Long COVID: defining the role of rheumatology in care and research (2022) Calabrese et Calabrese

[Milo]

Long COVID: defining the role of rheumatology in care and research

This is a commentary in the Lancet, advocating for rheumatology to be involved in the care of Long-Covid patients.

Given rheumatologists' familiarity with chronic fatigue states in both inflammatory and non-inflammatory diseases,
7 the frequent presence of neurocognitive complaints in many rheumatic disorders, and rheumatologists' particular expertise in musculoskeletal pain, our field has potential to contribute meaningfully to these efforts.

Right... And you'd think that they can say no to ME but say yes to LC?

Unfortunately, at present, there are no approved therapies for long COVID, but numerous candidate therapies have been widely discussed, including antivirals, immunomodulators, metabolomic modifiers, and a host of integrative medicine approaches. With regards to immune-based therapies, rheumatologists' extensive clinical trial experience with agents now being considered candidate therapies for long COVID make them particularly suited for the task.
10

Right. And you think you can do all that for LC patients but not ME patients?

At present, rheumatologists and other subspecialists are limited to some of the foremost tools in our armamentarium (ones that we have long offered to legions of patients with incurable chronic diseases): careful listening, providing validation, and offering empathy. These tools, although in themselves not curative, for now could help patients with long COVID.

This sounds more like a courtship for a well funded disease. But they still seem to leave ME behind.

Link to article: https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(22)00266-1/fulltext

 

[Trish]

My summary:
Rheumatologists have experience with some of the symptoms cropping up in Long Covid and some of the hypotheses about cause and treatment because of overlaps with some rheumatological conditions so they should be involved in research and treatment.

Nobody else knows how to treat long covid, and neither do rheumatologists. Despite that, rheumatologists should be involved in treatment because they can offer listening, validation and empathy.

Frankly, your hairdresser can provide listening, validation and empathy. They should come as standard from any clinician, not needing to be claimed as a special skill of rheumatology.

 

[Amw66]

My summary:
Rheumatologists have experience with some of the symptoms cropping up in Long Covid and some of the hypotheses about cause and treatment because of overlaps with some rheumatological conditions so they should be involved in research and treatment.

Nobody else knows how to treat long covid, and neither do rheumatologists. Despite that, rheumatologists should be involved in treatment because they can offer listening, validation and empathy.

Frankly, your hairdresser can provide listening, validation and empathy. They should come as standard from any clinician, not needing to be claimed as a special skill of rheumatology.

Frankly the only medical input which has had any degree of any of these qualities have been optician and a current specialist physio from urology ( for high tone pelvic floor) .
Being treated as a " normal" person reduced my daughter to tears in the car afterwards .
It's that basic .

 

[Mij]

I have been referred to many specialists to r/o other diseases in my 31 years of M.E. I have never been referred to a Rheumatologist.

Isn't a Rheumatologist better suited for pwFM for treatments?

 

[Charles B.]

Nice to see Lenny Calabrese tossing his hat in the ring. The learned members of this forum will no doubt enjoy this gem from of his from several years back. I believe “learned helplessness” makes an appearance.

https://www.ccjm.org/content/ccjom/66/6/343.full.pdf

 

[chrisb]

He starts off well. It seeems that having no identified cause equates with having no identifiable cause.

 

[rvallee]

Actually, professionals should work on professional stuff. Providing "empathy" and "validation" is not the stuff expected of professionals and, sadly, they cannot do this anyway. "Hopes and dreams" medicine is just as useless as "thoughts and prayers" medicine.

From his comments on Twitter, Calabrese has Long Covid. This is simply not a way forward, though. It's precisely the siloed nature of medicine that is fundamentally broken here, petitioning a silo to pay attention to something they never did leaves us in the exact same state as things have been for decades.

Honestly this mentality is as creepy as the whole "smiles are back!" thing. This is simply not important, what sick people need from medical professionals is exactly what no one else can offer, expert medical care, and no offense meant here, but medicine is the last place I would be expecting empathy and validation of chronic illness, it's the literal origin and focus point of all the discrimination, neglect and disrespect we have to endure.

Medicine is oddly incapable of change. There is something fundamentally broken here that has to be fixed. This is all work medicine has to do for themselves, and so far the first step of solving that particular problem, acknowledging it, is still so far off it crosses tragedy and reaches all the way into comedic level of dogmatic ineptitude.

 

[Sid]

I don't see how/why rheumatologists would be useful in LC care. They haven't exactly covered themselves with glory when it comes to dealing with ME/CFS referrals.

 

[Charles B.]

Actually, professionals should work on professional stuff. Providing "empathy" and "validation" is not the stuff expected of professionals and, sadly, they cannot do this anyway. "Hopes and dreams" medicine is just as useless as "thoughts and prayers" medicine.

From his comments on Twitter, Calabrese has Long Covid. This is simply not a way forward, though. It's precisely the siloed nature of medicine that is fundamentally broken here, petitioning a silo to pay attention to something they never did leaves us in the exact same state as things have been for decades.

Honestly this mentality is as creepy as the whole "smiles are back!" thing. This is simply not important, what sick people need from medical professionals is exactly what no one else can offer, expert medical care, and no offense meant here, but medicine is the last place I would be expecting empathy and validation of chronic illness, it's the literal origin and focus point of all the discrimination, neglect and disrespect we have to endure.

Medicine is oddly incapable of change. There is something fundamentally broken here that has to be fixed. This is all work medicine has to do for themselves, and so far the first step of solving that particular problem, acknowledging it, is still so far off it crosses tragedy and reaches all the way into comedic level of dogmatic ineptitude.

I am not on Twitter, but if Calabrese is, someone should ask him about the article which he authored that I posted earlier in the thread. It recycles the sick role seeking tropes. So by his previous logic, all he needs is some CBT. I hope someone mentions this and hold him to account.

 

[Jonathan Edwards]

Never heard of the Calabrese's but it seems he is a doctor of osteopathic medicine about as old as I am. Time he turned to gardening.

And I guess the Lancet Rheumatology is a bit like an almost Rolex.

 

[Sean]

Nobody else knows how to treat long covid, and neither do rheumatologists. Despite that, rheumatologists should be involved in treatment because they can offer listening, validation and empathy.

Frankly, your hairdresser can provide listening, validation and empathy. They should come as standard from any clinician, not needing to be claimed as a special skill of rheumatology.

Better off just getting a nice pet.

He starts off well. It seems that having no identified cause equates with having no identifiable cause.

...which equates with having no physiological cause.

 

[Hutan]

I believe “learned helplessness” makes an appearance.

From the 1999 article authored by Leonard Calabrese


It's another one of those 'damned if you do and damned if you don't' things. If you are too fatigued to do things, you have learned helplessness. If you try to get investigations and better care, then that is evidence that you have health anxiety.

What is really being said is that the good patient does what they are told, stops whining and gets on with things. Anything outside of that is annoying, and evidence of a defective personality.

 

[NelliePledge]

Ugh

 

[FMMM1]

I don't see how/why rheumatologists would be useful in LC care. They haven't exactly covered themselves with glory when it comes to dealing with ME/CFS referrals.

[EDIT - hadn't read the comments above before posting this!]

Yea we don't know the underlying disease process in ME/CFS, or long COVID, so why send people to a rheumatologist? OK if we knew that ME/CFS, or long COVID, were B-cell autoimmune diseases (we don't) and the rheumatologist was a specialist in those autoimmune diseases/treatments then the referral would make sense.

Hopefully studies like GWAS will help to understand the underlying disease process.

I've said it before i.e. to members of the long COVID community - the same scam merchants, who have been active in ME/CFS, will purvey their wares to those with long COVID.

[EDIT - isn't calebrese a variety of cabbage/broccoli]

 

[FMMM1]

Nice to see Lenny Calabrese tossing his hat in the ring. The learned members of this forum will no doubt enjoy this gem from of his from several years back. I believe “learned helplessness” makes an appearance.

https://www.ccjm.org/content/ccjom/66/6/343.full.pdf

Actually “learned helplessness” leading to genetic studies, actimetry/sleep studies (to try to improve functioning in the short term), would be helpful --- where Lenny goes with current "helplessness" isn't. You do feel like asking - did you read what you wrote before submitting it?
As for the editor in the Lancet --- wow, not even pretence at caring or competence - revealing.