Primary Fibromyalgia Patients Research Articles

The relationship between serum leptin, insulin-like growth factor-1, and insulin-like growth factor binding protein-3 levels and clinical parameters in primary fibromyalgia patients.

The aim of this study was to investigate the levels of leptin, growth hormone, insulin-like growth factor-1, and insulin-like growth factor binding protein-3 and their relations with clinical parameters in patients with primary fibromyalgia and healthy controls. Our study was performed on 30 female patients with primary fibromyalgia and 30 healthy controls. The levels of insulin-like growth factor-1 and insulin-like growth factor binding protein-3 were measured by a two-site immunoradiometric assay. The serum level of leptin was measured by the ELISA kit. The serum level of leptin was significantly higher, but the serum levels of insulin-like growth factor-1 were significantly lower in patients with fibromyalgia syndrome than healthy controls (p<0.001). The leptin level was positively correlated with the Visual Analog Scale, Fibromyalgia Impact Questionnaire score, Beck Depression Inventory score, tender point count, age, and duration of disease (p<0.001), but it was negatively correlated with insulin-like growth factor-1 (p<0.001). The insulin-like growth factor-1 level was negatively correlated with age, Visual Analog Scale, Fibromyalgia Impact Questionnaire and Beck Depression Inventory scores, duration of disease, and tender point count (p<0.001). Our results indicate that high levels of serum leptin and low levels of serum insulin-like growth factor-1 may play a role in the physiopathogenesis of fibromyalgia and may be related to some symptoms.

Is fibromyalgia accompanying Behçet's disease more severe than primary fibromyalgia?

Objectives: Although there are studies in the literature about how Behçet's disease is affected in the presence of fibromyalgia, there is no information about how the severity of fibromyalgia is in the presence of Behçet's disease. This study aims to evaluate the severity of fibromyalgia by comparing the impact of fibromyalgia and pain thresholds between fibromyalgia patients with and without Behçet's disease. Methods: Twenty-five fibromyalgia patients with Behçet's disease and 34 primary fibromyalgia patients were included in this cross-sectional study. All participants completed the fibromyalgia impact questionnaire, and pain thresholds were measured at 18 tender points using algometry. Results: The mean fibromyalgia impact questionnaire scores in fibromyalgia patients with and without Behçet's disease were 66.6 ± 18.4 and 60.4 ± 14.5, respectively (p = 0.157). Pain thresholds were not different between the groups in 15 of the 18 tender points (TP). In fibromyalgia patients with Behçet's disease, pain thresholds in TP-15, TP-16 and TP-17 were 11.44 ± 4.84, 11.92 ± 5.00 and 15.16 ± 4.89 pounds, respectively, while in primary fibromyalgia patients those were 8.41 ± 2.68, 8.14 ± 2.76 and 12.14 ± 4.06 pounds respectively. Pain thresholds in TP-15, TP-16 and TP-17 were significantly different between the groups (p = 0.003, p = 0.003, p = 0.014, respectively). Conclusions: According to the literature data, although fibromyalgia has an effect on Behçet's disease, especially in cases associated with central sensitization syndromes, the severity of fibromyalgia was not found to be different in fibromyalgia patients with and without Behçet's disease in this study. There may be a relationship between Behçet's disease and fibromyalgia due to non-inflammatory causes such as central sensitization.

Effectiveness Of Mesotherapy In Treatment Of Fibromyalgia Tender Points

Background: Fibromyalgia is the second most common disease encountered in rheumatology practice Aim: This study designed to assess the potential effect of mesotherapy in treatment of tender points in primary fibromyalgia (PFM) patients. Methods: Thirty PFM patients who fulfilled the American Colleague of Rheumatology 1990 criteria, joined this study. They were divided into 2 groups randomly according to the treatment program received; Injection mesotherapy group (Group I: No=15 patients) who received a mixture of 2 ml of Ketoprofen (100mg/2ml) added to 3 ml of Saline Solution, once cession per week for a total of 6 successive weeks and other 15 patients (Group II) who received Ketoprofen 100 mg Extended- Release capsules once daily for 2 successive weeks which represent the control group. Patients‟ pain severity, quality of life and depression were assessed using visual analogue scale (VAS), fibromyalgia impact questionnaire (FIQ) and the Hamilton Rating Scale (HDRS) respectively before treatment and after the 3rd & the 6th cession then data were recorded and compared. Results: We found significant improvements (p<0.001) tender point‟s number, VAS, FIQ and HDRS in the injection mesotherapy group compared to the control group with no major adverse effects were described. Conclusion: This study supports the hypothesis that injection mesotherapy could offer a great therapeutic advantage in treatment of fibromyalgia tender points especially in the presence of associated comorbidities where there is a high risk of drug interaction, polypharmacy, or when conventional (oral or parenteral) NSAIDs use is contraindicated.

Effect of Selective Serotonin Reuptake Inhibitors and Serotonin Norepinephrine Reuptake Inhibitors on Trabecular Bone Score and Bone Mineral Density in Primary Fibromyalgia

Background: fibromyalgia is characterized by chronic widespread pain classified as primary and concomitant. Aim of the Work: this work aimed to determine the correlation between selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) usage and bone mineral density (BMD) and trabecular bone score (TBS) changes in primary fibromyalgia patients. Patients and Methods: The present study was conducted on study on 100 Egyptian patients diagnosed as primary fibromyalgia categorized according to drug medication into two 2 groups, 50 patients on SSRIs and 50 patients on SNRIs, recruited from Rheumatology, Physical Medicine and Rehabilitation Departments at Al-Hussein and Sayed Galal, Al-Azhar University Hospitals. In addition to another 50 age matched the control group subdivided into 25 primary fibromyalgia patients not on those drugs and 25 healthy individuals selected by nurses and medical staff, after an informed consent from all subjects from June 2018 to December 2018.Results: DXA and TBS revealed that usage of SSRIs and SNRI was significantly associated with low BMD (Osteopenia and osteoporosis) specially spine BMD reduction with low TBS (partially degraded and degraded) particularly for old people. Conclusion: the present study provided evidence that usage of SSRIs or SNRI was significantly associated with low BMD (Osteopenia and osteoporosis) specially spine BMD reduction with low TBS (Partially degraded and degraded) particularly for old people and despite low BMD was found in the SRI users; it also found in 1ry fibromyalgia not on SRIs so 1ry fibromyalgia should also be considered as a contributing factor for low BMD.

Effect of Selective Serotonin Reuptake Inhibitors and Serotonin Norepinephrine Reuptake Inhibitors on Trabecular Bone Score and Bone Mineral Density in Primary Fibromyalgia

Background: fibromyalgia is characterized by chronic widespread pain classified as primary and concomitant. Aim of the Work: this work aimed to determine the correlation between selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) usage and bone mineral density (BMD) and trabecular bone score (TBS) changes in primary fibromyalgia patients. Patients and Methods: The present study was conducted on study on 100 Egyptian patients diagnosed as primary fibromyalgia categorized according to drug medication into two 2 groups, 50 patients on SSRIs and 50 patients on SNRIs, recruited from Rheumatology, Physical Medicine and Rehabilitation Departments at Al-Hussein and Sayed Galal, Al-Azhar University Hospitals. In addition to another 50 age matched the control group subdivided into 25 primary fibromyalgia patients not on those drugs and 25 healthy individuals selected by nurses and medical staff, after an informed consent from all subjects from June 2018 to December 2018.Results: DXA and TBS revealed that usage of SSRIs and SNRI was significantly associated with low BMD (Osteopenia and osteoporosis) specially spine BMD reduction with low TBS (partially degraded and degraded) particularly for old people. Conclusion: the present study provided evidence that usage of SSRIs or SNRI was significantly associated with low BMD (Osteopenia and osteoporosis) specially spine BMD reduction with low TBS (Partially degraded and degraded) particularly for old people and despite low BMD was found in the SRI users; it also found in 1ry fibromyalgia not on SRIs so 1ry fibromyalgia should also be considered as a contributing factor for low BMD.

Capillaroscopic Findings in Primary Fibromyalgia.

Although Raynaud's Phenomenon (RP) is observed in a significant proportion of patients with primary fibromyalgia, the available data on capillaroscopic findings in primary fibromyalgia are scarce. The purpose of the study was to assess the capillaroscopic pattern in patients with primary fibromyalgia. 26 patients with primary fibromyalgia (25 women and 1 man) were included in the study. Mean age was 55±10 years. As control groups were examined 31 patients with primary RP and 35 healthy volunteers. Capillaroscopic examination was performed with a videocapillaroscope Videocap 3.0 (DS Medica), magnification 200x with analysis of the main capillaroscopic parameters as follows: capillary distribution, shape, mean capillary diameters and length, mean capillary density, visibility of the subpapillary plexus; presence of avascular areas, microhaemorrhages and neoangiogenic capillaries. Symptoms of RP were observed in 65% (17/26) of the cases with primary fibromyalgia. At capillaroscopic examination, the most frequent finding in patients with primary fibromyalgia was the presence of capillary dilation in 85% (22/26) of the patients - both in cases with and without RP. However, the mean arterial and venous capillary diameters were significantly higher in the subgroup of fibromyalgia patients with clinical symptoms of RP. Of note, microvascular abnormalities characteristic of connective tissue diseases could not be observed in primary fibromyalgia patients. Analogous changes - presence of dilated capillaries - were found in 96.6% (29/30) of patients with primary RP. In our study, the most frequent capillaroscopic finding in patients with primary fibromyalgia was the presence of dilated capillary loops analogous to primary RP. Capillaroscopic signs suggestive of connective tissue disease could not be found in primary fibromyalgia patients.

Reduced frontal activity during a verbal fluency test in fibromyalgia: A near-infrared spectroscopy study

Fibromyalgia (FM) is a complex disorder characterized by widespread chronic pain and associated sleep problems and cognitive dysfunction. However, only few studies focusing on cognitive dysfunction in FM are available so far. In the present study, we aimed to use near infrared spectroscopy (NIRS) to evaluate the brain function in FM patients subjected to a verbal fluency test (VFT). A total of 11 primary FM patients and 13 healthy individuals (HC) underwent NIRS while performing a VFT. The Fibromyalgia Impact Questionnaire (FIQ) was used to evaluate the symptom severity of FM and Beck Depression Inventory II (BDI) was used to evaluate the severities depression symptoms in study participants. Five regions of interests (ROIs) were defined: the frontal-, bilateral inferior frontal gyrus (IFG), and temporal regions. Brain activities of ROIs between the two groups were compared. In addition, we investigated the relationship between clinical symptoms and brain cortical activity in FM patients. Our results showed that there were no significant differences between HC and FM patients in age, sex, and BDI scores. We found significantly reduced brain activity over the frontal regions during a VFT in FM patients (p = .026). In addition, we found decreased frontal activity was associated with BDI scores (rho = −0.755, p = .007). Furthermore, there were no significant correlations between frontal activity and FIQ subscales. In conclusion, our study demonstrated a reduced frontal cortical activity during VFT in FM patients, and that NIRS could be a potential tool for evaluating brain function in FM patients in clinical settings.

Problem-focused coping and self-efficacy as correlates of quality of life and severity of fibromyalgia in primary fibromyalgia patients.

Patients with fibromyalgia syndrome (FMS) often experience problems such as poor quality of life (QoL), loss of self-efficacy (SE), inappropriate coping behavior, and chronic widespread pain along with other symptoms. Recent studies have indicated that sense of SE and effective coping strategies (CSs) are the crux on which the management of chronic pain and enrichment of QoL of FMS patients depend. Realizing the importance of this subject for the rehabilitation of the people with FMS, this study aimed at analyzing the correlation between severity of FMS, and QoL, SE, and CSs among the patients of FMS. One hundred patients with fibromyalgia (FM) and 100 control subjects were studied. Fibromyalgia Impact Questionnaire-Revised, Quality of Life Scale, Arthritis Self-efficacy Scale, and COPE Scales for CSs were administered to both the groups. Significantly lower SE, poor QoL, and less use of CSs were reported by FM patients (P < 0.01) vis-à-vis healthy people. Problem-focused coping (r = 0.27, P < 0.01) and SE (r = 0.20, P < 0.05) were found to be significantly and positively associated with QoL. Components of Fibromyalgia Impact Questionnaire-Revised, namely, pain, function, and symptoms, were found to be significantly and negatively associated with problem-focused coping (P < 0.05), SE (P < 0.01), and QoL (P < 0.01). This study confirms that problem-focused CSs and SE are important correlates of QoL and severity of FM in Indian as well as other populations.

AB0423 Impact of fibromyalgia on perceived pain in patients with systemic lupus erythematosus

BackgroundPersistent pain is the hallmark of various rheumatologic conditions, including systemic lupus erythematosus (SLE). The presence of diffuse pain compromises the quality of life of the patients. Fibromyalgia (FM) is...

Association between Thyroid Autoimmunity and Fibromyalgia

Evidence exists that autoimmune thyroiditis is present in a high percentage of fibromyalgia (FM) and associated with the presence of typical symptoms of FM. However, the role of thyroperoxidase antibody (TPO Ab) in the manifestation of FM is still unclear. The goal of this study was to investigate the prevalence of positive TPO Ab in euthyroid FM patients, and whether TPO Ab positivity is associated with the clinical manifestations in euthyroid FM patients.Thyroid assessment was done by free T4, TSH and TPO Ab. The clinical parameters including Fibromyalgia Impact questionnaire (FIQ), pain visual analogical scale (VAS) and tender point counts were evaluated in euthyroid primary FM patients, not associated with autoimmune rheumatic disease. The immunologic tests including rheumatoid factor and antinuclear antibody were measured. We compared the prevalence of positive TPO Ab between FM patients, and healthy control. We also compared clinical and laboratory parameter in FM patients according to the presence of TPO Ab.149 patients of FM, 68 healthy controls were recruited. FM patients showed higher prevalence of positive TPO Ab than healthy controls (28 out of 149 patients, 19%; 5 out of 68 healthy controls, 7%; P=0.04). There was no difference of clinical and laboratory parameters in FM patients between 2 groups subdivided by the presence of TPO Ab.In our study, euthyroid FM patients showed significantly higher prevalence of positive TPO Ab, as compared to age and sex matched healthy control. However, TPO Ab positivity was relatively low and not associated with the clinical manifestations in euthyroid FM patients. This finding support thyroid autoimmunity may influence the development of FM, but the evidence which support that FM is related to autoimmune etiology is not clear, and FM severity may not be affected by the presence of thyroid autoantibody.

Effect of duloxetine in patients with fibromyalgia: fatigue subgroups

Up to 90% of patients with fibromyalgia (FM) report moderate to severe fatigue. This study tested the hypothesis that baseline ratings of fatigue would negatively impact the efficacy of duloxetine on measures of pain and functional ability in American College of Rheumatology-defined primary fibromyalgia patients. A post hoc analysis of pooled data from 4 double-blind, placebo-controlled studies of duloxetine in FM was performed. The Fibromyalgia Impact Questionnaire (FIQ) tiredness item (0-10) was used to define fatigue.

Regional cerebral blood flow between primary and concomitant fibromyalgia patients: a possible way to differentiate concomitant fibromyalgia from the primary disease

Objectives: Technetium‐99m ethyl cysteinate dimer (Tc‐99m ECD) brain single photon emission computed tomography (SPECT) has been used to detect abnormal regional cerebral blood flow (rCBF) in women with primary fibromyalgia (FM). The main aim of this study was to investigate the rCBF deficit in concomitant FM patients and compare it with primary FM.Methods: An observational study was designed to analyse the SPECT findings in 92 female patients recruited from January 2002 to January 2004. Differences in the rCBF hypoperfusive areas between 49 primary and 29 concomitant FM patients were assessed in different areas of the brain using the χ2‐test for statistical significance.Results: Tc‐99m ECD brain SPECT in 71 FM patients revealed heterogeneous rCBF in comparison to the homogeneous scan in 14 control patients. The most prominent rCBF hypoperfusive region in both primary and concomitant FM groups was the left temporoparietal area, followed by the thalamus, right temporoparietal, frontal, and basal ganglia areas. Differences in rCBF hypoperfusion in these areas for both FM groups were not significant (all p>0.5).Conclusions: Reduced rCBF at cortical regions, in addition to previously reported areas at the thalamus and the subcortical nucleus, in FM patients was demonstrated in this study. The perfusion deficit areas were similar between primary and concomitant FM when the underlying disease activity was quiescent. The feasibility of using this neuroimaging study to differentiate FM from the primary disease, such as rheumatoid arthritis (RA)‐associated depression and neuropsychiatric lupus, should be considered.

Chest wall pain and related respiratory muscle strength in patients with primary fibromyalgia

AbstractIn this paper, maximum inspiratory pressure, maximum expiratory pressure, pulmonary function tests and maximum voluntary ventilation in primary fibromyalgia patients with chest pain were evaluated. Patients without any complaint of dyspnoea were selected. Fifty-nine fibromyalgia patients and 42 healthy controls were studied. Patients with fibromyalgia had lower maximum inspiratory pressure, maximum expiratory pressure, and maximum voluntary ventilation values than controls. Chest pain was assessed according to visual analog scale (VAS) score. There was no significant difference between groups in spirometric values, age and body mass index. The duration of fibromyalgia was 3.8 ± 4.4 years (1–15 years). Although the exact mechanism is not known, the results indicate that reduced respiratory muscle strength may be related to chest pain in fibromyalgia patients in the absence of dyspnoea.

Fibromyalgia in Italian patients with primary Sjögren’s syndrome

Objective. To assess the prevalence of fibromyalgia in primary Sjögren’s syndrome and to evaluate the clinical differences between patients affected with both primary fibromyalgia and primary Sjögren’s syndrome and those affected only with primary fibromyalgia. Methods. Clinical features of fibromyalgia were evaluated in 100 consecutive outpatients with primary Sjögren’s syndrome and, as controls, in 90 patients with non-insulin-dependent diabetes mellitus, in 75 patients with primary fibromyalgia and in 30 healthy subjects. Results. Fibromyalgia was recorded in 22% of patients with primary Sjögren’s syndrome, in 12.2% with diabetes and in 3.3% of healthy controls. In the primary Sjögren’s syndrome group the prevalence was significantly higher than in healthy controls ( P < 0.01), but not significantly different than in diabetes. Moreover, primary Sjögren’s syndrome with fibromyalgia and primary fibromyalgia patients did not differ with respect to the number of tender points, while the mean pain threshold was lower in the latter ( P = 0.05). Purpura, hypergammaglobulinemia, rheumatoid factor, and a focus score ≥ 1 on lip biopsy were significantly more frequent in primary Sjögren’s syndrome patients without than with fibromyalgia. Conclusions. As recently reported by other authors, our study confirms the moderate increase of fibromyalgia prevalence in primary Sjögren’s syndrome. Typical fibromyalgic findings are quite similar to those of primary fibromyalgia, but surprisingly, primary Sjögren’s syndrome patients with fibromyalgia show a less severe global involvement than those with primary Sjögren’s syndrome alone.

Autoantibodies to a 68/48 kDa protein in chronic fatigue syndrome and primary fibromyalgia: a possible marker for hypersomnia and cognitive disorders.

To identify antinuclear antibodies (ANA) specific for chronic fatigue syndrome (CFS), and in related conditions such as fibromyalgia (FM) or psychiatric disorders. One hundred and fourteen CFS patients and 125 primary and secondary FM patients were selected based on criteria advocated by the Centers for Disease Control and Prevention and by the American College of Rheumatology, respectively. As controls, healthy subjects and patients with either various psychiatric disorders or diffuse connective tissue diseases were included. Autoantibodies were examined by immunoblot utilizing HeLa cell extracts as the antigen. Autoantibodies to a 68/48 kDa protein were present in 13.2 and 15.6% of patients with CFS and primary FM, respectively. In addition, autoantibodies to a 45 kDa protein were found in 37.1 and 21.6% of the patients with secondary FM and psychiatric disorders, respectively. Meanwhile, these two autoantibodies were not found at all in connective tissue disease patients without FM, nor in healthy subjects (P<0.05). As a group, the anti-68/48 kDa-positive CFS patients presented more frequently with hypersomnia (P<0.005), short-term amnesia (P<0.07) or difficulty in concentration (P<0.05) than those CFS patients without the antibodies. The presence of the anti-68/48 kDa protein antibodies in a portion of both CFS and primary FM patients suggests the existence of a common immunological background. These antibodies may find utility as possible markers for a clinicoserological subset of CFS/FM patients with hypersomnia and cognitive complaints.

Memory functioning in patients with primary fibromyalgia and major depression and healthy controls

Memory functioning was assessed in 25 primary fibromyalgia (FM) patients by comparing them with 22 major depressed patients and 18 healthy controls. A broad range of short- and long-term memory tasks were included. Both major depressed and FM patients were significantly impaired on long-term memory tasks requiring effortful processing, compared to healthy controls. When the depressive status of the fibromyalgia patients was accounted for, only the subsample with a lifetime major depressive disorder showed memory impairment as compared with the healthy controls.

Treatment of Consecutive Severe Fibromyalgia Patients With Prolotherapy

AbstractThe potential of tendon and ligament triggers as primary nociceptors in fibromyalgia led to treatment of primary fibromyalgia patients with tendon and ligament strengthening injection. Trigger injection of ligament and tendon with proliferant (TILT therapy or prolotherapy) offers the advantage of creating increased strength of the connective tissue in the region of injection as well as affecting the pain cycle. Reduction in pain levels and increased functional abilities were seen in excess of 75% of patients with severe fibromyalgia in this study. The implications of this for further study are considered.

Effect of zopiclone on sleep quality, morning stiffness, widespread tenderness and pain and general discomfort in primary fibromyalgia patients. A double-blind randomized trial

Thirty-three patients fulfilling the diagnostic criteria for primary fibromyalgia completed an eight-week double-blind treatment trial with the drug zopiclone. Of outcome measures studied a score expressing subjective sleep quality showed improvement in more than ninety percent of zopiclone patients at 4 weeks and nearly eighty percent at 8 weeks, but similar improvement was also reported by more than sixty percent of the patients on placebo. Patient self-assessment of a treatment effect also showed an advantage for zopiclone, with most patients in the placebo group considering their state as unchanged at 8 weeks. According to examiner assessment, however, half the patients in both groups showed improvement at 8 weeks. For other assessment variables, e.g. dolorimeter assessment of widespread tenderness, visual analogue scales and pain drawings for pain and other subjective feelings of discomfort, the effects of zopiclone treatment were at the same level as those of placebo.

Pain Intensity in Patients with Fibromyalgia and Rheumatoid Arthritis

Three times daily continuously during a three-week inpatient rehabilitation course a visual analogue scale (VAS) was used in the assessment of pain intensity in 20 female patients with primary fibromyalgia (PF) and 20 female patients with rheumatoid arthritis (RA). The pain intensity in PF patients was constantly twice as high as in RA patients. The effect of the rehabilitation course on pain intensity, as assessed by linear regression analysis, was significantly higher in RA than in PF (p < 0.001). In comparison of the first and the last two days, the pain intensity decreased significantly (P < 0.01) in RA, but not in PF. The patients with PF were more depressive than the RA patients, but a positive correlation between depression score and pain intensity was found only in RA patients. Depression was not able to explain the high pain intensity in PF patients. Continuous monitoring of pain by VAS seems to be a useful tool for assessing changes in pain intensity in patients with rheumatic disorders.

Normal paraspinal muscle electromyographic fatigue characteristics in patients with primary fibromyalgia.

Paraspinal muscle fatigue mechanisms were compared in 14 primary fibromyalgia patients and 14 age and sex matched normal subjects using a standardized 60-s isometric endurance test of the paraspinal muscles, during which surface integrated electromyographic (IEMG) activity was recorded. Fatigue-induced IEMG increases were similar for both groups during the initial 40 s (up to 112 +/- 20% and 111 +/- 6% of initial values in patients and normal subjects respectively). Thereafter, IEMG fell significantly in patients (P < 0.05) but only slightly in controls, so that at 58 s IEMG was 102 +/- 13% in patients and 109 +/- 12% in controls. If patients were divided according to body mass index (BMI, range 19-25 in controls) those with a BMI < 26 (n = 5) showed IEMG changes similar to those of control subjects throughout the test, while obese patients with BMI > 26 (n = 9) showed greater IEMG declines after 40 s than either normal subjects or in the fibromyalgia group as a whole. Paraspinal muscle fatigue mechanisms appear normal in primary fibromyalgia patients. Isometric force maintenance in overweight patients, despite IEMG declines, illustrates the action of intrinsic fatigue resistance mechanisms which were presumably utilized to a greater extent in these patients to cope with the extra load.