Muscle dysfunction in the long coronavirus disease 2019 syndrome: Pathogenesis and clinical approach
Camilla Costa Silva, Cléa Nazaré Carneiro Bichara, Francisca Regina Oliveira Carneiro, Vera Regina da Cunha Menezes Palácios, Ana Virgínia Soares van den Berg, Juarez Antônio Simões Quaresma, Luiz Fábio Magno Falcão
Abstract
In long coronavirus disease 2019 (long COVID-19), involvement of the musculoskeletal system is characterised by the persistence or appearance of symptoms such as fatigue, muscle weakness, myalgia, and decline in physical and functional performance, even at 4 weeks after the onset of acute symptoms of COVID-19. Muscle injury biomarkers are altered during the acute phase of the disease. The cellular damage and hyperinflammatory state induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may contribute to the persistence of symptoms, hypoxaemia, mitochondrial damage, and dysregulation of the renin-angiotensin system. In addition, the occurrence of cerebrovascular diseases, involvement of the peripheral nervous system, and harmful effects of hospitalisation, such as the use of drugs, immobility, and weakness acquired in the intensive care unit, all aggravate muscle damage. Here, we review the multifactorial mechanisms of muscle tissue injury, aggravating conditions, and associated sequelae in long COVID-19.