Fibromyalgia Severity Research Articles

Subjective Cognitive Dysfunction in Patients With and Without Fibromyalgia: Prevalence, Predictors, Correlates, and Consequences.

Background: Subjective cognitive dysfunction (SCD) is common in fibromyalgia (FM), where it has been called 'fibrofog.' But its predictors and correlates are not well understood, including the extent to which SCD is present in fibromyalgia and non-fibromyalgia clinical populations. In addition, there are no studies available concerning SCD and fibromyalgia in the general population. We investigated these issues in a longitudinal rheumatic disease research databank and two cross-sectional general population studies.Methods: 11,150 unselected patients with rheumatoid arthritis completed an assessment of FM and cognitive severity (CS) status using the full 0-3 fibromyalgia 2016 criteria assessment. In addition, CS was dummy coded as present/absent (CS+). Assessments of SCD and fibromyalgia prevalence were available in two German general population studies.Results: Fibromyalgia was present (FM+) in 2,493 (21.7%) of clinical subjects and absent (FM-) in 9,017 (78.3%) by FM 2016 criteria. Cognitive severity was present in 1,304 (52.3%) of those with fibromyalgia and 1,009 (11.2%) of non-fibromyalgia subjects (FM-). In two general population studies, 42.0% to 52.3% of those with fibromyalgia were CS+ as were 1.4% to 5.5% of FM- subjects. Patients with CS+ had more abnormal scores for every measure of rheumatoid arthritis (RA) severity, fibromyalgia severity, and general health. The presence of CS+ was strongly related to somatic and non-somatic symptoms scores and less strongly to pain variables. The best predictor of CS+ in the clinic and the general population was the symptom severity scale (SSS), a criterion of fibromyalgia.Conclusions: Persons with SCD have high counts of somatic and psychological symptoms. Subjective cognitive dysfunction is best predicted by a simple symptoms score, and not by pain extent scores. Although SCD is called fibrofog in patients with FM, 43.6% of CS+ cases occurred in FM- subjects. Fibromyalgia and CS are correlated but appear to be different parts of a symptom severity continuum. 'Fibrofog' as a phenomenon linked only to fibromyalgia is a misnomer because it can be identified in many non-fibromyalgia patients as well.

EVALUATION OF EARLY MALADAPTIVE SCHEMES IN FEMALE FIBROMYALGIA PATIENTS

Aim: Fibromyalgia is a condition characterized by widespread musculoskeletal pain and tenderness without an underlying organic cause. Relationships with psychiatric factors and personality traits have been reported in many studies. In this study, we aimed to examine the relationship between early maladaptive schemes (EMS) and fibromyalgia severity from the perspective of schema theory. Materials and Methods: For the study, 73 patients with fibromyalgia who applied to the Physical Medicine and Rehabilitation outpatient clinic and were diagnosed with fibromyalgia were included. In addition, 78 healthy control patients (without additional psychiatric disease and chronic pain) were included. A sociodemographic data form, Young Schema Questionnaire – Short Form 3 (YSQ -SF3) and Fibromyalgia Impact Questionnaire (FIQ) self-report scale was administered to the participants. Results: We found significantly higher scores on emotional deprivation, failure to achieve, dependence/incompetence, vulnerability to harm, enmeshment, subjugation, self-sacrifice, and pessimism/negativity schemes in the patient group. We also found positive correlations with FIQ scores, emotional deprivation, and vulnerability to harm schemes. Finally, we found that age was a positive predictor on FIQ. After controlling for age, we found that emotional deprivation and vulnerability to harm schemes predicted FIQ scores. Discussion and Conclusion: Fibromyalgia is a disease of unknown etiology. Psychological factors should be considered in the holistic treatment approach. In this sense, schema theory-oriented perspective can contribute to the treatment process.

The Probiotic VSL#3® Does Not Seem to Be Efficacious for the Treatment of Gastrointestinal Symptomatology of Patients with Fibromyalgia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Gastrointestinal symptomatology is frequent among patients with fibromyalgia, which increases disease burden and lacks specific treatment, either pharmacological or non-pharmacological. We aimed to evaluate the efficacy and tolerability of a multi-strain probiotic, VSL#3®, for the treatment of fibromyalgia-associated gastrointestinal manifestations. This randomized, placebo-controlled trial included 12 weeks of probiotic or placebo treatment followed by 12 weeks of follow up. The primary outcome variable was the mean change from the baseline to the endpoint in the composite severity score of the three main gastrointestinal symptoms reported by patients with fibromyalgia (abdominal pain, abdominal bloating and meteorism). Secondary outcome variables were the severity of additional gastrointestinal symptoms, fibromyalgia severity, depression, sleep disturbance, health-related quality of life and patients’ overall impression of improvement. No differences were found between VSL#3® (n = 54) and the placebo (n = 56) in the primary outcome (estimated treatment difference: 1.1; 95% confidence interval [CI]: −2.1, 4.2; p = 0.501), or in any of the secondary outcomes. However, responders to VSL#3 were more likely to maintain any improvement during the follow-up period compared to responders in the placebo arm. Overall, VSL#3 tolerability was good. Our data could not demonstrate any beneficial effects of VSL#3® either on the composite score of severity of abdominal pain, bloating and meteorism or in any of the secondary outcome variables. More research is needed to elucidate specific factors that may predict a favourable response to treatment in patients with fibromyalgia.

Common and Contrasting Characteristics of the Chronic Soft-Tissue Pain Conditions Fibromyalgia and Lipedema.

ObjectiveTo examine the common and specific characteristics of fibromyalgia and lipedema, two chronic soft-tissue pain syndromes without curative therapy options.MethodsDiseases’ characteristics were compared using the findings of extensive literature and the empiric data from two cohorts, both fulfilling standardized diagnostic criteria. Outcome was measured by various socio-demographics, the generic Short Form 36 (SF-36), the Fibromyalgia Severity Questionnaire (FSQ), and the 6-minute walk distance (6MWD). Empiric SF-36 data were compared to specific population-based norms and between the diagnostic groups, using standardized mean differences (SMD).ResultsFemale participants with fibromyalgia (n = 77) and lipedema (n = 112) showed comparable education levels and living situations. Lipedema cases were, on average, 3.9 years younger and BMI 6.3kg/m2 more obese. Women with fibromyalgia smoked more, did less sport, had more comorbidities, and worked less. Compared to the norms, health in fibromyalgia was worse than expected by SMD = –1.60 to –2.35 and in lipedema by –0.44 to –0.82 on the SF-36. The score differences between the two conditions ranged from SMD = –0.96 to –1.34 (all p < 0.001) on the SF-36 and the FSQ. For the inpatients (n = 77 fibromyalgia, n = 38 lipedema), the 6MWD was comparable (SMD = –0.09, p = 0.640). These findings were consistent with detailed data from the literature reviewed.DiscussionFibromyalgia and lipedema share characteristics of clinical phenomenology and comorbid conditions. Disease perception is more pronounced in fibromyalgia than in lipedema, especially in social and role dysfunction, whereas the walking distance was similar for both syndromes. This difference may be explicable by limited coping skills in fibromyalgia.

Attention-deficit hyperactivity disorder symptoms and quality of life in female patients with fibromyalgia

Background/aim The present study aimed to determine the association between attention-deficit hyperactivity disorder (ADHD) symptoms severity, fibromyalgia (FM) severity, and QoL.Materials and methodsWhile the FM group consisted of 113 (74%) patients, the control group consisted of 40 (26%) individuals. FM symptom severity, ADHD symptom severity, and QoL were evaluated using the fibromyalgia impact questionnaire (FIQ), adult ADHD self-report scale (ASRS), and World Health Organization quality of life scale-brief version (WHOQOL-BREF), respectively. ResultsIt was found that the FM group had significantly higher scores on the ASRS than the control group (p < 0.05). There was a significant difference in FIQ scores and three WHOQOL-BREF domain scores between the FM alone and comorbid FM/high probability of ADHD groups (p < 0.05). We found a negative correlation between ASRS total scores and all other scale scores (except for the social relationships domain score of the WHOQOL-BREF) and a positive correlation between ASRS total scores and FIQ scores in FM patients. ADHD scores would mediate the relationship between depression severity and QoL.ConclusionsOur findings indicated that the presence of ADHD symptoms was related to greater FM symptom severity and poorer QoL. Also, ADHD scores would mediate the relationship between depression severity and QoL.

Fibromyalgia in HIV-positive patients in Nigeria: A cross-sectional prospective study.

Fibromyalgia is a chronic pain syndrome of unknown etiology characterized by chronic widespread musculoskeletal pain and tenderness. It affects the quality of life of patients and has been associated with the human immunodeficiency virus (HIV). The study aimed to determine the prevalence of fibromyalgia in HIV-positive patients and assess the effect of fibromyalgia on their functional status. This was a cross-sectional study comprising 160 treatment-naive HIV-positive patients and 160 age- and sex-matched HIV-negative controls. The diagnosis of fibromyalgia was based on the 2011 modification of the 2010 American College of Rheumatology diagnostic criteria by assessing the widespread pain index and symptom severity score. The severity of fibromyalgia was assessed with the revised fibromyalgia impact questionnaire. The prevalence of fibromyalgia in HIV-positive individuals was found to be 10.6%, which was significantly higher compared with controls (3.1%; P=.008). There was no significant association between fibromyalgia and age, gender, or occupation. There was a significant relationship between CD4 count levels (P<.001), WHO clinical stage (P<.001), and fibromyalgia. A statistically significant higher score on the Revised FM Impact Questionnaire was found in HIV-positive individuals with fibromyalgia (P<.001). The study found that HIV-positive patients had a significantly higher incidence of fibromyalgia than controls and this was related to active indices of HIV disease. Fibromyalgia had a greater clinical impact on HIV patients than in controls. As a result, fibromyalgia should be identified and treated in people living with HIV.

Psychological Flexibility Is Key for Reducing the Severity and Impact of Fibromyalgia.

Fibromyalgia has a significant impact on the lives of patients; symptoms are influenced by psychological factors, such as psychological flexibility and catastrophizing. The objective of this study was to determine the importance of these variables in moderating the association between the severity and impact of fibromyalgia symptoms. A total of 187 patients from a general hospital population were evaluated using the Combined Index of Severity of Fibromyalgia (ICAF), the Fibromyalgia Impact Questionnaire (FIQ), the Acceptance and Action Questionnaire-II (AAQ-II), and the Pain Catastrophizing Scale (PCS). A series of multiple regression analyses were carried out using the PROCESS macro and decision tree analysis. The results show that psychological flexibility modulates the relation between severity and the impact of fibromyalgia symptoms. Catastrophism has residual importance and depends on the interaction with psychological flexibility. Interaction occurs if the severity of the disease is in transition from a mild to a moderate level and accounts for 40.1% of the variance in the sample. These aspects should be considered for evaluation and early intervention in fibromyalgia patients.

The correlation between the ACR questionnaire and fitness for work of fibromyalgia patients.

Fibromyalgia (FM) is a central pain syndrome characterised by widespread pain, fatigue, unrefreshing sleep, memory impairment and cognitive changes, predominantly in women, and is a cause for disability and frequent sick leave. So far, no assessment has been made of the use of the American College of Rheumatology (ACR) 2010 questionnaire in the fitness for work (FFW) assessment of FM patients. To assess the correlation between the severity of FM as measured by the ACR questionnaire and other parameters and FFW. We conducted a retrospective cross-sectional study involving women with FM who had their FFW assessed at an occupational health clinic between 2014-2018. The ACR questionnaire was completed during the medical assessment. We examined 60 files of women, mean age 48.8 years. Absolute loss of working capacity (ALWC) was calculated in relation to a standard 8-hour workday, while relative loss of working capacity (RLWC) was based on the patient's actual appointment percentage before the examination. The average ALWC determined by the occupational physicians was 59% ± 33%. Age group correlated significantly with ALWC (correlation coefficient = 0.03, p<0.05). The Part 2b symptoms (0-41) also correlated significantly with ALWC (mean ± SD 21.8±5.6, correlation coefficient = 0.23, p<0.05). Medical treatment correlated significantly with RLWC (correlation coefficient = 0.02, p<0.05). The rate of disability was high compared to what was reported in other studies. The correlation between different parts of the ACR questionnaire and disability demonstrated that symptom severity is a predictor of loss of working capacity. When performing a FFW assessment of FM patients, physicians may use the ACR questionnaire, since FFW correlates with its score. We assume that patients who experience more pain visit their physicians more often and consume more analgesics.

Fibromyalgia position paper.

Fibromyalgia syndrome is one of the most common causes of chronic widespread pain, but pain accompanies a wide range of ancillary symptoms. To date, its aetiopathogenesis remains elusive, and diagnosis is exquisitely clinical, due to the lack of biomarkers or specific laboratory alterations in fibromyalgia patients. This position paper has the purpose to summarise the current scientific knowledge and expert opinions about the main controversies regarding fibromyalgia syndrome, namely: (i) fibromyalgia definition and why it is still not recognised in many countries as a distinct clinical entity; (ii) fibromyalgia severity and how to evaluate treatment outcome; (iii) how to treat fibromyalgia and which is a correct approach to fibromyalgia patients.

Marital adjustment in patients with fibromyalgia: its association with suicidal ideation and related factors. A cross-sectional study.

Fibromyalgia has been associated with suicidal ideation, suicide attempts and completed suicide. Non-married status is a risk factor for suicidal behaviours but the quality of the marital relationship has been scarcely investigated. The objectives of the present study were to evaluate, in patients with fibromyalgia, the relationship between marital adjustment suicidal ideation and potentially related variables: depression severity, sleep disturbance, perceived burdensomeness, thwarted belongingness, fibromyalgia severity and pain intensity. A survey was done in patients with fibromyalgia which collected sociodemographic data and included the following questionnaires: the Locke and Wallace Marital Adjustment Test, the Beck's Depression Inventory II, the Plutchik Suicide Risk Scale, a 10-item version of the Interpersonal Needs Questionnaire, the Insomnia Severity Index, and the Revised Fibromyalgia Impact Questionnaire. Suicidal ideation was assessed with item 9 of the Beck's Depression Inventory, and pain intensity was measured with the VAS scale of the Revised Fibromyalgia Impact Questionnaire. Of 257 participants 71 were single, 107 had a good marital adjustment and 79 a poor marital adjustment. Suicidal ideation was most frequent among patients with poor marital adjustment than among those with good marital adjustment or patients without partner. The poor marital adjustment group showed significantly worse scores in most of the remaining variables with the only exceptions of the FIQR and pain scores. In patients with fibromyalgia the degree of marital adjustment seems to be a relevant factor for suicidal ideation and related variables.

Clinical impact of confinement due to the COVID-19 pandemic on patients with fibromyalgia: a cohort study.

To our knowledge, the impact of the COVID-19 pandemic on fibromyalgia (FM) patients has not been studied before. FM patients often experience clinical impairment with stress. The aim of this study was to determine whether severity of FM increases because of confinement by the COVID-19 pandemic. This prospective study includes patients from the Combined Index of Severity of Fibromyalgia (ICAF) cohort who met the 2010 ACR FM criteria. In this cohort, all patients have a periodical evaluation of their quality of life through two questionnaires, the ICAF, which assesses the ability to perform daily living activities, anxiety and depression, and through the Patient Global Impression of Change (PGIC), which assesses overall change after a therapeutical intervention. Pre- and post-confinement measurements were analysed. Inferential statistical analysis and ANOVA for repeated measurements were used. A total of 93 patients received a phone consultation, (95.5% females), mean (SD) age of 48.23 (8.38) years. Four patients were excluded as presenting COVID-19 and 51 (57%) completed the post-confinement ICAF. Following confinement, 25 (49%) patients got worse (group-worse) and 26 (51%) patients experienced no change or improved (group-stable). Comparisons between pre- and post-confinement ICAF did not show significant differences in both groups. Passive coping was significantly different in group-worse in pre-confinement evaluation. In the 80% of patients with passive coping predominance there were no changes in coping strategy. No clinical impairment due to COVID-19 confinement occurred. The perceived worsening among FM patients relies primarily on how patients cope with their disease, without a real impact on clinical manifestations.

Fibromyalgia severity according to age categories: results of a cross-sectional study from a large national database.

The role of age in influencing the severity of fibromyalgia (FM) is still controversial. The aim of this study is to define the contribution of age in the severity of FM from data from a large national database. This cross-sectional study included adult patients with FM diagnosed according to the 2010/2011 American College of Rheumatology criteria. Disease severity was assessed with the revised Fibromyalgia Impact Questionnaire (FIQR) and the modified Fibromyalgia Assessment Status (FAS 2019mod). Patients were grouped into five age categories (between 18-40 years, between 41-50 years, between 51-60 years, between 61-70 years, and ≥71 years). Differences in disease severity between groups were assessed by one-way analysis of variance (ANOVA). The study included 2889 patients (199 males and 2690 females), mean age of 52.58 (±11.82) years, with a mean FIQR score of 59.22 (±22.98) and a mean FAS 2019mod of 25.50 (±8.66). Comparing the mean values of the various indices between age categories, there were no statistically significant differences between the groups for FIQR total score and FAS 2019mod. However, the 60-70 years category showed the lowest scores for both scales. The main difference emerged for the FIQR physical function subscale, where the ≥71 years category showed significantly higher scores (p<0.05) compared the 18-40 years category. The severity of FM has a significant level of stationarity according to age categories. Patients between 60-70 years have a lower disease burden. Physical function is the health domain with the most significant difference between the groups.

Fear of pain moderates the relationship between self-reported fatigue and methionine allele of catechol-O-methyltransferase gene in patients with fibromyalgia

Previous research has shown a consistent association among genetic factors, psychological symptoms and pain associated with fibromyalgia. However, how these symptoms interact to moderate genetic factors in fibromyalgia has rarely been studied to date. The present research investigates whether psychological symptoms can moderate the effects of catechol-O-methyltransferase on pain and fatigue. A total of 108 women diagnosed with fibromyalgia and 77 healthy control participants took part in the study. Pain, fatigue, and psychological symptoms (anxiety, depression, pain catastrophizing, fear of pain and fear of movement) were measured by self-report questionnaires. Two types of statistical analyses were performed; the first was undertaken to explore the influences of COMT genotypes on clinical symptoms by comparing patients with fibromyalgia and healthy controls. In the second analysis, moderation analyses to explore the role of psychological symptoms as potential factors that moderate the relationship between pain/fatigue and COMT genotypes were performed. The main results indicated that patients carrying the Met/Met genotype reported significantly higher levels of fatigue than heterozygote carriers (i.e., Met/Val genotype) and higher levels of fatigue, but not significantly different, than Val homozygote carriers. Among patients with fibromyalgia carrying methionine alleles (i.e., Met/Met + Met/Val carriers), only those who scored high on medical fear of pain, experienced an intensified feeling of fatigue. Thus, the present research suggests that fear of pain, as a psychological symptom frequently described in fibromyalgia may act as a moderating factor in the relationship between the Met allele of the COMT gene and the increase or decrease in self-reported fatigue. Although further research with wider patient samples is needed to confirm the present findings, these results point out that the use of psychological interventions focused on affective symptomatology might be a useful tool to reduce the severity of fibromyalgia.

Spa Therapy for the Treatment of Fibromyalgia: An Open, Randomized Multicenter Trial

Fibromyalgia is a common chronic pain pathology with an incidence of 4.3 per 1,000 person-years. An open, randomized clinical trial of patients with fibromyalgia comparing an immediate vs. delayed 18-day spa therapy in five spa therapy care facilities in France enrolled 220 patients. Randomization was in blocks of four, stratified by center, severity of fibromyalgia and previous spa therapy. Patients continued usual treatment. The main endpoint was the number of patients achieving minimal clinically important difference at 6 months, defined as 14% change in their baseline fibromyalgia impact questionnaire score. The intention-to-treat analysis included 100 and 106 patients in the intervention and control groups, respectively. At 6 months, 45/100 (45.0%) and 30/106 (28.3%) patients in the intervention and control groups, respectively, achieved a minimal clinically important difference (P= .013). There was also a significant improvement in pain, fatigue, and symptom severity (secondary outcomes) in the intervention group but not for generic quality of life (QOL), sleep or physical activity. None of the 33 serious adverse events reported by 25 patients were related to the spa therapy. Our results demonstrate the benefit of spa treatment in patients with fibromyalgia. PerspectiveA 12-month, open, randomized clinical trial of 220 patients with fibromyalgia compared an immediate versus delayed (ie, after 6 months) 18-day spa therapy. The results showed a clinically significant improvement at 6 months for those who received immediate therapy which was maintained up to 12 months. Trial registration numberClinicalTrials.gov: NCT02265029

The oracle study - fibromyalgia, prevalence and severity in the hospital setting in the Pakistani population.

To assess the prevalence and severity of fibromyalgia in hospital-visiting patients. The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from July, 2018, to January, 2019, and comprised patients aged 18-75 years of either gender. Demographic information, comorbidities and previous medications were recorded for each patient. The modified American College of Rheumatology preliminary diagnostic criteria 2010-11 for fibromyalgia diagnosis. If diagnosed, the fibromyalgia impact questionnaire was administered to assess its severity. Data was analysed using SPSS 25. Of the 750 hospital-visiting patients, fibromyalgia was diagnosed in 250(33.3%); 190(76%) of them being females (p<0.0001). Comorbidities, age and increased elevated body mass index were significantly associated with fibromyalgia. Severity was not influenced by comorbidities, marital status, education or economic status (p>0.05). Menarche at a later age and menstrual irregularity were associated with fibromyalgia severity (p<0.05). The hospital-based prevalence of fibromyalgia was found to be high, especially among females.

Impact of sleep disturbances and autonomic dysfunction on the quality of life of patients with fibromyalgia.

Fibromyalgia, a painful musculoskeletal disorder is associated with sleep disturbances as well as autonomic dysfunction. Pathophysiology of fibromyalgia is yet not clear and neuroanatomical proximity of sleep and autonomic centre prompts probable involvement of the two impacting the quality of life of fibromyalgia patients. Present study was done with the objective to explore the extent of sleep disturbances and/or autonomic dysfunction in fibromyalgia and asses their impact on quality of life of fibromyalgia patients. Thirty consecutive fibromyalgia patients (diagnosed by ACR 2010) from out-patient department and 30 age-gender matched controls were enrolled after the ethical clearance. All participants were evaluated for: (1) sleep using Pittsburgh sleep quality index and medical outcomes study sleep scale-12 Revised, (2) Quality of life by 36 item short-form health survey-36v2TM and revised fibromyalgia impact questionnaire (only patients). Autonomic functions of patients were evaluated by standard cardiovascular autonomic function tests by Ewing's battery and heart rate variability (5-min) measurement. Fibromyalgia patients had increased sleep disturbances compared to controls (39.46±11, 59.61±2.31; p=0.0001) and very poor sleep quality (13.63±4.15, 3.03±1.56; p=0.0001) as well as quality of life (p=0.0001) which further deteriorated with increasing severity of fibromyalgia. Twelve patients had autonomic dysfunction but it was neither associated with sleep disturbances nor with quality of life. Mild to moderate grade fibromyalgia patients have significant sleep disturbance, poor sleep quality which remarkably impacts their quality of life. Autonomic dysfunction is not an early feature of disease. The study suggests that full spectrum of sleep disturbances and sleep quality should be explored in fibromyalgia syndrome (FMS) patients.

The association between body mass index and fibromyalgia severity: data from a cross-sectional survey of 2339 patients

ObjectiveVarious studies have shown that overweight and obesity are central features of FM, but the real impact of a high BMI on clinical severity in patients with FM is still controversial. The aim of this study was to analyse the relationships between BMI categories and measures of symptom severity and functional impairment using data from a Web-based registry of patients with FM.MethodsAdult patients with an ACR 2010/2011 diagnosis of FM underwent a complete physical examination and laboratory tests and were asked to complete a package of questionnaires covering their sociodemographic and treatment details, in addition to the following disease-specific questionnaires: the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromyalgia Assessment Status questionnaire (ModFAS) and the Polysymptomatic Distress Scale (PDS).ResultsA total of 2339 patients were recruited and divided into two weight categories, underweight/normal (U/N, n = 1127, 48.2%) and overweight/obese (O/O, n = 1212, 51.8%). The total and subscales of FIQR, ModFAS and PSD scores were significantly higher in the O/O patients, as were all the mean scores of the individual FIQR items (P < 0.001 for all).ConclusionOur findings demonstrate that O/O patients with FM are significantly more impaired than U/N patients in all the symptomatological and functional domains as measured using the FIQR, ModFAS and PDS, thus suggesting that being O/O has an additional effect on symptoms and function.

The evaluation of nailfold capillaroscopy pattern in patients with fibromyalgia.

Objectives This study aims to evaluate nailfold capillaroscopic pattern in patents with fibromyalgia and to assess the relation of capillaroscopic parameters with clinical variables and disease-related measures.Patients and methods This cross-sectional, case-control study included 60 participants (4 males, 56 females; mean age: 44.0±8.2 years; range, 26 to 64 years) between August 2019 and November 2019. All participants were divided into two groups as the primary fibromyalgia group (n=30) who met the 2016 modified American College of Rheumatology Diagnostic Criteria for Fibromyalgia and the control group (n=30) consisting of age- and sex-matched healthy individuals. Nailfold capillaroscopy was performed by a digital microscope under a magnification of 200X. Capillary density, capillary loop diameter, number of dilated, giant and neoangiogenic capillaries, capillary shape, number of avascular areas, micro-aneurysms and micro-hemorrhages were evaluated by an assessor who was blind to the group allocation. In the fibromyalgia group, Widespread Pain Index, Symptom Severity Scale scores, and Fibromyalgia Severity scores were calculated. Health status and presence of benign joint hypermobility syndrome (BJHS) were evaluated using the Fibromyalgia Impact Questionnaire (FIQ) and revised Brighton criteria, respectively.Results Of the capillaroscopic parameters, the mean capillary loop diameter, number of micro-aneurysms, avascular areas, and neoangiogenic capillaries were significantly higher in the patient group compared to the controls (p<0.001, p=0.016, p=0.038, and p=0.04, respectively). Nailfold capillaroscopic findings did not significantly differ between the patients with (n=16) and without concomitant BJHS (n=14). Of the disease-related measures, only FIQ score showed a weak correlation with the number of dilated capillaries (p=0.324).Conclusion Patients with fibromyalgia have distinct capillaroscopic patterns than healthy population. Capillaroscopic features, in general, are not related to clinical variables and disease-related measures.

Comparison for oral health-related quality of life in fibromyalgia subgroups according to fibromyalgia impact questionnaire: A preliminary study

Aim: This study aimed to compare the relationship between the severity of fibromyalgia and oral health-related quality of life in participant subgroups according to the fibromyalgia impact questionnaire.. Materials and Methods: Forty female participants aged 46.18±8.91 years old who were diagnosed with fibromyalgia were included in the study. Demographic data, education status, smoking, systemic anamnesis, employment status was recorded. Decayed, missing and filled teeth index values, periodontal situation and removable prosthesis conditions were evaluated. Participants were asked to fill three self-reported questionnaires: the fibromyalgia impact questionnaire, oral health impact profile-14 and general oral health assessment index scores. Fibromyalgia subgroups were classified as FM-Type I and FM-Type II according to the Souza et al classification. The primary outcome of which relationship between subcategorize of oral health related quality of life indexes and fibromyalgia impact questionnaire values were evaluated with Spearman correlation analysis. Results: The total value of oral health impact profile-14 was found to be 12.25±9.17 in the FM-Type I group and 19.74±10.48 in the FM-Type II group. There was a statistically significant relationship between fibromyalgia subgroups and oral health impact profile-14 psychological impacts (p=0.031) and total values (p=0.023). The values of total fibromyalgia impact questionnaire scores were obtained on a wide scale between 34.08 and 93.34, and the mean value was measured as 67.06 ± 16.06. The fibromyalgia impact questionnaire median cut-off score was detected as 66.42 according to ROC analysis.Conclusion: The higher negative oral health related quality of life values were observed in participants more severely affected by fibromyalgia. In addition to medical and psychiatric treatment of fibromyalgia participants, evaluation of dental conditions may be suggested.

Impact of central sensitization on pain intensity, pain-related symptoms, and health-related quality of life in chronic pain outpatient department

Context: Central sensitization (CS) has been proposed as a common underlying pathophysiology to explain poorly understood pain-related syndromes. This is termed under central sensitivity syndromes (CSSs), for which no specific organic cause has been found. Aims: The aim of the present study was to investigate whether there is an association between the CS Inventory (CSI) score, pain-related symptoms, pain-related disability, health-related quality of life (QOL), and poorly understood pain-related syndromes and whether they differed by disease type. This study also evaluated the association between severity of CS and the associated CSSs. Methods: A total of seventy patients who attended a pain clinic (chronic pain outpatient department) were assessed randomly. CSI score, CSSs, EuroQOL-5 Dimension-5 Level, Brief Pain Inventory, and Fibromyalgia (FM) Severity Scale were assessed and compared. Statistical Analysis: Univariate correlation analysis was performed in each group to evaluate: (1) severity of CS, (2) presence/absence of CSSs, (3) pain intensity and pain interference, and (4) CSI score and FM Severity Scale. Results: CSI score has a significant association with CSSs, pain-related symptoms such as pain/discomfort, anxiety/depression, mood, and sleep. Conclusions: In our study, CS has been shown to have a significant impact on mean pain score and QOL by strongly impacting mobility, mood, and sleep. CS is the underlying root cause of various CSSs. This study concludes that CS should be evaluated as a routine in all chronic pain patients.