Fatigue, mental health and sleep quality during the COVID-19 pandemic in Brazilian women with rheumatological diseases: comparative study

When the world paused for the pandemic, the silence brought a new kind of noise for millions of people: the internal struggle of living with chronic pain and illness while the outside world shut down. For women, who make up the majority of those living with rheumatological diseases, this period was not just a time of isolation but a potential storm for their physical and mental well-being. Rheumatological diseases are a broad group of conditions that affect the joints, muscles, and connective tissues, often causing persistent pain, stiffness, and exhaustion. Unlike a broken bone that heals, these conditions are long-term, requiring constant management and often involving medications that calm an overactive immune system. When a global crisis hits, the fear of infection, the disruption of medical care, and the stress of social distancing can weigh heavily on anyone, but for those whose bodies are already fighting an internal battle, the added pressure can feel overwhelming. Understanding how this specific group fared during those difficult months helps us see the full human cost of a pandemic, beyond just the virus itself.

In Brazil, a team of researchers set out to measure exactly how the pandemic affected the daily lives of women with these conditions compared to women who were healthy. They focused on three specific areas that define how a person feels day-to-day: the quality of their sleep, the level of fatigue they experience, and their mental health, specifically looking for signs of anxiety and depression. To do this, they turned to the internet, creating a detailed survey that reached women across the country between March and September 2020. They invited 650 women to participate, dividing them into two groups: one group of 250 women who had been diagnosed with a rheumatological disease, and a control group of 400 women without any such condition. The survey asked them to reflect on their experiences over the previous month or week, using standard questions designed to gauge how well they slept, how tired they felt, and whether they were struggling with worry or sadness.

The results painted a clear and concerning picture. Women with rheumatological diseases reported significantly worse outcomes in every category measured compared to their healthy counterparts. Nearly all of the women in the disease group, about 92 percent, said they were suffering from poor sleep or sleep disorders, a figure that was notably higher than the 83 percent reported by the healthy group. The feeling of exhaustion was even more pronounced; more than 91 percent of the women with rheumatological diseases reported significant fatigue, whereas only about 71 percent of the healthy women felt the same level of tiredness. The mental toll was equally stark. Anxiety was reported by over 90 percent of the women with rheumatological diseases, and depression was found in nearly 86 percent of them. In contrast, among the healthy women, these numbers were much lower, with about two-thirds reporting anxiety and less than half reporting depression. When the researchers looked at women who were experiencing both anxiety and depression at the same time, the gap widened further, with more than 82 percent of the disease group affected compared to just 41 percent of the healthy group.

The study did not stop at comparing the sick to the healthy; it also looked inside the group of women with diseases to see if some conditions were harder to live with than others. The researchers separated the participants into three categories: those with autoimmune diseases, those with degenerative conditions like osteoarthritis, and those with fibromyalgia, a condition known for causing widespread pain and tenderness. While all groups struggled, the women with fibromyalgia stood out as the most affected. In this subgroup, every single woman surveyed reported symptoms of anxiety, and nearly 96 percent reported depression. Their sleep quality and fatigue levels were also the worst among the three groups. This suggests that while the pandemic was difficult for everyone with a chronic condition, those with fibromyalgia faced a unique and intense convergence of physical and emotional challenges.

Interestingly, the study found that the fear of the virus itself was not the differentiator. Both groups of women, whether they had a rheumatological disease or not, reported similar rates of knowing someone who had been diagnosed with COVID-19 or who had died from it. The difference in their well-being was not driven by a higher likelihood of infection or loss, but rather by how the pandemic amplified the existing burdens of their conditions. The researchers noted that the stress of the pandemic likely triggered a cycle where worry and lack of movement worsened their symptoms, which in turn made them feel more anxious and tired. While the study could not prove that the pandemic caused these specific levels of suffering, the data strongly suggests that the isolation and disruption of the time acted as a multiplier for the difficulties these women already faced.

The findings serve as a reminder that a global health crisis does not affect everyone equally. For women with rheumatological diseases, and particularly those with fibromyalgia, the pandemic was a period where their quality of life deteriorated significantly more than it did for the general population. The study highlights that the impact of such a crisis extends far beyond the immediate threat of the virus, reaching deep into the daily rhythms of sleep, energy, and emotional stability for the most vulnerable. As the world moves forward, these results underscore the need to pay close attention to the mental and physical health of people with chronic conditions, ensuring that support systems are in place to help them navigate not just the disease itself, but the stressful environments that can make it harder to manage.