Coexistence of Fibromyalgia and Metabolic Syndrome in Females: The Effects on Fatigue, Clinical Features, Pain Sensitivity, Urinary Cortisol and Norepinephrine Levels: a Cross-sectional Study

Abstract

Objectives This 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 methods One-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. Results Twenty-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). Conclusion We 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.

Stress biomarkers in individuals with fibromyalgia syndrome: a systematic review with meta-analysis

“…However, the data on norepinephrine were very heterogeneous, with studies reporting increased norepinephrine levels 1,34 as well as studies showing decreased norepinephrine levels. 33,55,63,84 Predominantly studies with wide confidence intervals showed increased levels, 6,18,57,82 indicating higher uncertainty of the estimate, whereas studies with narrower confidence intervals tended to show reduced levels, 8,33,55,63,82 usually indicating more precise estimates. The idea of an increased sympathetic tone in individuals with FMS has therefore been extended by the hypothesis of an inadequate norepinephrine synthesis in individuals with FMS as a result of chronic stress.…”

“…5,71 Existing studies show contradictory patterns. Although some studies report an HPA-axis upregulation with increased levels of plasma cortisol, 8 others suggest HPA-axis suppression with reduced cortisol levels 19 in individuals with FMS compared with controls. The same inconsistency can be found on data of SAM dysregulation.…”

“…Some studies found increased levels of epinephrine 34,44 or norepinephrine, 18,67 whereas others reported decreased levels of epinephrine 63,67 or norepinephrine. 8,33 These conflicting findings evoke the need to synthesize and evaluate the current literature to determine whether a consistent pattern of HPAand SAM-axis dysregulation can be found in FMS, to better understand the pathogenesis and mechanisms of FMS and inform diagnosis and treatment of FMS in the long term. Although several reviews have been published on this topic, no comprehensive analysis of the entire HPA-axis has been made so far and the role of the HPA-axis in the pathomechanisms of FMS is still ambiguous.…”

Fibromyalgia: Associations Between Fat Infiltration, Physical Capacity, and Clinical Variables

“…111 This study found a significantly higher proportion of FM with a systolic blood pressure ≥130 mm Hg. Most studies report high prevalence of Metabolic syndrome (MetS) in FM, [112][113][114] which is associated with increased risk for cardiovascular disease, diabetes mellitus, and all-cause mortality. 113,115 The increased VAT, ASAT, liver fat, and BMI together with nearly a third of the patients displaying systolic hypertension may indicate that this FM cohort had increased prevalence of MetS.…”