Long COVID and hypermobility spectrum disorders have shared pathophysiology.
Ganesh, Ravindra, Munipalli, Bala · Frontiers in neurology · 2024 · DOI
Quick Summary
This review highlights that people with long COVID and ME/CFS often have joint hypermobility (excessive flexibility) at rates much higher than the general population. Both conditions share similar symptoms like pain, heart rate problems, brain fog, and fatigue, and may involve similar inflammatory processes affecting connective tissues. The authors suggest that screening for joint hypermobility and related conditions is important for long COVID patients, and that treatment should focus on managing individual symptoms through medication, gentle exercise, massage, and relaxation techniques.
Why It Matters
Understanding shared pathophysiology between long COVID, ME/CFS, and hypermobility disorders could improve clinical recognition and management of these often-misdiagnosed conditions. This framework suggests that screening protocols and treatment strategies may need to address connective tissue and immune dysfunction simultaneously, potentially improving outcomes for patients with overlapping symptom profiles.
Observed Findings
Hypermobility is detected in 30-57% of ME/CFS, POTS, fibromyalgia, and long COVID patients compared to lower rates in the general population.
Both long COVID and HSD present with overlapping extrapulmonary symptoms including musculoskeletal pain, dysautonomia, cognitive dysfunction, and fatigue.
Mast cell activation and degranulation occur in both long COVID and ME/CFS populations.
ME/CFS shares multiple symptom domains with HSD presentations.
Inferred Conclusions
Mast cell activation and hyperinflammation may be shared pathophysiological mechanisms linking long COVID, ME/CFS, and hypermobility spectrum disorders through connective tissue damage.
Screening for hypermobility and related conditions (fibromyalgia, POTS, chronic pain) should be integrated into long COVID clinical evaluation.
Symptom-focused, individualized pharmacological and non-pharmacological treatments (paced exercise, massage, yoga, meditation) are recommended for managing overlapping presentations.
Remaining Questions
Does hypermobility predispose individuals to developing ME/CFS and long COVID, or does post-viral inflammation induce hypermobility in susceptible individuals?
What specific mast cell biomarkers or activation pathways distinguish these overlapping conditions and predict treatment response?
What This Study Does Not Prove
This editorial does not establish causality between mast cell activation and hypermobility development, nor does it prove that hypermobility causes ME/CFS or long COVID symptoms. It cannot confirm the proposed mechanistic pathway through original experimental or clinical data, and it does not determine whether hypermobility is a predisposing factor, consequence, or independent comorbidity in these populations.
Which paced exercise protocols, dosages, and types (aerobic vs. resistance vs. flexibility-based) are safe and effective for patients with comorbid hypermobility and ME/CFS?
Do treatments targeting mast cell stabilization improve both the inflammatory state and hypermobility symptoms in these populations?