Thread by @LCalabreseDO

Brilliant/provocative review proposing unifying view of medically unexplained illness w implications 4 #LongCovid #MECFS and beyond-why this syndrome is NOT MIND OR BODY @VirusesImmunity @fitterhappierAJ @EricTopol @MichaelPelusoMD @CCalabreseDO
nature.com/articles/s4158…

Many medically unexplained diseases #LongCovid #MECFS #Fibromyalgia @SjogrensOrg #Lupus share a common clinical endotype w prominent fatigue/pain/brain fog- as well as increased rates of psychosocial disruption

Brain and immune system are one organ and communication between brain & immune system is a 2 way street where psychologic stress can influence immune response & immune act can influence brain & behavior

CNS immune activation can clearly drive central and peripheral pathways tied to dysautonomia( POTS, tachycardia, cough, GI etc)-HPA axis dysfunction & beyond --all disrupted in #LongCovid #MECFS @LongCovidKids @LongCovidSOS

Central CNS sensitization is a unifying principle and can be driven by peripheral and/or central neuro-immune imbalance BUT with each disorder may having unique triggers (exposomal factors) and genetic influences

In #LongCovid –CNS activation may be triggered/driven by microclots, viral persistence, inflammation and other putative mechanisms
cell.com/neuron/fulltex… @Dr2NisreenAlwan
BUT....

CNS neuroactivation may also be modulated by disrupted emotional reg /stress/PTSD/mood & are well documented epidemiologic risk factors for LC + may serve as additional primary/secondary drivers of sleep pain fatigue dysautonomia etc @Dr2NisreenAlwan jamanetwork.com/journals/jamap…

In some people psychosocial factors are likely minor or absent but in others may be major contributors to morbidity & end organ dysfunction yet BRAIN EMMOTION-IMMUNE interactions in NO WAY negate the physicality of #LongCovid #MECFS or any of these disorders @Dr2NisreenAlwan

For example #Lupus is clearly autoimmune though pts are plagued by fatigue/pain/Brain Fog when disease is ‘inactive’ (Type2 Lupus) & does not negate the organic nature of sxs #DukeRheum

AND Neuropsyche disorders are over represented in virtually all immune mediated diseases RA SLE Ps PsA IBD MS & this does not negate the bitter reality of these conditions

We must leave the Cartesian model of thinking originating 4 centuries ago by stopping our efforts to separate mind & body(& immune regulation)-Illness is experienced by the while person- 'it can be no other way' (h/t Eric Cassell)
there is NO blame here

We also need to critically appraise the extant psychoneuroimmunologic corpus to incorporate these putative mechanisms in #longCovid immunopathogenesis ncbi.nlm.nih.gov/pmc/articles/P… @UCLAStressLab

THE #LongCovid debate of mind vs body should/must end by thinking creatively to solve the puzzle & all diseases which may relate to this model #empathy #emapthy #empathy