A recent study has revealed a 7.5% prevalence of post-exertional malaise (PEM) among 1,158 individuals with confirmed rheumatic diseases, with notably higher rates in those affected by COVID-19 or long COVID.

The study highlighted that PEM is present across various rheumatologic conditions, with prevalence rates ranging from 4% in osteoarthritis to 20% in fibromyalgia.

PEM is characterized by worsening fatigue following exertion, typically manifesting 24 to 72 hours later and can last for days or weeks, making it a critical concern for patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID.

Experts note that PEM often overlaps with diagnostic criteria for ME/CFS, with 50% to 70% of ME/CFS patients also meeting the criteria for fibromyalgia.

Given the potential for exercise to exacerbate symptoms in PEM patients, experts recommend a cautious approach, as traditional graded exercise may worsen their condition.

Brayden P. Yellman, MD, emphasized the necessity for careful monitoring of exercise in patients with long COVID or ME/CFS due to the risks associated with triggering PEM.

In response to these challenges, experts are working on guidelines to differentiate between pacing and graded exercise, refine definitions of PEM, and establish quality care standards for managing infection-associated chronic conditions.

The Bateman Horne Center advocates for a non-harmful approach to managing PEM, discouraging the promotion of graded exercise as a first-line therapy.

Patients are generally advised to pace their activities to avoid PEM, often described as staying within their 'energy envelope' to manage their symptoms effectively.

The DePaul Symptoms Questionnaire, utilized in the study to assess PEM, may lack specificity, prompting updates to enhance its accuracy as a screening tool.

Current rheumatology training often falls short in adequately covering PEM, which may lead to underdiagnosis in patients with overlapping conditions such as fibromyalgia.

Kaleb Michaud, PhD, highlighted the increasing importance of assessing PEM in long COVID patients, noting that this study is the first to report PEM rates in a rheumatological disease population.