Fibromyalgia Syndrome and Vitiligo: A Novel Association.

Introduction: Rheumatoid arthritis (RA) patients with fibromyalgia syndrome (FMS) report worse functional status and quality of life hence the association has important clinical implications. FMS can be challenging to treat, and the current evidence recommends a multidisciplinary treatment approach focused on symptom management. Aim: Information regarding the current prevalence of FMS in RA patients is lacking. Thus, this study aims to address the prevalence and predictors of FMS in seropositive RA patients and demonstrate our clinical practice in the management of FMS. Methods: Participants’ data was gathered from Aseer central hospital (ACH) rheumatology clinics and daycare units over a period of 2 years. Subjects were assessed using the 2010 American College of Rheumatology (ACR) criteria for FMS. Data were collected from medical records, including patient demographics, comorbidities and concomitant FMS-related data. Results: Out of 310 seropositive RA patients, 15% (n = 47) fulfilled the diagnostic criteria for FMS. Of them, 29, 11 and 7 were on pregabalin, amitriptyline and duloxetine, respectively. Half of FMS patients showed one or more therapy changes. A significant difference between RA patients with and without concomitant FMS was observed, including age, gender and comorbidities. Conclusion: In this retrospective study, a high prevalence of FMS in individuals with seropositive RA was identified. This study explores real-world practice in the treatment of FMS with remarkable findings regarding underdosing and lower discontinuation rate of pregabalin.

We have studied the prevalence of fibromyalgia syndrome (FMS) in patients with type 1 and type 2 diabetes mellitus (DM). Relationship with disease control of DM and the presence of FMS was also evaluated. We have studied 93 consecutive patients with DM (85 with type 2 DM and 8 patients with type 1 DM) followed in Diabetes Center. Single researcher took the history and did physical examination including manual tender point examination according to Manual Tender Point Survey instructions. For the diagnosis of FMS, 1990 American College of Rheumatology Classification Criteria for FMS was used. We measured patients' fasting blood sugar levels and HbA1c levels around the same time period. Patients were excluded from the study if they had any other serious disease, and if there was any history of drug use that interferes with the symptoms of FMS. Patients with rheumatoid arthritis (RA) were accepted as controls. FMS was found in 18% of patients with DM type 2 (no patients with FMS in type 1 DM group), in 34% of patients with RA. Female patients with DM type 2 had significantly higher FMS rates. Mean fasting blood sugar levels and mean HbA1c levels were not significantly different between type 2 DM patients with FMS and DM patients without FMS. In RA group, in RA patients without FMS, the use of steroids was significantly higher. We have found an increased prevalence rate of FMS in patients with DM type 2 and RA. There was no correlation between the prevalence rate of FMS and good DM disease control.

This pilot study was designed to test the efficacy of a physical activity program for improving psychological variables and fibromyalgia syndrome (FMS) symptoms and to provide preliminary evidence regarding the effects on perceived cognitive symptoms and objectively measured cognitive performance by FMS patients. Sixteen women diagnosed with FMS were randomly assigned to an 18-week physical activity program or to a control condition. Psychological measures, FMS symptoms, perceived cognitive function, objective measures of cognition, and walking capacity were assessed at baseline and posttest. At posttest, there were significant differences in fatigue (effect size, ES=1.86), depression (ES=1.27), FMS symptoms (ES=1.56), self-reported cognitive symptoms (ES=1.19), and delayed recall performance (ES=1.16) between the physically active group and the control group, indicating that the FMS patients benefited from physical activity. Beneficial effects were also observed for 6 of the 7 objective measures of cognition and ranged from small to large (ESs=0.26 to 1.06). Given that all FMS patients do not respond well to conventional treatments, these beneficial effects of physical activity are important. Future studies with larger samples are warranted to test the reliability of the findings for the objective measures of cognition.

Objective: This study aimed to estimate fibromyalgia Syndrome (FMS) prevalence in diabetes mellitus (DM) patients and explore associated factors. Methods: A cross-sectional study was conducted from June 2023 to February 2024 at King Khalid University Hospital in Riyadh, Saudi Arabia, targeting DM patients aged 18 years and above. A non-probability sampling technique was utilized. Participants were screened for FMS using the Arabic fibromyalgia rapid screening tool. Results: A total of 224 participants were included. The prevalence of FMS was 12.5%. A significant gender disparity was observed to be greater in females (OR = 4.32, 95% CI: 1.63-13.2, p = 0.005). No significant correlation was found between FMS prevalence and HbA1c levels (p = 0.215). Moreover, the presence of diabetic complications, namely diabetic foot, was significantly associated with FMS (OR = 5.68, 95% CI: 1.57-20.5, p = 0.007). Noteworthy, a prior diagnosis with psychiatric illness showed higher odds of fibromyalgia (OR= 7.42, 95% CI: 1.88-31.1, p = 0.004) Conclusion: The study revealed a significant prevalence of FMS among DM patients in Riyadh, underscoring the need for healthcare professionals to incorporate FMS screening into routine diabetic care, particularly for females and those with diabetic complications. This approach would ensure a holistic management strategy for DM patients, potentially improving their quality of life. Further research is warranted to explore the mechanisms linking DM and FMS.

Systemic lupus erythematosus (SLE) and fibromyalgia syndrome (FMS) are two diseases with similar clinical symptoms, but different pathophysiological mechanisms. Both diseases are chronic and generally more prevalent in women. Common symptoms include widespread muscle and joint pain, fatigue, sleep disorders and cognitive problems such as forgetfulness and difficulty concentrating. However, despite their similar symptoms, the two diseases require quite different treatment approaches. Therefore, a correct diagnosis is critical for patients to access appropriate treatment and improve their quality of life. We present the case of a 49-year-old female patient who had been under observation for two years with a diagnosis of FMS. Despite treatment, her symptoms persisted and she was subsequently diagnosed with SLE in addition to FMS. Initially, the patient presented with joint pain, weakness, fatigue and sleep disorders; however, there were no objective clinical findings suggesting SLE. Subsequent objective findings and laboratory values led a rheumatologist to diagnose SLE, and hydroxychloroquine sulfate treatment was started.

Purpose: The aim was to investigate the skin findings in patients with Fibromyalgia Syndrome (FMS), and the relations of these findings with the clinical symptoms of the disease, quality of life and depression levels of the patient. Materials and Methods: A total of 77 patients with FMS were included in the study as the study group, 74 individuals were included as the control group. The pain levels were evaluated with Visual Analogue Scale (VAS). The short form-36 (SF-36) was used to evaluate the quality of life levels of the patients. The Beck Depression Scale (BDS) was used to evaluate the depression levels of the patients. All participants were evaluated by the same dermatology specialist. Results: Although 37.1% patients who had FMS had at least one cutaneous symptom, 19.9% of the control group had at least one cutaneous symptom (p<0.01). According to the BDS, significant increases were detected in FMS patients (p=0.001). Significant decreases were detected in terms of all SF-36 parameters in the FMS group (p=0.001). There was at least one dermatological disease in 43% of the patients, and in 20.5% of the controls. Although no significant differences were detected between BDS and VAS scores of the FMS patients with and without dermatological findings, SF-36 total score and physical role strength score were found to be significantly lower in the patients who had dermatological symptoms. Conclusions: It must be known that there may be dermatological symptoms in FMS, a more multidisciplinary approach must be used in treatment and follow-up.

BackgroundBehçet’s syndrome (BS) is a rare multi-organ systemic vasculitis of unknown aetiology with hallmark manifestations of mucocutaneous ulcers and skin lesions. Morbidity is high in BS; with high prevalence of...

Background and Objective Fibromyalgia syndrome (FMS) is a distressing clinical condition. Metabolic syndrome (MetS) is a biochemical and clinical condition characterised by visceral obesity, dyslipidaemia, hyperglycaemia and hypertension. The relation between the two conditions is rarely discussed. This study aimed to determine the prevalence of MetS in FMS patients and to uncover its association with the clinical severity of FMS. Patients and Methods This cross-sectional study included 200 patients with newly diagnosed FMS. The diagnosis of FMS was established on the basis of the American College of Rheumatology (ACR) 2016 revised criteria. Patients were assessed using the validated Arabic version of Fibromyalgia Impact Questionnaire (FIQ). FMS severity was categorised according to FIQ scores into mild (≤45), moderate (&gt;46 and≤65), and severe (&gt;65). Results The study included 200 FMS patients. They comprised 180 females (90.0%) and 20 males (10.0%). Among the studied patients, there were 96 patients (48.0%) who fulfilled the criteria of MetS diagnosis. A comparison between FMS patients with MetS and patients without MetS revealed a significantly higher Widespread Pain Index (WPI) [median (IQR): 12.0 (10.0–17.0) vs. 9.0 (6.0–11.0), p&lt;0.001], a higher Symptoms Severity Scale (SSS) (10.5±1.04 vs. 8.1±1.8, p&lt;0.001) and a higher FIQ (58.8±20.7 vs. 45.4±16.6) in patients with MetS. Patients with MetS had a significantly higher frequency of severe FMS (31.2 vs. 10.6%, p&lt;0.001). Using binary logistic regression analysis, significant predictors of severe FMS included WPI, SSS and MetS in a univariate analysis. However, in a multivariate analysis, only WPI and SSS remained significant. ConclusionsThis study found that MetS is prevalent in FMS patients and it may be associated with more severe forms of the disease.

AB0710 PATIENT PERCEPTIONS OF FIBROMYALGIA SYMPTOMS AND THE OVERLAP WITH AXIAL SPONDYLOARTHRITIS

Fibromyalgia syndrome (FMS) is a common condition lacking strong diagnostic criteria; these criteria continue to evolve as more and more studies are performed to explore it. This investigation sought to identify whether participants with FMS have more frequent and larger postural/spinal displacements in comparison to a matched control group without the condition of FMS. A total of 67 adults (55 females) out of 380 participants with FMS were recruited. Participants with FMS were sex- and age-matched with 67 asymptomatic participants (controls) without FMS. We used a three-dimensional (3D) postural assessment device (Formetric system) to analyze five posture variables in each participant in both groups: (1) thoracic kyphotic angle, (2) trunk imbalance, (3) trunk inclination, (4) lumbar lordotic angle, and (5) vertebral rotation. In order to determine whether 3D postural measures could predict the likelihood of a participant having FMS, we applied the matched-pairs binary logistic regression analysis. The 3D posture measures identified statistically and clinically significant differences between the FMS and control groups for each of the five posture variables measured (p < 0.001). For three out of five posture measurements assessed, the binary logistic regression identified there was an increased probability of having FMS with an increased: (1) thoracic kyphotic angle proportional odds ratio [Prop OR] = 1.76 (95% CI = 1.03, 3.02); (2) sagittal imbalance Prop OR = 1.54 (95% CI = 0.973, 2.459); and (3) surface rotation Prop OR = 7.9 (95% CI = 1.494, 41.97). We identified no significant probability of having FMS for the following two postural measurements: (1) coronal balance (p = 0.50) and (2) lumbar lordotic angle (p = 0.10). Our study’s findings suggest there is a strong relationship between 3D spinal misalignment and the diagnosis of FMS. In fact, our results support that thoracic kyphotic angle, sagittal imbalance, and surface rotation are predictors of having FMS.

Vitiligo is an acquired depigmentary disorder involving a progressive loss of melanocytes from the epidermis and hair follicles. Gujarat has a high prevalence of vitiligo. One of the major hypotheses in the pathogenesis of vitiligo is the neurochemical hypothesis. According to the neural hypothesis neurochemical mediator/s such as acetylcholine secreted by the nerve endings cause the destruction of melanocytes. Acetylcholine esterase (AChE) activity has been found to be lowered in vitiligo patients during the process of depigmentation. We have earlier reported impairment of systemic antioxidant status in Baroda vitiligo patients, and we now show analysis of blood AChE activity in these patients. The study consisted of 121 vitiligo patients and 126 age and sex-matched healthy controls. Acetylcholine esterase activity showed significant decrease in vitiligo patients. However, there is no significant difference in AChE activity in segmental and non-segmental types as well as in active and stable types of vitiligo. The age group 16-25 showed a significant decrease in AChE activity. This study suggests that AChE may be inactivated due to high systemic oxidative stress in these patients. This is the first report showing that AChE may be playing a role in the pathogenesis of vitiligo in Baroda patients.

Objective Fibromyalgia syndrome (FMS) is a chronic condition with symptoms known to be exacerbated by stress. Individuals with FMS may be experiencing particular distress under Covid-19 pandemic-related lifestyle restrictions. The present study examined wellbeing, perceived symptom change and coping in individuals with and without FMS during pandemic-related social lockdown in the UK. Design Participants with a diagnosis of FMS (N = 390) and a general public sample with no FMS (N = 151) completed questionnaires at three time points. Main Outcome Measures BBC Wellbeing Scale, Cognitive-Emotional Regulation Questionnaire measure of coping, perception of extent to which symptoms have worsened or improved over time. Results Contrary to expectations, FMS participants reported no worsening of symptoms and an increase in wellbeing over the study period. Non-FMS participants experienced worsening health symptoms and no change in wellbeing. Coping strategies involving positive reappraisal, refocussing and planning were positively associated with wellbeing in the FMS group. Conclusion The unpredictable symptom profile in FMS, and the regular readjustment this necessitates, may support a form of resilience which has been adaptive during the pandemic. The results have implications for supporting people with FMS, and potentially other chronic conditions, especially at times of stress.

IntroductionThe objective of this study was to analyze health care and non-health care resource utilization under routine medical practice in a primary care setting claims database and to estimate the incremental average cost per patient per year of fibromyalgia syndrome (FMS) compared with a reference population.MethodsA 12-month cross-sectional and retrospective study was completed using computerized medical records from a health provider database. Analyses were conducted from the perspective of the provider and from the viewpoint of society. Health care and non-health care resource utilization included drugs, complementary tests, all types of medical visits, referrals, hospitalizations, sick leave, and early retirement because of disability due to FMS. Patients with a diagnosis of FMS in accordance with ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th revision) criteria were included in the analysis if they had at least one claim for FMS during the 12 months prior to the end of May 2007. A non-FMS comparison group was also created with the remaining subjects.ResultsOf the 63,526 patients recruited for the study, 1,081 (1.7%) (96.7% of whom were women, 54.2 [10.1] years old) met the criteria for FMS. After an adjustment for age and gender, FMS subjects used significantly more health care resources than the reference population and had more sick leave and the percentage of subjects with premature retirement was also significantly higher (P < 0.001 in all cases). As a result, FMS subjects showed an incremental adjusted per-patient per-year total cost of €5,010 (95% confidence interval [CI] 3,494 to 6,076, +153%, P < 0.001) on average compared with non-FMS subjects. Significantly higher differences were observed in both health care and non-health care adjusted costs: €614 (404 to 823, +66%) and €4,394 (3,373 to 5,420, +189%), respectively (P < 0.001 in both cases). Annual drug expenditure per patient on average was considerably higher in FMS patients, €230 (124 to 335, +64%, P < 0.001), than the reference group.ConclusionsUnder routine medical practice, patients with FMS were associated with considerably higher annual total costs in the primary care setting compared with the reference population.

Heightened interoception in adults with fibromyalgia

ObjectivesThis study aims to evaluate the coexistence of metabolic syndrome (MetS) and fibromyalgia syndrome (FMS) and determine the effects of this coexistence on neuroendocrine levels and clinical features of FMS.Patients and methodsOne-hundred female FMS patients (mean age 40.1±7.8 years; range, 24 to 58 years) and 38 healthy females (mean age 40.4±5.8 years; range, 30 to 55 years) were included in this cross-sectional study. MetS was identified by using the criteria from the Adult Treatment Panel III. Widespread pain index, symptom severity score and number of tender points were determined. Visual analog scale, Fibromyalgia Impact Questionnaire, Fatigue Severity Scale, Beck Depression Inventory, and pain pressure threshold were used as the outcome measures. The severity of FMS was assessed with total myalgic score (TMS) and control point score.ResultsTwenty-four (24%) of the 100 FMS patients and three (7.9%) of the 38 control patients fulfilled the MetS criteria (p=0.047). The coexistence of FMS and MetS was associated with higher symptom severity score (p=0.004), widespread pain index (p=0.001), number of tender points (p=0.039), and lower total myalgic score (p=0.029) values. There was a significant association between the occurrence of FMS and MetS (odds ratio=3.76; 95% confidence interval: 1.04-13.4; p=0.043).ConclusionWe found that patients with FMS had a nearly four times higher risk for MetS and the coexisting MetS may increase the severity of FMS. In clinical practice, when evaluating a patient with FMS, metabolic characteristics should also be evaluated.