Fibromyalgia incidence among patients with hepatitis B infection

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Fibromyalgia incidence among patients with hepatitis B infection
Key Take-Away: 
  • The mean tender point counts and the visual analog scale values were significantly higher among the hepatitis B viral (HBV) patients than the control group.
  • The incidence of Fibromyalgia syndrome (FMS), widespread body pain, anxiety, arthralgia and morning stiffness was significantly greater among the HBV patients than in the control group.

Fibromyalgia syndrome (FMS) is a chronic and painful disease defined by tender points with a painful response to pressure, widespread pain, and muscular hypersensitivity. The etiology and pathogenesis of FMS remains unclear. Various factors including genetic, neuronal, hormonal and immunologic disorders, infectious diseases, rheumatic diseases, physical injury and psychological disorders might contribute in the etiology and pathogenesis of this disease.

ABSTRACT: 
Background: 

Fibromyalgia syndrome (FMS) is a chronic and painful disease defined by tender points with a painful response to pressure, widespread pain, and muscular hypersensitivity. The etiology and pathogenesis of FMS remains unclear. Various factors including genetic, neuronal, hormonal and immunologic disorders, infectious diseases, rheumatic diseases, physical injury and psychological disorders might contribute in the etiology and pathogenesis of this disease.

A putative role of hepatitis B viral (HBV) infection in the pathogenesis of FMS is suggested by two prior reports evaluating the high incidence of FMS in patients with HBV infection. A few pathogenic mechanisms have been suggested for the raised incidence of FMS in HBV-infected individuals. First, the release of inflammatory mediators following direct infection of host tissues may induce FMS. The release of certain inflammatory products or cytokines, such as interferon (IFN)-alpha, has been related with the existing of FMS. Alternately, FMS may be triggered by the stress and anxiety that results from being diagnosed with a chronic infectious disease.

Rationale behind research

  1. Prior studies evaluate the high incidence of FMS in patients with HBV infection so we conduct this study to appraise the role of hepatitis B viral (HBV) infection in the pathogenesis of FMS
  • Objective

To evaluate the incidence of fibromyalgia syndrome (FMS) and identify FMS-related clinical symptoms in hepatitis B virus (HBV) patients. 

Methods: 

 

Study outcomes

  • The systematic evaluation of fatigue, widespread body pain, sleep disturbance, anxiety, irritable bowel syndrome, headache, morning stiffness, menstrual cycle disturbance, joint examination (arthralgia or arthritis) and a standard evaluation of tender points.
  • Severity of Pain was measured by using a visual analogue scale (VAS: 0 mm = no pain, 100 mm = very serious pain).
  • Laboratory tests including aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were performed.
  • HBV-DNA, hepatitis Be antigen (HBeAg), anti-HBe and anti-Delta were evaluated using enzyme linked immunosorbent assay (ELISA). 
Results: 

 

Outcome

  • There were no significant age, sex or BMI differences between the HBV patients and the control group. Mean BMI was significantly higher in the HBV carrier group than in the chronic active HBV patient group (P < 0.05).
  • Serum AST and ALT levels were significantly higher in HBV patients relative to the control group (P < 0.05)
  • The incidence of FMS, widespread body pain, sleep disturbance, fatigue, anxiety, arthralgia and morning stiffness was significantly greater among the HBV patients than in the control group.
  • The chronic active HBV patients had the highest incidence of FMS, widespread body pain, anxiety and arthralgia, while the HBV carrier group had the lowest incidence of these symptoms.
  • The incidence of morning stiffness was significantly greater among the HBV carrier group and chronic active HBV patient group than in the HBV patients undergoing active treatment (P < 0.01)
  • The mean number of tender points and VAS values were also significantly higher among the HBV patients than in the control group. Although arthritis, irritable bowel syndrome, headache and menstrual cycle disturbance frequency were more common among the HBV patients, there were no significant differences between the HBV patients and controls (P > 0.05).
  • Fatigue frequency was significantly greater among the chronic active HBV patients than in the HBV carrier group (P < 0.05). 

 

Figure 1: Clinical characteristics of all patients and control group

 

 

Figure 1: Clinical characteristics of the patients group ​

Conclusion: 

This study demonstrates that FMS incidence is greater among HBV patients relative to control subjects. However, there were no differences in FMS incidence among the subgroups of HBV.

Previous studies reported a relationship between FMS and infectious diseases such as human immunodeficiency virus (HIV), HBV, and hepatitis C virus (HCV) and even Lyme disease HBV patients generally have rheumatologic symptoms, including myalgia, arthralgia, arthritis, morning stiffness and fibromyalgia. A few studies have also suggested that vaccinations have been implicated in the etiopathology of FMS. The fibromyalgia incidence is greater among individuals with rheumatic diseases. Hence, this disorder may share similar clinical properties. However, the present study included a highly detailed clinical assessment relative to previous studies on FMS in HBV infection and our study included a larger patient population.

Int J Rheum Dis. 2015 Jul 1
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