RESUMO
The fibromyalgia syndrome (FMS) is considered to result from the exposure of a genetically susceptible individual to various triggers, such as physical trauma, stress, viral infections etc. A possible role of vaccination in FMS etiology has been suspected. Our objective was to evaluate the efficacy and safety of influenza vaccination in FMS patients. Nineteen FMS patients underwent physical and dolorimetric examinations and answered the fibromyalgia impact questionnaire (FIQ), the widespread pain index (WPI) checklist and the symptoms severity scale (SSS), which are part of the 2010 diagnostic criteria. Thirty-eight healthy subjects were recruited as controls. All participants were vaccinated with the inactivated split virion influenza vaccine. Serum was collected for antibody titration. Six weeks after vaccination, sera were tested by hemagglutination (HI) against A/California (H1N1), A/Perth (H3N2) and B/Brisbane. Humoral response was defined as either a fourfold or greater increase in titer, or an increase from a non-protective baseline level of <1/40 to a level of 1/40. No severe vaccination reactions were observed. No significant change was observed between WPI, SSS and FIQ values before and after vaccination, indicating no worsening of FMS symptoms. Vaccine immunogenicity: Six weeks after vaccination, FMS patients showed a significant increase in geometric mean titers of HI antibody. The rates of sero-protection increased from 22.9% for H1N1 to 89.5% post-vaccination. A significant increase in HI antibody titers was also demonstrated among healthy controls. Influenza vaccination was both safe and effective in FMS patients. In view of these results, FMS patients should be encouraged to undergo influenza vaccination according to the standard WHO recommendations.
Assuntos
Fibromialgia/fisiopatologia , Vacinas contra Influenza/efeitos adversos , Vacinação/efeitos adversos , Adulto , Anticorpos Antivirais/biossíntese , Anticorpos Antivirais/sangue , Progressão da Doença , Feminino , Humanos , Imunogenicidade da Vacina , Vírus da Influenza A Subtipo H3N2/imunologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Vacinas de Produtos InativadosRESUMO
Fibromyalgia syndrome (FMS) is a common and intriguing condition, manifest by chronic pain and fatigue. Although the pathogenesis of FMS is not yet completely understood, predicting the future development of FMS and chronic pain is a major challenge with great potential advantages, both from an individual as well as an epidemiological standpoint. Current knowledge indicates a genetic underpinning for FMS, and as increasing data are accumulated regarding the genetics involved, the prospect of utilizing these data for prediction becomes ever more attractive. The co-existence of FMS with multiple other functional disorders indicates that the clinical identification of such symptom constellations in a patient can alert the physician to the future development of FMS. Hypermobility syndrome is another clinical (as well as genetic) phenotype that has emerged as a risk factor for the development of FMS. Stressful events, including early life trauma, are also harbingers of the future development of FMS. Functional neuroimaging may help to elucidate the neural processes involved in central sensitization, and may ultimately also evolve into markers of predictive value. Last but not least, obesity and disturbed sleep are clinical (inter-related) features relevant for this spectrum. Future efforts will aim at integrating genetic, clinical and physiological data in the prediction of FMS and chronic pain.
Assuntos
Dor Crônica/diagnóstico , Fibromialgia/diagnóstico , Fibromialgia/etiologia , Humanos , Fatores de RiscoRESUMO
OBJECTIVES: The purpose of the current study was to evaluate sexual dysfunction among female fibromyalgia syndrome (FMS) patients. METHODS: Fifty female subjects were recruited and were asked to complete a questionnaire regarding sexual functioning. The control group included fifty-five healthy age-matched volunteers. The participants underwent a physical examination and tender point assessment was performed using manual palpation. All participants filled out the Arizona Sexual Experience Scale, which evaluates five areas of sexual functioning: sexual drive, sexual arousal, vaginal wetting, orgasm and sexual satisfaction. RESULTS: FMS patients had significantly lower scores on all five aspects of sexual function assessed. A positive correlation was observed between the sexual drive score, signifying a decrease in sexual drive, and the number of tender points documented on examination. Similarly, a positive correlation was observed between the sexual satisfaction scale (indicating decreasing levels of sexual satisfaction) and the number of tender points documented. A positive correlation was demonstrated between the sexual arousal and orgasmatic scales and between the tender point counts, indicating a decrease in sexual arousal and in orgasmatic function in correlation with an increasing number of tender points. CONCLUSIONS: The results of the current study indicate a multi-factorial sexual dysfunction among female FMS patients. All stages of sexual functioning, evaluated were significantly disturbed in comparison with the healthy controls. Physicians treating FMS patients should be aware of, and actively inquire about, sexual dysfunction as part of a multi-disciplinary evaluation of such patients.
Assuntos
Dor Crônica/fisiopatologia , Fibromialgia/fisiopatologia , Hiperalgesia/fisiopatologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Adulto , Idoso , Nível de Alerta/fisiologia , Dor Crônica/epidemiologia , Dor Crônica/psicologia , Comorbidade , Feminino , Fibromialgia/epidemiologia , Fibromialgia/psicologia , Humanos , Hiperalgesia/epidemiologia , Hiperalgesia/psicologia , Israel/epidemiologia , Libido/fisiologia , Pessoa de Meia-Idade , Orgasmo/fisiologia , Medição da Dor , Palpação , Satisfação Pessoal , Qualidade de Vida , Índice de Gravidade de Doença , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/psicologia , Inquéritos e Questionários , Síndrome , Adulto JovemRESUMO
OBJECTIVES: To assess the frequency of fibromyalgia among a population of Holocaust survivors in Israel as well as the occurrence of post-traumatic stress disorder (PTSD) and concurrent psychiatric symptoms, including depression and anxiety among survivors. METHODS: Eighty-three survivors of the Nazi Holocaust and 65 age-matched individuals not exposed to Nazi occupation were recruited. Physical examination and manual tender point assessment was performed for the establishment of the diagnosis of fibromyalgia and information was collected regarding quality of life (SF-36), physical function and health (FIQ), psychiatric symptoms (SCL-90) and PTSD symptoms (CAPS). RESULTS: Significantly increased rates of fibromyalgia were identified among Holocaust survivors compared with controls (23.81% vs. 10.94, p<0.05). Significantly increased rates of posttraumatic symptoms and measures of mental distress were also identified among survivors. CONCLUSIONS: The results indicate a significantly increased prevalence of fibromyalgia among Holocaust survivors six decades after the end of the Second World War. This finding furthers our knowledge regarding the long-term effect of stress on the development of fibromyalgia.
Assuntos
Fibromialgia/epidemiologia , Holocausto , Estresse Fisiológico , Estresse Psicológico , Sobreviventes , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Estudos de Casos e Controles , Depressão/epidemiologia , Feminino , Fibromialgia/fisiopatologia , Fibromialgia/psicologia , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Prevalência , Transtornos de Estresse Pós-Traumáticos/epidemiologiaRESUMO
UNLABELLED: Although both acute and chronic stress leads to pain, the precise characteristics of this association have not been well defined. Sderot is an Israeli town exposed to repeated missile attacks. Ofakim, a town of similar demographic and socioeconomic characteristics, had not been targeted, as of the period of our study. We examined the occurrence and characteristics of pain and related somatic symptoms in Sderot and Ofakim. METHODS: One thousand and twenty-four individuals in Sderot and 1006 in Ofakim were interviewed regarding pain, somatic symptoms, mood, trauma-exposure, and general health status. RESULTS: Significantly higher levels of trauma-related symptoms and somatic symptoms were noted in Sderot compared with Ofakim (p<0.001). Chronic widespread pain (CWP) was more common in Sderot (11.1%) than Ofakim (8.3%; OR 1.37, p=0.038). Women were more likely (13.9% vs. 9.3%; OR 1.45, p=0.06) than men (8.9% vs. 7.3%, OR 1.24, p=0.37) to experience CWP in Sderot vs. Ofakim. Amongst males, chronic regional pain (CRP) was more common in Sderot (19.2%) than in Ofakim (14.2%; p=0.036). Pain severity in Sderot was significantly higher than in Ofakim (p<0.001). CONCLUSIONS: Similar to previous studies that have suggested that chronic stress is associated with chronic pain, this study demonstrates significantly increased rates of somatic complaints, including pain, fatigue and IBS-like symptoms, among individuals in Sderot compared with Ofakim, as well as significantly higher rates of trauma-related symptoms. Thus, a fibromyalgia-like symptoms cluster was more likely to be found in Sderot compared with Ofakim. Widespread pain was reported as being significantly more frequent by inhabitants of Sderot compared with Ofakim. These results have relevance to both the general population and for populations enduring chronic stress.
Assuntos
Conflito Psicológico , Sistema Musculoesquelético/fisiopatologia , Dor/epidemiologia , Dor/fisiopatologia , Estresse Psicológico/complicações , Adulto , Feminino , Humanos , Entrevistas como Assunto , Israel , Masculino , Prevalência , Índice de Gravidade de Doença , Inquéritos e Questionários , Armas , Ferimentos e Lesões/complicaçõesRESUMO
OBJECTIVES: To evaluate the expression of CCR3 receptors as well as CCR3 agonists, including eotaxin-2 and RANTES, among patients suffering from rheumatoid arthritis and healthy controls, as a possible pathogenetic mechanism in inflammatory joint disease. METHODS: Twenty-two patients and 13 healthy controls were recruited and clinically evaluated. CCR3 expression on CD4+ lymphocytes and mononuclear cells was evaluated by FACS analysis after staining with human CD4 APC (bioscience) and human CCR3 (CD193)PE. Levels of eotaxin-2 and RANTES were analysed by ELISA. RESULTS: A significant decrease was observed in the level of CD4+ cells expressing the CCR3 receptor in serum of RA patients (0.96+/-0.5) as compared with healthy controls (1.48+/-0.6) (p<0.05). A significant decrease in serum eotaxin-2 levels was evident among RA patients suffering from active disease, defined by a DAS-28 score above 5.5, compared with RA patients with lower activity scores (2.1+/-1.6 vs. 7.0+/-5.1; p=0.01). A significant decrease was evident in the number of CCR3 expressing Monocytes among RA patients treated with steroids and anti TNF-a medications as compared with RA patients not receiving such treatment. CONCLUSIONS: CCR3 is differentially expressed on inflammatory cells in RA, while eotaxin-2, a potent CCR3 agonist, is differentially expressed in active disease. Anti-inflammatory medications may down-regulate CCR3 expression in RA. The CCR3-CCR3 agonist pathway may thus have a pathogenic role in RA and may be a future target for novel treatment modalities.
Assuntos
Artrite Reumatoide/sangue , Linfócitos T CD4-Positivos/metabolismo , Receptores CCR3/sangue , Adulto , Idoso , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/patologia , Linfócitos T CD4-Positivos/patologia , Estudos de Casos e Controles , Quimiocina CCL24/sangue , Quimiocina CCL5/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Receptores CCR3/agonistas , Esteroides/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
Eotaxin-2 is a potent chemoattractant for eosinophils, basophils and T helper type 2 (Th2) lymphocytes. The eotaxin-2/CCL24 receptor CCR3 is expressed in human brain, skin, endothelium and macrophages. The aim of the current study was to evaluate the protective effect of a monoclonal anti-eotaxin-2 antibody on the development of adjuvant-induced arthritis in rats (AIA). Adjuvant arthritis was induced in Lewis rats by intradermal injection of incomplete Freund's adjuvant +Mycobacterium tuberculosis. Rats were treated by intraperitoneal (i.p.) injection with three monoclonal antibodies against eotaxin-2 (G7, G8, D8) three times per week. Controls were treated with total mouse immunoglobulin G (IgG), methotrexate (MTX) or phosphate-buffered saline (PBS). Arthritis severity was evaluated by measuring ankle swelling, arthritic score, whole animal mobility and body weight. Sample joints were obtained for pathological evaluation and postmortem X-ray of ankle joints was performed to document erosions. Significant inhibition of arthritis was observed in rats treated with anti-eotaxin-2 antibodies compared to those treated with immunoglobulin or PBS. Inhibition was manifest in ankle diameter, arthritic score and mobility score. The antibody marked D8 showed the greatest efficacy. The effect was observed both in animals treated before the appearance of arthritis and in those where treatment was begun after development of joint inflammation. Combined treatment with D8 and MTX caused additional protection. Significant reduction of inflammation in D8-treated animals was also demonstrated in pathological and X-ray examinations. Inhibition of eotaxin-2 by monoclonal antibodies has a significant protective effect in adjuvant arthritis. These results may introduce a novel therapeutic target in rheumatoid arthritis and additional inflammatory joint disorders.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Artrite Experimental/tratamento farmacológico , Artrite Experimental/prevenção & controle , Quimiocina CCL24/antagonistas & inibidores , Animais , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/imunologia , Anticorpos Monoclonais/farmacologia , Artrite Experimental/diagnóstico , Artrite Experimental/patologia , Artrografia , Peso Corporal/efeitos dos fármacos , Quimiocina CCL24/imunologia , Relação Dose-Resposta a Droga , Quimioterapia Combinada/métodos , Adjuvante de Freund/administração & dosagem , Adjuvante de Freund/imunologia , Articulações/efeitos dos fármacos , Articulações/patologia , Locomoção/efeitos dos fármacos , Masculino , Metotrexato/administração & dosagem , Metotrexato/farmacologia , Metotrexato/uso terapêutico , Ratos , Ratos Endogâmicos Lew , Tarso Animal/efeitos dos fármacos , Tarso Animal/patologiaRESUMO
BACKGROUND: Substance P receptor modulates stress, depression, anxiety and pain. Substance P is increased in CSF of fibromyalgia (FMS) patients. We examined the frequency of the substance P receptor (TACR1) 1354 G>C polymorphism in FMS.The dopamine transporter (DAT) SLC6A3 3' variable number tandem repeat (VNTR) polymorphism is associated with post traumatic stress disorder (PTSD), a condition with clinical and epidemiological overlap with FMS. We have evaluated the allele frequency of this polymorphism in FMS.Alpha1-antitrypsin (AAT) deficiency is an autosomal recessive metabolic disease. The PI ZZ phenotype, encoded by the E342K mutation, is associated with emphysema and liver disease, and has been linked with FMS. We have examined the frequency of this mutation in FMS. METHODS: Eighty-seven Jewish FMS patients participated; 45 of Ashkenazi origin, 32 of non-Ashkenazi origin and 10 of unknown or mixed Jewish origin. Controls consisted of 200 healthy Jewish individuals. Genotyping of the 1354G >C allele in the 3' UTR of TACR1 gene was performed by DdeI restriction analysis, genotyping the SCL6A3 DAT 3' VNTR polymorphism was performed by PCR combined with GeneScan analysis, and the AAT E342K mutation was identified by TaqI restriction analysis. RESULTS: No significant association was found between FMS and the three genetic markers studied here. CONCLUSIONS: The current candidate-gene approach study failed to identify significant associations between FMS and three genetic markers with hypothesis-driven clinical relevance. We suggest that a genome-wide association study would be a more fruitful approach for further investigation of the genetic basis of FMS.
Assuntos
Proteínas da Membrana Plasmática de Transporte de Dopamina/genética , Fibromialgia/genética , Receptores da Neurocinina-1/genética , alfa 1-Antitripsina/genética , Adulto , Alelos , Distribuição de Qui-Quadrado , Feminino , Frequência do Gene , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Humanos , Israel , Judeus/genética , Masculino , Pessoa de Meia-Idade , Mutação , Razão de Chances , Polimorfismo de Nucleotídeo Único/genéticaRESUMO
OBJECTIVES: To evaluate the prevalence of fibromyalgia in survivors of a major train crash in southern Israel, three years after the event. METHODS: Survivors were contacted by mail and telephone. Individuals consenting to participate in the study underwent physical examination, including a tender point count and dolorimetry, as well as extensive evaluation of parameters relating to quality of life, presence of widespread pain, fatigue, physical and social function, posttraumatic symptoms and symptoms related to anxiety, dissociation, depression, somatisation, etc. RESULTS: Fifteen percent of survivors participating in the study met ACR criteria for the classification of fibromyalgia. Significantly lower rates of physical and emotional functioning were found among survivors with fibromyalgia compared with those not meeting the classification criteria. Survivors with fibromyalgia rated significantly higher on scales of somatisation, obsessive-compulsive ideation, interpersonal sensitivity, depression, anger and hostility, phobic and general anxiety, paranoid ideation and psychoticism. Survivors with fibromyalgia also rated significantly higher on scales of posttraumatic symptoms including intrusion, avoidance and arousal. These individuals also rated significantly higher on the Peritraumatic Dissociative Experiences Questionnaire (PDE-Q) and the Dissociative Experiences Scale (Hebrew version) (DES-H). CONCLUSION: Fibromyalgia was found to be highly prevalent, three years after a major train crash, among individuals exposed to the combination of physical injury and extreme stress. This finding is in accordance with previous data regarding the association of fibromyalgia with both physical and emotional trauma and calls attention to studying the underlying susceptibility factors which may partake in this association.