinical improvement in FM symptoms. Interestingly, the patients who improved articulated more pandemic-related challenges, perhaps suggesting that insight into one’s challenges is key to healthy coping. Further research is needed to identify risk factors and protective factors for SLE patients in the setting of the COVID-19 pandemic.

Figure 1. FSS change over time. For each patient participating in the survey, a pre-pandemic FSS (FSS from the most recent clinical visit prior to March 18, 2020) was compared to the post-pandemic FSS (collected from the online survey distributed on May XX, 2020). Red lines indicate patients with worsening FSS; blue lines indicate patients with improving FSS; grey lines indicate patients with unchanged FSS. The thick black line highlights the pre-pandemic mean (7.5) compared to the post-pandemic mean (8.7).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-impact-of-the-covid-19-pandemic-on-the-fibromyalgia-symptoms-of-sle-patients/