Understanding Comorbidities in Hypermobile Ehlers-Danlos Syndrome: Could a Viral Infection Lead to a Diagnosis?

Hypermobile Ehlers-Danlos Syndrome (hEDS) is a complex, underdiagnosed connective tissue disorder characterized by widespread symptoms affecting multiple organ systems. Recent clinical observations suggest that individuals with hEDS may be at increased risk for persistent symptoms following COVID-19, commonly referred to as Long COVID. Using data from over 23 million patients across the United States, we examined associations between hEDS, COVID-19 infection, Long COVID, and related chronic conditions.

We identified nearly 30,000 individuals with hEDS and found that the estimated prevalence was approximately 1 in 800, higher than previously recognized. While rates of COVID-19 infection were similar between patients with hEDS and matched controls, those with hEDS were significantly more likely to develop Long COVID. This risk was especially elevated among patients with hEDS with overlapping conditions commonly seen in post-viral syndromes, including autonomic dysfunction, immune dysregulation, and chronic fatigue. Specifically, individuals with postural orthostatic tachycardia, mast cell-related symptoms, or chronic fatigue syndrome had the highest rates of Long COVID.

Cumulative incidence analysis revealed that many patients received an hEDS diagnosis only after a COVID-19 infection, suggesting that viral illness may exacerbate or reveal previously unrecognized symptoms. Patients with hEDS also exhibited higher odds of having additional risk factors for severe or prolonged illness, including chronic lung and autoimmune conditions, depression, and cerebrovascular disease.

These findings highlight a previously unrecognized vulnerability in patients with hEDS and underscore the need for greater clinical awareness of their heightened risk for persistent post-COVID illness.

Improved screening, earlier diagnosis, and integrated care pathways are urgently needed to support this complex and underserved patient population.

Author summary

We studied patients with hypermobile Ehlers-Danlos Syndrome (hEDS), a connective tissue condition that affects joints, skin, and many body systems. This condition is often misunderstood or overlooked, leaving many people undiagnosed. During the COVID-19 pandemic, people with hEDS appeared to experience more long-term symptoms after infection, a condition often called Long COVID. Here, we analyzed the health records of millions of patients in the United States to better understand post-viral outcomes.

Patients with hEDS were more likely to be diagnosed with Long COVID compared to similar patients without hEDS. This was especially true for those who also had conditions such as chronic fatigue, immune conditions, or issues with heart rate and blood pressure regulation. In many cases, people were diagnosed with hEDS for the first time only after they had COVID-19, suggesting the virus may worsen or reveal symptoms that had been previously missed.

Our findings show that hEDS may be more common than previously thought and that such patients face higher risks after COVID-19. Greater awareness and earlier recognition of hEDS could improve care for many patients with complex, long-lasting symptoms