Fibromyalgia in primary antiphospholipid (Hughes) syndrome

Abstract

Fibromyalgia (FM) is a syndrome that can be associated with several rheumatic diseases. However, no study has evaluated its frequency in patients with primary antiphospholipid syndrome (PAPS). The objective of this study was to analyze the frequency of FM in PAPS patients compared with healthy controls, to determine the possible associations between FM and PAPS features, and also to evaluate quality of life and depression in these patients. This case-control study included 30 PAPS patients (by the Sapporo criteria) and 40 healthy subjects. Demographic and clinical data, drug use, and antiphospholipid antibodies were analyzed. FM was diagnosed based on international criteria (ACR). Questionnaires on quality of life, including the Short Form 36 Health Survey (SF-36), Beck Depression Inventory (BDI), Fibromyalgia Impact Questionnaire (FIQ), and Visual Analog Scale (VAS), were also applied. PAPS patients and controls were similar in mean age as well as in distributions of gender and Caucasian race. Mean disease duration was 5.4 ± 4.2 years. A diagnosis of fibromyalgia was made in five (16.7%) PAPS patients and no controls (p = 0.012). PAPS patients had more diffuse pain (53% vs. 0%, respectively, p < 0.0001), ≥11 tender points (23% vs. 5%, respectively, p = 0.032), and a greater total number (175 vs. 57, respectively, p < 0.0001) as well as median number of tender points per patient than controls (5 [0-18] vs. 0 [0-11], respectively, p< 0.0001). PAPS patients had lower values in all dimensions of the SF-36, as well as higher FIQ scores, higher BDI scores, more depression diagnoses according to BDI results, and increased VAS in comparison with controls. Analysis of PAPS patients with FM compared with those subjects without FM revealed no significant differences regarding demographic features or thrombotic or clinical events; however, PAPS patients who also had FM had lower values in SF-36 dimensions as well as higher FIQ (82.6 ± 9.6 vs. 33.6 ± 29.8, respectively, p < 0.0001) and VAS scores (6.6 ± 2.97 vs. 3.25 ± 3.11, respectively, p = 0.03). BDI scores, in contrast, were similar in both groups. In conclusion, one-fifth of PAPS patients had fibromyalgia and a low quality of life when compared with healthy subjects.

Cytokine secretion and the risk of depression development in patients with connective tissue diseases

“…Increased reports of depression diagnoses have been established amongst APS subjects . The investigation into circulating aPL antibodies in subjects found that depressed patients exhibited higher antibody titers compared with normal controls .…”

“…Chronic pain can independently contribute to the pathogenesis of depression, through elevation of inflammatory cytokines IL‐1β, IL‐6, and TNF‐α . Here, we review the prevalence and characteristics of depression, and its correlation to the levels of inflammatory cytokines and disease activity among different CTD (Tables and ).…”

The interaction between autoimmune diseases and fibromyalgia: risk, disease course and management

“…In an article published by Costa et al [24], the focus was on FM frequency and primary antiphospholipid syndrome (PAPS) compared with healthy controls to determine the possible associations between FM and PAPS features, and also to evaluate quality of life (QoL ) and depression in these patients. They found a percentage of FM of 16.7% in PAPS patients and none in the controls.…”

“…Antipolymer antibody 67-15 15% in HP [14][15][16] Antibodies to 5-hydroxytryptamine 73 5.7% in HP [20] Antibodies to gangliosides 71 9% in HP [20] Phospholipids 54 0% in HP [20] Anti-68/48 kDa 15.6 0% in HP [21] Anti-45 kDa 37.1 (patients with secondary FM) 21.6% patients with psychiatric disorders 0% in HP [21] Antinuclear antibody 30.0-11.5 20% in HP [22,23,34] Autoantibodies targeting voltage-gated potassium channel 10 0% in HP [24] Primary antiphospholipid syndrome 16.7 Frequently associate with SLE (35%) [27] Rheumatoid arthritis 15-43 0.5-1% in HP [29][30][31] Psoriatic arthritis 53.3 0.5% in HP [35] Behçet's disease 18 0.04% in HP [36,37] Hashimoto's thyroiditis 31 5-15% in female 1-5% in male [38] Thyroid autoimmunity 19 41% of FM patients showed at least 1 Ab [38][39][40][41] Diabetes mellitus 17 5% [43] With respect to the HP, FM is more frequent in autoimmunity manifestations. Ab: Antibody; FM: Fibromyalgia; HP: Healthy population; SLE: Systemic lupus erythematosus.…”

Fibromyalgia Syndrome in Patients with Nasal Septum Deviation

“…It is known that FMS frequency increases in certain diseases. In studies conducted so far, FMS frequency in rheumatic diseases was found to be 44% in Sjogren's syndrome (19), 17.1% in rheumatoid arthritis (9), 22% in systemic lupus erythematosus (20) and 16.7% in antiphospholipid syndrome (21). In infectious diseases this rate was found as 25% in hepatitis B and 18.9% in hepatitis C (10,22).…”