Plaut Shiloh
Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus.
Front Med (Lausanne). 2023 Apr 6;10:952278. doi: 10.3389/fmed.2023.952278. eCollection 2023.
The coronavirus pandemic has led to a wave of chronic disease cases; "Long COVID-19" is recognized as a new medical entity and resembles "fibromyalgia" which, likewise, lacks a clear mechanism. Observational studies indicate that up to 30%-40% of convalescent COVID-19 patients develop chronic widespread pain and fatigue and fulfill the 2016 diagnostic criteria for "fibromyalgia." A recent study suggested a theoretical neuro-biomechanical model (coined "Fascial Armoring") to help explain the pathogenesis and cellular pathway of fibromyalgia, pointing toward mechanical abnormalities in connective tissue and fascia, driven by contractile myo/fibroblasts and altered extracellular matrix remodeling with downstream corresponding neurophysiological aberrations. This may help explain several of fibromyalgia's manifestations such as pain, distribution of pain, trigger points/tender spots, hyperalgesia, chronic fatigue, cardiovascular abnormalities, metabolic abnormalities, autonomic abnormalities, small fiber neuropathy, various psychosomatic symptoms, lack of obvious inflammation, and silent imaging investigations. Pro-inflammatory and pro-fibrotic pathways provide input into this mechanism stimulation of proto/myofibroblasts. In this hypothesis and theory paper the theoretical model of Fascial Armoring is presented to help explain the pathogenesis and manifestations of "long COVID-19" as a disease of immuno-rheumo-psycho-neurology. The model is also used to make testable experimental predictions on investigations and predict risk and relieving factors.
新冠疫情导致了一波慢性病病例;“长新冠”被公认为一种新的医学实体,与“纤维肌痛”相似,而纤维肌痛同样缺乏明确的发病机制。观察性研究表明,高达30%-40%的新冠康复患者会出现慢性广泛性疼痛和疲劳,并符合2016年“纤维肌痛”的诊断标准。最近的一项研究提出了一种理论神经生物力学模型(称为“筋膜铠甲”),以帮助解释纤维肌痛的发病机制和细胞途径,指出结缔组织和筋膜存在机械异常,这是由收缩性肌成纤维细胞驱动的,同时细胞外基质重塑改变,并伴有下游相应的神经生理异常。这可能有助于解释纤维肌痛的一些表现,如疼痛、疼痛分布、触发点/压痛点、痛觉过敏、慢性疲劳、心血管异常、代谢异常、自主神经异常、小纤维神经病变、各种心身症状、缺乏明显炎症以及影像学检查无异常。促炎和促纤维化途径为这一机制提供了输入 对原成纤维细胞/肌成纤维细胞的刺激。在这篇假说与理论论文中,提出了筋膜铠甲的理论模型,以帮助解释“长新冠”作为一种免疫-风湿-心理-神经疾病的发病机制和表现。该模型还用于对研究做出可检验的实验预测,并预测风险和缓解因素。