Environmental factors and fibromyalgia syndrome: a narrative review.

This in-depth review of fibromyalgia (FM), which is a complex condition characterised by chronic pain, fatigue, sleep disturbances, and a spectrum of diagnostically and therapeutically challenging symptoms, underlines the need for a comprehensive and integrated approach that also takes into account the psychological factors affecting patient responses. We focus on the substantial impact that environmental factors (climatic variations, air pollution, electromagnetic field exposure, physical and emotional traumas, dietary patterns, and infections) have on the manifestation and intensity of symptoms, and advocate personalised, holistic treatment of patients' psychological and environmental sensitivities by suggesting the benefits of tailored dietary and stress management. We also call for further research into the complex interplay of environmental, biological and psychological factors influencing FM in order to develop more effective individualised treatments that are capable of enhancing patient care and outcomes.

Risk for cancer development in familial Mediterranean fever and associated predisposing factors: an ambidirectional cohort study from the international AIDA Network registries.

Objective: Inflammation has been associated with an increased risk for cancer development, while innate immune system activation could counteract the risk for malignancies. Familial Mediterranean fever (FMF) is a severe systemic inflammatory condition and also represents the archetype of innate immunity deregulation. Therefore, the aim of this study is to investigate the risk for cancer development in FMF. Methods: The risk ratio (RR) for malignancies was separately compared between FMF patients and fibromyalgia subjects, Still's disease patients and Behçet's disease patients. Clinical variables associated with cancer development in FMF patients were searched through binary logistic regression. Results: 580 FMF patients and 102 fibromyalgia subjects, 1012 Behçet's disease patients and 497 Still's disease patients were enrolled. The RR for the occurrence of malignant neoplasms was 0.26 (95% Confidence Interval [CI.] 0.10-0.73, p=0.006) in patients with FMF compared to fibromyalgia subjects; the RR for the occurrence of malignant cancer was 0.51 (95% CI. 0.23-1.16, p=0.10) in FMF compared to Still's disease and 0.60 (95% CI. 0.29-1.28, p=0.18) in FMF compared to Behçet's disease. At logistic regression, the risk of occurrence of malignant neoplasms in FMF patients was associated with the age at disease onset (ß1 = 0.039, 95% CI. 0.001-0.071, p=0.02), the age at the diagnosis (ß1 = 0.048, 95% CI. 0.039-0.085, p=0.006), the age at the enrolment (ß1 = 0.05, 95% CI. 0.007-0.068, p=0.01), the number of attacks per year (ß1 = 0.011, 95% CI. 0.001- 0.019, p=0.008), the use of biotechnological agents (ß1 = 1.77, 95% CI. 0.43-3.19, p=0.009), the use of anti-IL-1 agents (ß1 = 2.089, 95% CI. 0.7-3.5, p=0.002). Conclusions: The risk for cancer is reduced in Caucasic FMF patients; however, when malignant neoplasms occur, this is more frequent in FMF cases suffering from a severe disease phenotype and presenting a colchicine-resistant disease.

[POST-COVID SYNDROME, SICK BUILDING SYNDROME, SILICONE BREAST SYNDROME, CHRONIC FATIGUE SYNDROME, FIBROMYALGIA; AUTOIMMUNITY TO THE AUTONOMIC NERVOUS SYSTEM].

INTRODUCTION: POST-COVID SYNDROME, SICK BUILDING SYNDROME, SILICONE BREAST SYNDROME, CHRONIC FATIGUE SYNDROME, FIBROMYALGIA; AUTOIMMUNITY TO THE AUTONOMIC NERVOUS SYSTEM.

Mitochondrial Dysfunction and Coenzyme Q10 Supplementation in Post-Viral Fatigue Syndrome: An Overview.

Post-viral fatigue syndrome (PVFS) encompasses a wide range of complex neuroimmune disorders of unknown causes characterised by disabling post-exertional fatigue, myalgia and joint pain, cognitive impairments, unrefreshing sleep, autonomic dysfunction, and neuropsychiatric symptoms. It includes myalgic encephalomyelitis, also known as chronic fatigue syndrome (ME/CFS); fibromyalgia (FM); and more recently post-COVID-19 condition (long COVID). To date, there are no definitive clinical case criteria and no FDA-approved pharmacological therapies for PVFS. Given the current lack of effective treatments, there is a need to develop novel therapeutic strategies for these disorders. Mitochondria, the cellular organelles responsible for tissue energy production, have recently garnered attention in research into PVFS due to their crucial role in cellular bioenergetic metabolism in these conditions. The accumulating literature has identified a link between mitochondrial dysfunction and low-grade systemic inflammation in ME/CFS, FM, and long COVID. To address this issue, this article aims to critically review the evidence relating to mitochondrial dysfunction in the pathogenesis of these disorders; in particular, it aims to evaluate the effectiveness of coenzyme Q10 supplementation on chronic fatigue and pain symptoms as a novel therapeutic strategy for the treatment of PVFS.

Implication of intestinal microbiota in the etiopathogenesis of fibromyalgia: A systematic review.

Fibromyalgia (FM) is a highly prevalent chronic disease. About 4.7% of the world's population suffers from generalized pain and hypersensitivity, in addition to a wide range of physical and psychological symptoms. The etiopathogenesis of this disease is multifactorial, which makes its diagnosis and treatment challenging. Recently, the increase in the number of studies on microbiota has provided new data that can help to understand the onset and development of FM. An updated systematic review of the causes of FM has been carried out in this work. Particularly in the last decade, research has focused on the gut-brain axis, which has emerged as a crucial mechanism for microbiota-host crosstalk. In FM patients, quantitative imbalances of the intestinal microbiota (dysbiosis) and bacterial metabolites with differential relative abundance have been found, especially short-chain fatty acids and lipopolysaccharides. Furthermore, the microbiota has been found to indirectly influence host neurotransmitter mechanisms, mainly through the serotonin precursor, glutamate, and gamma-aminobutyric acid. Thus, all these mechanisms and their influence on the etiopathogenesis of FM are discussed in this review.

The impact of the presence of fibromyalgia on fatigue in patients with psoriatic arthritis: comparison with controls

Abstract Background: Coexisting fibromyalgia (FM) to psoriatic arthritis (PsA) has been identified and it has been associated with more severe symptoms, impaired function, and greater disability. It was aimed to explore the effect of the presence of FM on fatigue in patients with PsA comparing with controls. Methods: Fifty patients with PsA and 34 sex-age matched controls were enrolled. In patients; pain was assessed by Visual Analogue Scale, disease activity by DAS-28, enthesitis by The Leeds Enthesitis Index. Fatigue level of all participants was evaluated by Multidimensional Assessment of Fatigue. In all participants, FM was determined according to 2010 American College of Rheumatology criteria. Results: Seventeen patients with PsA (34%) and 4 controls (11.8%) were diagnosed with FM and all of them were women. There was significant difference between the patients and controls in terms of presence of FM (p < 0.05). Patients' fatigue scores were significantly higher than controls' (p = 0.001). There were significant differences between the PsA patients with and without FM with regard to gender, enthesitis, DAS-28 and pain scores (p < 0.05); fatigue scores (p < 0.001). The significant effect of the presence of FM on fatigue was found by univariate analysis of variance in patients (p < 0.001). Conclusion: It was observed that FM presence and fatigue were more common in PsA patients than controls and comorbid FM had significant effect on fatigue in these patients. Physicians should be aware of the possibility of concomitant FM in patients with PsA.(AU)

The Effect of Tadalafil on Renal Fibrosis Induced by Ureteral Obstruction / Efecto del Tadalafil en la Fibrosis Renal Inducida por Obstrucción Uretral

ABSTRACT Objective: It has been reported that phosphodiesterase-5 (PDE-5) inhibitors improve kidney function during acute and chronic renal failure. This study aimed to determine the possible therapeutic effects of tadalafil, a specific PDE-5 inhibitor, on renal fibrosis induced by unilateral ureteral obstruction (UUO). Methods: Male Sprague-Dawley rats were used and randomly divided into three groups (n = 6) as sham-operated, UUO and tadalafil-treated (10 mg/72 hours, ig) UUO (UUO+T) groups. Unilateral ureteral obstruction was induced by complete ligation of the left ureter and 14 days after surgery creatinine clearance, urinary cyclic guanosine monophosphate (cGMP), renal alpha-smooth muscle actin (α-sma) and transforming growth factor βeta (TGF-β) levels, as well as histologic changes, were observed in all the animals. Results: Unilateral ureteral obstruction-induced renal fibrosis was confirmed by increased α-sma level, collagen deposition, tubular dilation, inflammatory cell infiltration and necrosis. An increased renal TGF-β level and decreased urinary cGMP level was also observed in obstructed animals in addition to reduced creatinine clearance. Tadalafil treatment, which restored the animals 'urinary cGMP level, significantly attenuated the fibrotic changes and TGF-β increase in their kidneys. Conclusion: This study suggests that tadalafil treatment ameliorates renal fibrosis by reducing TGF-β expression and may have important clinical relevance since tadalafil is currently used clinically to treat erectile dysfunction and pulmonary hypertension.

RESUMEN Objetivo: Se ha reportado que los inhibidores de la fosfodiesterasa-5 (PDE-5) mejoran las funciones renales durante la insuficiencia renal aguda y crónica. Este estudio tuvo por objetivo determinar los posibles efectos terapéuticos del tadalafil - un inhibidor específico de la PDE-5 - sobre la fibrosis renal inducida por una obstrucción ureteral unilateral (OUU). Métodos: Se utilizaron ratas machos Sprague-Dawley, divididas de manera aleatoria en tres grupos (n = 6): operación simulada, OUU y tratamiento con tadalafil (10 mg/72 horas, IG), y OUU (OUU+T). La obstrucción uretral unilateral fue inducida por una ligadura completa del uréter izquierdo y 14 días después de la cirugía, se observaron niveles de monofosfato de guanosina cíclico (GMP) urinario, alfa-actina de músculo liso (α-SMA), y factor de crecimiento transformante βeta (FCT-β), así como cambios histológicos en todos los animales. Resultados: La fibrosis renal inducida por obstrucción uretral unilateral fue confirmada por un aumento del nivel de α-SMA, deposición de colágeno, dilatación tubular, infiltración de células inflamatorias y necrosis. También se observó un aumento del nivel de FCT-β renal y una disminución del nivel de GMP urinario en los animales con obstrucción, además de una reducción del aclaramiento de la creatinina. El tratamiento con tadalafil, que restauró el nivel de GMP urinario de los animales, atenuó significativamente los cambios fibróticos y el aumento de FCT-β en los riñones. Conclusión: Este estudio sugiere que el tratamiento con tadalafil mejora la fibrosis renal al reducir la expresión de FCT-β y puede tener una importante relevancia clínica por cuanto el tadalafil se usa hoy día clínicamente para tratar la disfunción eréctil y la hipertensión pulmonar.

Tratamiento con pregabalina en pacientes con fibromialgia / Treatment with pregabalin in patients with fibromyalgia

A partir de una viñeta clínica, la autora describe los resultados de dos revisiones sistemáticas que evaluaron la eficacia y la seguridad de la pregabalina para el alivio del dolor en pacientes con fibromialgia. (AU)

Based on a clinical vignette, the author describes the results of two systematic reviews that evaluated the efficacy and safety of pregabalin for pain relief in patients with fibromyalgia. (AU)

Prevalence of fibromyalgia in patients treated at the bariatric surgery outpatient clinic of Hospital de Clínicas do Paraná - Curitiba / Prevalência de fibromialgia em pacientes acompanhados no ambulatório de cirurgia bariátrica do Hospital de Clínicas do Paraná - Curitiba

Abstract Introduction: Fibromyalgia (FM) is a chronic pain syndrome characterized by generalized pain. It is known that obese patients have more skeletal muscle pain and physical dysfunction than normal weight patients. Therefore, it is important that the early diagnosis of FM be attained in obese patients. Objective: To determine the prevalence of FM in a group of obese patients with indication of bariatric surgery. Materials and methods: The patients were recruited from the Bariatric Surgery outpatient clinic of Hospital de Clínicas of UFPR (HC-UFPR) before being submitted to surgery. Patient assessment consisted in verifying the presence or absence of FM using the 1990 and 2011 ACR criteria, as well as the presence of comorbidities. Results: 98 patients were evaluated, of which 84 were females. The mean age was 42.07 years and the BMI was 45.39. The prevalence of FM was 34% (n = 29) according to the 1990 criteria and 45% (n = 38) according to the 2011 criteria. There was no difference in age, BMI, Epworth score and prevalence of other diseases among patients who met or not the 1990 criteria. Only depression was more common in patients with FM. (24.14% vs. 5.45%). The same findings were seen in patients that met the 2011 criteria. Conclusions: The prevalence of FM in patients with morbid obesity is extremely high. However, BMI does not differ in patients with or without FM. The presence of depression may be a risk factor for the development of FM in these patients.

Resumo Introdução: Fibromialgia (FM) é uma síndrome de dor crônica caracterizada por dor generalizada. Sabe-se que pacientes obesos têm mais dor músculo esquelética e disfunção física do que pacientes de peso normal. Portanto, é importante que o diagnóstico precoce da FM seja feito em pacientes obesos. Objetivo: Determinar a prevalência de FM em um grupo de pacientes obesos com indicação de cirurgia bariátrica. Materiais e métodos: Os pacientes foram captados do ambulatório de Cirurgia Bariátrica do Hospital de Clínicas da UFPR (HC-UFPR), antes de serem submetidos à cirurgia. A avaliação dos pacientes consistia em constatar a presença ou ausência de FMG pelos critérios ACR 1990 e 2011 e também a presença de comorbidades. Resultados: Foram avaliados 98 pacientes, 84 mulheres. A idade média foi de 42,07 anos e o IMC de 45,39. A prevalência de FM foi de 34% (n = 29) pelos critérios de 1990 e de 45% (n = 38) pelos de 2011. Não houve diferença em idade, IMC, escala de Epworth e prevalência de outras doenças entre pacientes que preenchiam ou não os critérios de 1990. Apenas depressão foi mais comum nas pacientes com FM (24,14% vs. 5,45%). Os mesmos achados foram vistos nas pacientes que preenchiam os critérios de 2011. Conclusões: A prevalência de FM em pacientes com obesidade mórbida é extremamente alta. Porém o IMC não difere nos pacientes com ou sem FM. A presença de depressão pode ser um fator de risco para o desenvolvimento de FM nesses pacientes.

Fibromyalgia and the old dilemma: theory vs. practice

The objective of this article is to review some aspects of the fibromyalgia syndrome and its mechanisms of development. We also discuss how to go from preclinical research to clinical practice. Fibromyalgia is a clinical syndrome whose main features include diffuse musculoskeletal pain, fatigue, sleep disturbances, and cognitive disorders. Russell & Larsson (2009) proposed "pronociceptive" and "antinociceptive" systems under normal conditions. Functional pain states such as fibromyalgia are derived from central disturbances in pain processing. The association with anxiety and depression is a negative prognostic factor. Distress is an important part of its physiopathology. The concomitance of other functional syndromes is a rule. The already known etiopathogenic mechanisms of fibromyalgia can be applied in clinical practice for diagnosis and rational therapeutic approaches. Pharmacological but mainly nonpharmacological measures must be applied. Although much information still needs to be obtained, the clinician presently has sufficient tools for efficiently treating fibromyalgia patients. An important aspect is that such knowledge needs to reach primary care physicians because the prevalence of fibromyalgia does not allow all patients to be treated by specialists.

Association between childhood trauma and loss of functionality in adult women with fibromyalgia / Associação entre trauma na infância e perda de funcionalidade em mulheres adultas com fibromialgia

OBJECTIVE: To investigate whether history of childhood trauma is associated with loss of functionality in adult women with fibromyalgia (FM). A secondary objective was to assess the presence of differences between depressed and non-depressed adult women with FM in a regression model for functionality. METHODS: A total of 114 adult women with FM according to the American College of Rheumatology diagnostic criteria answered the Childhood Trauma Questionnaire and the Fibromyalgia Impact Questionnaire. All subjects were interviewed by trained psychiatrists and evaluated for depression using the Mini International Neuropsychiatric Interview (MINI) - Brazilian version 5.0.0. Correlation and regression models were used to investigate associations between childhood trauma and loss of functionality among patients with FM. The sample was stratified by presence and absence of clinical depression. RESULTS: Overall, childhood trauma was associated with of loss of functionality in adult women with FM. When stratified by depression, the regression model significantly increased the association among non-depressed patients, even after adjustment for age and use of psychotropic medications. CONCLUSIONS: Childhood trauma showed a clinically important association with loss of functionality among adult women with FM. The associations were more pronounced among subjects without comorbid depression

OBJETIVO: Investigar se a presença de história de trauma na infância está associada com perda de funcionalidade em mulheres adultas com fibromialgia (FM). Um segundo objetivo foi avaliar a presença de diferenças entre mulheres adultas deprimidas e não deprimidas com FM utilizando um modelo de regressão para funcionalidade. MÉTODOS: Um total de 114 mulheres adultas com FM de acordo com os critérios diagnósticos do American College of Rheumatology responderam o Childhood Trauma Questionnaire e o Questionário de Impacto da Fibromialgia. Todos os indivíduos foram entrevistados por psiquiatras treinados e avaliados para depressão utilizando o Mini International Neuropsychiatric Interview (MINI) - versão brasileira 5.0.0. Modelos de correlação e regressão foram utilizados para investigar associações entre trauma na infância e perda de funcionalidade em pacientes com FM. A amostra foi estratificada pela presença e ausência de depressão clínica. RESULTADOS: Em geral, o trauma na infância esteve associado com perda de funcionalidade em mulheres adultas com FM. Quando estratificadas por depressão, o modelo de regressão aumentou significativamente a associação em pacientes não deprimidos, mesmo após ajuste para idade e uso de medicação psicotrópica. CONCLUSÕES: Trauma na infância esteve associado de forma clinicamente importante à perda de funcionalidade em mulheres adultas com FM. As associações foram mais pronunciadas nos indivíduos sem depressão comórbida

Fibromialgia: aspectos clínicos e ocupacionais / Fibromyalgia: clinical and occupational aspects

A fibromialgia (FM) é uma síndrome clínica comumente observada na prática médica diária e possui etiopatogenia ainda obscura. Caracterizada por quadro de dor musculoesquelética crônica associada a variados sintomas, a FM pode ser confundida com diversas outras doenças reumáticas e não reumáticas, quando estas cursam com quadros de dor difusa e fadiga crônica. O tratamento da FM deve ser multidisciplinar, individualizado, contar com a participação ativa do paciente e basear-se na combinação das modalidades não farmacológicas e farmacológicas. Presente tanto em ambientes laborais como não laborais, não há evidência científica na literatura de que a FM possa ser causada pelo trabalho. A FM comumente não leva à incapacidade laborativa. Nos casos em que a dor ou a fadiga não respondem ao tratamento adequado, atingindo níveis significativos, o afastamento do trabalho por curto período de tempo pode ser considerado. Pela relevância do tema, os autores elaboraram este artigo de revisão a partir de investigação exploratória, qualitativa e bibliográfica com objetivo de estudar os principais aspectos clínicos e ocupacionais da FM, dando ênfase ao embasamento teórico-conceitual e na experiência de especialistas.

Fibromyalgia (FM) is a clinical syndrome commonly observed in daily medical practice and its etiopathogenesis is still unclear. As it is characterized by chronic musculoskeletal pain associated with several symptoms, FM may be confused with several other rheumatic and nonrheumatic diseases when they course with pictures of diffuse pain and chronic fatigue. FM treatment should be multidisciplinary, individualized, count on active participation of the patient, and based on combined pharmacological and nonpharmacological modalities. It is found both in work and non-work settings, and there is no scientific evidence in the literature showing that FM might be caused by occupation. FM seldom leads to incapacity to work. In cases where pain or fatigue do not respond to appropriate treatment, reaching significant levels, a short period away from work can be considered. As FM is a relevant subject, this review article was based on exploratory, qualitative, and bibliographic investigation, aiming to study the main clinical and occupational aspects of FM, emphasizing the theoretical-conceptual background and the experience of specialists.

Influência da interação entre qualidade ambiental e o SNP T102C do gene HTR2A sobre a suscetibilidade à fibromialgia / Influence of the interaction between environmental quality and T102C SNP in the HTR2A gene on fibromyalgia susceptibility

OBJETIVO: Investigar a influência genética da variante T102C do gene do receptor 2A de serotonina (HTR2A) e sua interação com aspectos do meio ambiente, como exposição a ruídos, trânsito, clima, oportunidades de adquirir novas informações, segurança física e proteção, dentre outras, como possíveis fatores de risco para o desenvolvimento da síndrome da fibromialgia (SFM). MÉTODOS: Foram avaliados 41 pacientes com SFM e 49 indivíduos-controle. Os fatores ambientais foram avaliados pela aplicação do domínio V do questionário WHOQOL-100 (OMS). Solicitou-se aos pacientes que as respostas representassem os momentos antes do surgimento dos sintomas. A variante T102C do gene do receptor 2A de serotonina (HTR2A) foi determinada por PCR-RFLP. RESULTADOS: Na amostra de pacientes, o número de portadores do alelo 102C foi maior do que o encontrado na amostra controle (76,5% vs. 50%; P = 0,028). Os escores do domínio V foram menores em pacientes quando comparados aos controles (P < 0,001). O fator "falta de oportunidades de adquirir novas informações e habilidades" elevou em quase 14 vezes a chance de desenvolvimento da síndrome (P = 0,009). "Baixa qualidade de cuidados sociais e de saúde", somada à presença do alelo 102C, elevou em mais de 90 vezes (P = 0,005). Contudo, indivíduos portadores desse mesmo alelo que possuem alta qualidade de cuidados sociais e de saúde não se encontram sob risco de desenvolver a SFM. CONCLUSÕES: Esses dados sugerem que tais fatores podem predispor à SFM, especialmente em portadores do alelo 102C. Entretanto, são necessárias investigações com amostras maiores.

OBJECTIVES: This study aimed to investigate the genetic influence of the T102C polymorphism of the 2A serotonin receptor gene (HTR2A) and its interaction with environmental aspects, such as exposure to noise, traffic, climate, and opportunities to acquire new information, physical protection, and security, among others, as possible risk factors for developing fibromyalgia syndrome (FMS). METHODS: Forty-one FMS patients and 49 controls were evaluated. Environmental factors were evaluated by application of the V domain of the WHOQOL-100 questionnaire. Patients were asked that their answers represented only the periods preceding the onset of symptoms. The T102C variant of the HTR2A gene was determined through PCR/RFLP. RESULTS: Among patients, the frequency of carriers of the 102C allele was higher than in controls (76.5% vs. 50%; P = 0.028). The scores of the V domain were lower in patients than in controls, indicating a worst perception of the environmental quality by patients (P < 0.001). The factor "lack of opportunities for acquiring new information and skills" increased the chance of developing FMS by almost 14-fold (P = 0.009). The factor "low quality of social care and health" together with the presence of the 102C allele also increased this chance by more than 90-fold (P = 0.005). However, carriers of the same allele who have high quality social care and health are not at a higher risk to develop FMS. CONCLUSION: These data suggest that these factors may predispose to FMS, especially in carriers of the 102C allele. However, studies with larger samples are required to confirm this hypothesis.

Interação entre qualidade do meio ambiente, estresse e a variação do gene APOE na determinação da suscetibilidade à fibromialgia / Association between environmental quality, stress and APOE gene variation in fibromyalgia susceptibility determination

INTRODUÇÃO: A fibromialgia se trata de uma desordem multifatorial, cuja etiologia reside na interação entre a susceptibilidade genética e o ambiente. No entanto, poucos trabalhos procuram detectar quais seriam os fatores considerados de risco. OBJETIVO: Investigar a influência genética e sua interação com qualidade ambiental e com estresse como possíveis fatores de risco para o desenvolvimento da fibromialgia. PACIENTES E MÉTODOS: Neste estudo transversal, foram investigados dois grupos de mulheres, sendo 47 com diagnóstico clínico de fibromialgia, e 41 mulheres do grupo controle, todas da comunidade de Novo Hamburgo, RS. O polimorfismo do gene da apolipoproteína E (APOE) foi analisado, a partir do DNA extraído do sangue total de ambas as amostras. Os fatores ambientais foram avaliados através do inventário de sintomas para adultos de Lipp (ISSL), para a averiguação do estresse comportamental, e da aplicação do domínio V do WHOQOL-100. RESULTADOS: Dentre as pacientes, foram encontradas mais mulheres com níveis altos de estresse, quando comparado à amostra controle (P < 0,001); além disto, os escores médios do domínio V do WHOQOL-100, que avalia qualidade do meio ambiente, foram inferiores neste grupo (P < 0,001). As frequências genotípicas e alélicas do gene APOE foram similares entre os dois grupos. A análise multivariada demonstrou que baixos escores do WHOQOL-100, aumentaram a chance de desenvolvimento da doença em 57,7 vezes (P < 0,001), e que altos níveis de estresse foram significativamente relacionados com a doença (OR = 197,2; P < 0,001). Essa abordagem apontou para uma interação entre estresse e a presença do alelo E*2 (P = 0,028). A doença foi muito mais frequente em pacientes com altos níveis de estresse que não eram portadoras do alelo E*2 (OR estimado = 265,1), quando comparada a pacientes com o mesmo nível de estresse e portadoras do alelo E*2 (OR estimado = 1,06). CONCLUSÃO: A presença do alelo E*2 pode indicar possível ...

INTRODUCTION: Fibromyalgia is a multifactorial disease, of which etiology is based on interaction between genetic susceptibility and environment. However, few studies attempted to identify the risk factors. OBJECTIVE: To investigate the genetic influence and its interaction with environmental quality and stress, as possible risk factors for fibromyalgia development. PATIENTS AND METHODS: This cross-sectional study investigated two groups of women, of which 47 had a clinical diagnosis of fibromyalgia, and 41 women comprising thre control group, all from the town of Novo Hamburgo, RS. The apolipoprotein E (APOE) gene polymorphism was analyzed in DNA extracted from total blood, in both samples. Environmental factors were studied through Lipp's Inventory of Stress Symptoms for Adults and by applying the WHOQOL-100 domain V. RESULTS: Among the patients, more women had high stress levels when compared to the control sample (P < 0.001); moreover, the average scores of the WHOQOL-100 domain V, which analyze environment quality, were lower in this group (P < 0.001). APOE genotypic and allelic frequencies were similar between the two groups. Multivariate analysis showed that low WHOQOL-100 scores increase the chance of disease development by 57.7 times (P < 0.001), and that high stress levels were related with the disease (OR = 197.2; P < 0.001). This approach pointed out an interaction between stress and presence of E*2 allele (P = 0.028). Fibromyalgia was much more frequent in patients with high stress levels that were E*2 non-carriers (estimated OR = 265.1), when compared to patients with the same stress level, but E*2 carriers (estimated OR = 1.06). CONCLUSION: E*2 allele presence could have a protective action regarding the association between fibromyalgia and stress.

Fibromialgia: interfaces com as LER/DORT e considerações sobre sua etiologia ocupacional / Fibromyalgia: interfaces to RSI and considerations about work etiology

Através da comparação de dois grupos de pacientes, um de portadores de fibromialgia com diagnóstico anterior de LER/DORT e outro com diagnóstico apenas de fibromialgia, tentou-se compreender as relações entre as duas condições e também entre a fibromialgia e o trabalho. Foi utilizado o método biográfico, através de entrevistas em profundidade e construção de casos clínicos de seis pacientes portadoras de fibromialgia, sendo três de cada grupo. Observou-se que as pacientes do primeiro grupo apresentaram clara relação entre a evolução da doença e a sobrecarga ocupacional. Já as pacientes do segundo grupo apresentaram alguns dos sintomas desde infância ou adolescência, sendo que estes ficaram ainda mais intensos após vivenciarem experiências de forte impacto emocional. Além disso, essas pacientes relatavam história familiar de sintomas semelhantes aos da fibromialgia, ao contrário do primeiro grupo. Concluiuse que, em alguns pacientes portadores de fibromialgia, a sobrecarga ocupacional constitui um importante fator etiológico, podendo ser precedida pelas LER/DORT, e, nesses casos, o diagnóstico de fibromialgia pode estar sendo utilizado como uma tentativa de desvincular o nexo dos sintomas com o trabalho, impedindo o trabalhador de ter acesso aos benefícios previdenciários.

Two groups of patients, one presenting symptoms of fibromyalgia and previous diagnostics of RSI (Repetitive Strain Injury), and the other only with fibromyalgia were compared in attempt to comprehend the relations between these two conditions and also between fibromyalgia and work. It was used the biographical method, with detailed interviews and creation of clinical cases from six patients with fibromyalgia, three of each group. It was noticed that patients from the first group showed a clear relationship between the disease's evolution and the overload of work. The patients of second group showed some of the symptoms since childhood or adolescence that became worse after they had suffered an emotionally strong impact. Also, these patients reported cases of similar symptoms of fibromyalgia in their families, on the contrary of the first group. It was conclude that in some patients with fibromyalgia, the overload work is an important etiologic factor, and could be preceded by RSI. In these cases the diagnosis of fibromyalgia could be used as an attempt of disassociate the relation between symptoms and the work, preventing the worker to get social security benefits.

Polimorfismos dos genes do receptor de serotonina (5-HT2A) e da catecol-O-metiltransferase (COMT): fatores desencadeantes da fibromialgia? / Serotonin receptor (5-HT 2A) and catechol-O-methyltransferase (COMT) gene polymorphisms: Triggers of fibromyalgia?

INTRODUÇÃO: A fibromialgia é uma síndrome reumática caracterizada por dor difusa e crônica associada a fadiga, insônia, ansiedade, depressão, perda de memória e tontura. Embora os mecanismos fisiológicos que controlam a fibromialgia não tenham sido estabelecidos, fatores neuroendócrinos, genéticos ou moleculares podem estar envolvidos. OBJETIVO: O objetivo do presente estudo foi caracterizar os polimorfismos dos genes do receptor de serotonina (5-HT2A) e da catecolO-metiltransferase (COMT) em pacientes brasileiros com fibromialgia, a fim de avaliar sua participação na etiologia da doença. MATERIAL E MÉTODOS: O DNA genômico extraído de 102 amostras de sangue (51 pacientes, 51 controles) foi usado para a caracterização molecular dos polimorfismos dos genes 5-HT2A e COMT, por meio de PCR-RFLP. RESULTADOS: A análise molecular dos polimorfismos do gene 5-HT2A demonstrou frequências de 25,49 por cento C/C, 49,02 por cento T/C e 25,49 por cento T/T, nos pacientes com fibromialgia, e 17,65 por cento C/C, 62,74 por cento T/C e 19,61 por cento T/T, no grupo controle, não apresentando diferença significativa entre o grupo de pacientes e o grupo controle. Os polimorfismos do gene da COMT em pacientes com fibromialgia apresentaram uma frequência de 17,65 por cento e 45,10 por cento para os genótipos H/H e L/H, respectivamente. No grupo controle, as frequências foram de 29,42 por cento, para H/H, e 60,78 por cento, para L/H, sem diferença significativa entre ambos os grupos. Entretanto, houve diferença significativa na frequência do genótipo L/L em pacientes (37,25 por cento) e controles (9,8 por cento), o que permitiu a diferenciação entre os dois grupos. CONCLUSÃO: A frequência do genótipo L/L foi maior nos pacientes com fibromialgia. Apesar de a fibromialgia envolver uma situação poligênica e fatores ambientais, o estudo molecular do SNP rs4680 do gene da COMT pode auxiliar a identificação de indivíduos suscetíveis.

INTRODUCTION: Fibromyalgia is a rheumatic syndrome characterized by diffuse and chronic pain associated with fatigue, sleep disorders, anxiety, depression, memory loss, and dizziness. Although the physiological mechanisms that control fibromyalgia have not been precisely established, neuroendocrine, genetic or molecular factors may be involved in fibromyalgia. OBJECTIVE: The aim of the present study was to characterize serotonin receptor (5-HT2A) and catecholO-methyltransferase (COMT) gene polymorphisms in Brazilian patients with fibromyalgia and to evaluate the participation of these polymorphisms in the etiology of the disease. MATERIAL AND METHODS: Genomic DNA extracted from 102 blood samples (51 patients, 51 controls) was used for molecular characterization of the 5-HT2A and COMT gene polymorphisms by PCR-RFLP. RESULTS: Analysis of the 5-HT2A polymorphism revealed a frequency of 25.49 percent C/C, 49.02 percent T/C and 25.49 percent T/T in patients, and of 17.65 percent C/C, 62.74 percent T/C and 19.61 percent T/T in the control group, with no differences between the two groups.Analysis of the COMT polymorphism in patients showed a frequency of 17.65 percent and 45.10 percent for genotypes H/H and L/H, respectively. In the control group the frequency was 29.42 percent for H/H and 60.78 percent for L/H, also with no differences between the two groups. However, there was a significant difference in the frequency of the L/L genotype between patients (37.25 percent) and controls (9.8 percent), which permitted differentiation between the two groups. CONCLUSION: The L/L genotype was more frequent among fibromyalgia patients. Though considering a polygenic situation and environmental factors, the molecular study of the rs4680 SNP of the COMT gene may be helpful to the identification of susceptible individuals.

As possíveis fontes fisiopatológicas da fibromialgia e suas importâncias como alvos para tratamento / The possible physiopathological sources of fibromyalgia and its importance as targets for treatment

A fibromialgia é uma síndrome caracterizada por dor difusa, fadiga e alterações do sono, além de diversos outros sintomas. Sua fisiopatologia permanece desconhecida, porém existem diversas hipóteses acerca de sua origem.Inicialmente, discute-se a teoria da somatização, que tem como base a ocorrência de comorbidades com agravos psicológicos e psiquiátricos, tais como traumas e abusos na infância e síndrome do estresse pós-traumático. Posteriormente, discorre-se sobre a hipótese neurológica, baseada em alterações de fluxo e ativação cerebral encontradas em métodos diagnóstico de imagem é revista a teoria neuroendócrina, fundamentada em alterações dos níveis hormonais e de neurotransmissores a hipótese inflamatória, que se apoia em níveis alterados de citocinas plasmáticas e de biópsias de pele e, por fim, as alterações receptoriais que residem em um número alterado dos receptores NMDA, relevantes no processo de alodinia, evidencia-se a possível importância destas hipóteses como base terapêutica.

Frequência de infecção por vírus da hepatite C em pacientes com síndrome da fibromialgia / Infection frequency of hepatite C virus in patients with fibromyalgia syndrome

Objetivo: avaliar a frequência da infecção pelo vírus da hepatite C (VHC) em pacientes com síndrome da fibromialgia (SF) de hospital de referência da cidade de Salvador (Bahia), onde a prevalência de portadores de anticorpos contra o VHC é menor ou igual 1,25%. Métodos: em 86 pacientes com SF, diagnosticada pelos critérios previamente estabelecidos, foi pesquisado o marca­dor sérico do VHC (ELISA) e, naqueles soro-positivos, o RNA viral pela reação da polimerase em cadeia. No grupo de com­paração, havia igual número de pacientes com outras doenças reumatológicas, sem SF, atendidos no mesmo hospital. Resultados: a pesquisa de anticorpos anti-VHC mostrou positividade de 3,5% (3/86) nos pacientes do grupo com SF, sendo negativa em todos do outro grupo, mas essa diferença não alcançou significado estatístico (p igual 0,081). A pesquisa do RNA viral foi po­sitiva nos três pacientes (dois com o subtipo 1 a e um 1 b), todos com exposição prévia a fator de risco de infecção pelo VHC. Esses três casos, comparados com os 83 VHC-negativos, apre­sentaram número de tender-points significativamente maior (p igual 0,001), respectivamente 17,33 mais ou menos 0,33 e 13,51 mais ou menos 0,19. Conclusão: apesar da frequência do VHC nos pacientes com SF (3,5%) não apresentar significância estatística, clinica­mente pode ser considerada importante, pois nenhum paciente do grupo de comparação apresentou soropositividade, além de ser maior do que a descrita em outras amostras de Salva­dor e do Nordeste brasileiro. Entretanto, a associação entre infecção pelo VHC e SF, nessa amostra, ficou pouco fortaleci­da porque os portadores do VHC tinham exposição prévia ao aparecimento da SF.