Long COVID and Arthritis 

By Linda Rath | Feb. 28, 2026

Since the COVID-19 epidemic, many people have been dealing with long-term symptoms, or long COVID. And people with arthritis may face particular concerns. Not only do fatigue and joint pain overlap in arthritis and long COVID, having an autoimmune or inflammatory form of arthritis could affect a person’s risk of and recovery from long COVID.

What is long COVID?

Definitions of long COVID are as diverse as the 200 or more symptoms associated with it — many of which are also symptoms of arthritis, especially rheumatoid, psoriatic and other autoimmune forms of arthritis. Studies also show that inflammatory autoimmune arthritis can develop after a coronavirus infection. 

The National Institutes of Health (NIH) identified the 12 most common symptoms, though not necessarily the most severe or debilitating ones. These symptoms last or develop two months or more after a bout of COVID-19 and have no other explanation. They include:

• Fatigue
• Brain fog
• Dizziness
• Gastrointestinal (GI) symptoms
• Heart palpitations
• Change in sexual desire or ability to have sex
• Loss of or change in smell or taste
• Thirst
• Chronic cough
• Chest pain
• Abnormal movements
• Worse symptoms after physical or mental exertion

Other researchers have narrowed the definition, with fatigue and shortness of breath at the top of the list, followed by mental and gastrointestinal (GI) problems. Research also shows that symptoms often vary by age, sex, race and ethnicity as well as the variant of the virus.

A study published in February 2026 found that people who have long COVID are more than twice as likely to experience depression or anxiety as those who don’t have it. But most experts say mental distress doesn’t result from having long COVID but instead is a common symptom of it. It might be due to brain inflammation (which might explain memory problems and brain fog), low serotonin levels or too little glucose to fuel the brain.

What causes long COVID?

The current thinking is that long COVID is several different diseases with overlapping symptoms. The exact causes still aren’t known, but some research points to:

• Proteins in the immune system that attack your own tissues
• Leftover traces of the virus in different parts of the body
• Low-level inflammation
• Changes to the gut microbiome
• Damaged mitochondria (the energy sources of cells)

Some people may be affected by all these possible causes, while others may be affected by only one or two.

Does having arthritis make long COVID more likely?

One survey conducted during the pandemic suggested that people who have arthritis are at higher risk of long COVID. But the risk can vary. Being vaccinated seemed to lower the risk while having COVID multiple times raised it.

A 2024 systematic review and meta-analysis of 15 studies involving about 3,000 people with autoimmune rheumatic disease found long COVID in 56% of them, most often those with rheumatoid arthritis. Prevalence was higher (69%) in people who had been hospitalized for COVID-19, although other studies haven’t found a difference based on how severe the COVID was. The most common long COVID symptoms were fatigue and joint pain, which are common in arthritis, too. Some scientists speculate that a faulty immune system makes people with arthritis more vulnerable to lingering health problems after a coronavirus infection.

Other long COVID risk factors

Most long COVID patients are 40- and 50-year-olds who had been healthy.

David Putrino, PhD, a neuroscientist, physical therapist, director of Rehabilitation Innovation at Mt. Sinai Health System and family director of the new Mt. Sinai Cohen Recovery from Chronic Illness Center, has treated thousands of people with long COVID. Many of them were healthy, athletic people in their 40s who had just a mild initial infection, he says. 

Additionally, studies have found increased risks of long COVID for people who:

• Have COVID more than once
• Smoke
• Have diabetes 
• Are overweight or obese
• Are economically disadvantaged
• Are Black or Hispanic (they’re also less likely to be diagnosed)
• Are trans or bisexual

Understanding who gets long COVID and why would go a long way toward helping to prevent and treat it. Research on similar post-viral illnesses, such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and postural orthostatic tachycardia syndrome (POTS) provides some clues. For example, symptoms of ME/CFS and long COVID overlap, and may potentially involve similar treatments. POTS, which causes an abnormally fast heart rate and dizziness on standing, is a disorder of the nervous system that also affects most long haulers.

Guidance for long-haulers

Just as there doesn’t seem to be single cause of long COVID, it’s unlikely to have a treatment that works for all patients. Researchers are investigating everything from medications to physical rehabilitation, breathwork and Chinese herbs.

But Putrino has some suggestions for long COVID patients:

• Pay attention to triggers, including physical activity, fluctuating blood pressure and weather. Notice if heat and humidity make symptoms worse.
• Stay active, but only within your comfort zone, which at first may be extremely small. Compression stockings can help stabilize blood pressure. 
• Plan small, easily digested meals; eating a lot of heavy food at once is likely to trigger a fast heart rate and dizziness.
• Practice breath work. Many people develop abnormal breathing patterns due to damage from COVID or the ventilators sometimes used to treat it. (Evidence-based breathing strategies are available for free on the Stasis website.)
• Look for support. Long COVID Alliance has a helpful list of support and advocacy groups and other resources.
• Some insurers won’t cover tests or treatments for long COVID, which are largely experimental. Out-of-pocket costs vary widely.