Systematic review and meta-analysis of prevalence of small fiber pathology (SFP) in fibromyalgia: Implications for a new paradigm in fibromyalgia etiopathogenesis

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Systematic review and meta-analysis of prevalence of small fiber pathology (SFP) in fibromyalgia: Implications for a new paradigm in fibromyalgia etiopathogenesis
Key Take-Away: 

The study results affirm that there is a high prevalence of small fiber pathology (SFP), in fibromyalgia. The study also provides evidence about the involvement of a distinct phenotype involving SFP in fibromyalgia. Moreover, this is probably the first study to collate data on the overall prevalence of SFP in fibromyalgia.

Introduction

Fibromyalgia is a condition which exhibits widespread chronic pain with neuropathic pain features and has a significant impact on health-related quality of life. The pathophysiology of the disease remains unclear. However, there is increasing evidence for the involvement of the peripheral nervous system with a high prevalence of small fiber pathology (SFP). This systematic literature review aims to establish the incidence of SFP in fibromyalgia.

 

Methods

The electronic literature was searched from MEDLINE, EMBASE, PubMed, Web of Science, CINAHL and the Cochrane Library databases. The published full-text, English language articles that provide SFP prevalence data in studies of fibromyalgia of patients over 18 years were considered for evaluation. Two independent reviewers screened all the articles using a priori criteria. Methodological quality and risk of bias were examined using the critical appraisal tool by Munn et al. Overall and subgroup pooled prevalence were evaluated by random-effects meta-analysis with 95% CI.

 

Results

The database searches found a total of 935 studies. 45 articles were screened of which 8 full-text articles fulfilled the inclusion criteria, keeping in view the data from 222 participants. The meta-analysis portrayed that the pooled prevalence of SFP in fibromyalgia was observed to be 49% (95% CI: 38–60%) with an average degree of heterogeneity, (I2= 68%). The prevalence estimate achieved by a skin biopsy was 45% (95% CI: 32–59%, I2= 70%) and for corneal confocal microscopy, was 59% (95% CI: 40–78%, I2= 51%).

 

Conclusion

SFP is highly common in fibromyalgia. This study provides convincing evidence of a distinct phenotype comprising SFP in fibromyalgia. Recognising SFP will help to determine its relationship to pain and potentially enable the development of future interventions and pharmacotherapy.

Source

Seminars in Arthritis and Rheumatism

Link:

https://www.sciencedirect.com/science/article/pii/S0049017218303639

Original title of article:

A systematic review and meta-analysis of the prevalence of small fiber pathology in fibromyalgia: Implications for a new paradigm in fibromyalgia etiopathogenesis

Authors:

Rebecca Grayston et al.

Exploratory, Fibromyalgia, Meta-analysis, Systematic literature review
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