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Objectives:To investigated serum cortisol and serum dehydroepiandrosterone-sulphate (DHEA-S) levels between fibromyalgia (FMS) patients and a control group, and the effect of balneotherapy (BT) on these hormones.Methods:Seventy-two patients with FMS and 39 healthy volunteers were included in the study. This prospective and cross-sectional study was carried out in the Medical Faculty, Physical Medicine and Rehabilitation Clinic, Cumhuriyet University, Cumhuriyet, Turkey between June 2012 and June 2013. Patients were divided into 2 groups. There were 40 patients in the first group, consisting of BT and physical therapy (PT) administered patients. There were 32 FMS patients in the second group who were only administered PT. Thirty-nine healthy volunteers were enrolled as a control group.Result:Cortisol was observed to be lower in FMS patients compared with the controls (10.10±4.08 μg/dL and 11.78±3.6 μg/dL; p=0.033). Serum DHEA-S level was observed to be lower in FMS patients compared with the controls (89.93±53.96 μg/dL and 143.15±107.92 μg/dL; p=0.015). Average serum cortisol levels of patients receiving BT were determined to be 9.95±3.20 μg/dL before treatment and 9.06±3.77μg/dL after treatment; while average serum DHEA-S levels were 77.60±48.05 μg/dL before treatment, and 76.84±48.71 μg/dL after treatment. No significant changes were determined in serum cortisol and DHEA-S levels when measured again after BT and PT.Conclusion:Low levels of serum cortisol and DHEA-S were suggested to be associated with the physiopathology of FMS.

SUMMARYObjective: Psychopathological symptoms presented by fibromyalgia patients include introversion, inability to reflect emotional needs, lack self-esteem, and inefficiency in social relationships. There are measures to assess the relationship of the expressed emotion of patients and spouses with severity of fibromyalgia syndrome (FS). The aim of this study to assess the effect of expressed emotion of patient (LEE) and her spouse (EE) on the severity of FS in women. Method: 123 FS patients and 105 healthy controls enrolled for the study. In the study, fibromyalgia impact questionnaire (FIQ), Montgomery-Asberg Depression Rating Scale (MADRAS), and level of expressed emotion (LEE) and expressed emotion (EE) were recorded. Results: LEE in FS was significantly higher than that in healthy controls [15 (2-56) vs. 11 (3-38); p<0.05]. The EE in FS was significantly higher than that in healthy controls (14.2±4.3 vs. 12.4±4.2; p<0.05). The FIQ score had mild correlations with LEE and EE, place of residence, and family history of FS (r=0241, r=0183, 0.214, and 0.203; respectively) but not with education status, family type, MADRAS score, number of tender points, and duration of FS (p>0.05). After linear hierarchical regression analysis was done to determine to the interaction of EE on the relationship of LEE and FIQ scores, there was no statically significant interaction of EE on the relationship of LEE and FIQ scores (p>0.05). Conclusions: The findings of this study support the value of assessment of EE from the perspective of patients and their spouses during the management of FS.

Amaç: Bu çalışmanın amacı fibromiyalji (FM) tanısı konulmuş hastalarda depresyon ile serum kortizol düzeyi arasındaki ilişkinin araştırılmasıdır. Gereç ve Yöntem: Çalışmaya; fizik Tedavi polikliniğine başvuran, çalışmayı kabul eden, Amerikan Romatoloji Birliği (ACR) kriterlerine göre Fizik tedavi uzmanları tarafından FM tanısı konulduktan sonra psikiyatri polikliniğinde değerlendirilmeye alınan toplam 72 hasta alınmıştır. Sosyodemografik veri toplama formu ve Beck Depresyon Ölçeği içeren test formları doldurularak veriler elde edildi. Kontrol grubu olarak 39 sağlıklı birey alındı. Kortizol düzeylerinin saptanması için, çalışma ölçütlerine uyan hasta ve kontrol grubundan kan örnekleri sabah 08.00-09.00 saatleri arasında alındı. Bulgular: Çalışmaya katılanların %33.2' sinde hafif düzeyde depresyon tespit edilmiştir. Hasta grubundaki bireylerin serum kortizol ortalaması 10.10 ± 4.08 цg/dL, kontrol grubundaki bireylerin kortizol ortalaması 11.78 ± 3.6 цg/dL bulunmuştur. Sonuç: Çalışmamızda fibromiyalji hastalarının serum kortizol düzeylerinin sağlıklı kontrollerden anlamlı düzeyde daha düşük olduğu saptanmıştır. Depresyon ile serum kortizol düzeyi arasında korelasyon bulunmamıştır. Bu çalışma FM hastalarının tedavisinde psikiyatrik değerlendirmenin gerekliliğini göstermiştir.