Evaluation of Fibromyalgia Frequency in Chronic Urticaria Patients and Its Association with Urticaria Severity

Year 2022, Volume: 6 Issue: 3, 276 - 281, 25.12.2022

Emine Müge Acar , Senem Şaş

https://doi.org/10.46332/aemj.975877

Abstract

Purpose: Chronic urticaria is a skin disease with unknown etiology. Autoimmunity and psychogenic factors have been suggested to play a role in pathogenesis. Fibromyalgia is a rheumatic disease that may be associated with psychogenic factors. The aim of the study was to determine the frequency and severity of fibromyalgia and the effect of fibromyalgia coexistence on clinical features and dermatology life quality index in urticaria patients.

Materials and Methods: One hundred patients with chronic urticaria and no history of any systemic disease and 100 age and sexmatched healthy controls were included. Urticaria severity was evaluated by the dermatology life quality index (DLQI). Clinical severity and disability status were evaluated by the visual analog scale (VAS) and fibromyalgia impact questionnaire (FIQ).

Results: The mean age of the chronic urticaria patient group was 37.7±1.32, and that was 40.7±11.2 in the control group (p=0.09). Fibromyalgia frequency (45%) in the chronic urticaria group was significantly higher than in the control group (13%) (p=0.00). The duration of chronic urticaria was significantly higher in the patients with FMS than in the patients without FMS (p=0.001). There was a statistically significant correlation between FIQ and DLQI (p=0.019). No significant differences in terms of FMS durations, VAS, and FIQ values were detected between groups (p=0.432, p=0.201, p=0.332).

Conclusion: High frequency of fibromyalgia in chronic urticaria patients was found. This may be related to the chronic effect of neuromediators involved in chronic urticaria pathogenesis. 

Keywords

chronic urticaria, fibromiyalgia, neurogenic inflammation, pruritus, quality of life

Supporting Institution

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Project Number

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Thanks

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Kronik Ürtiker Hastalarında Fibromiyalji Sendromu Sıklığının Değerlendirilmesi

Abstract

Amaç: Kronik ürtiker, nedeni tam olarak aydınlatılamamış kaşıntılı bir deri hastalığıdır. Otoimmünite ve psikojenik faktörlerin de patogenezde rolü olabileceği düşünülmektedir. Fibromiyalji sendromu (FMS) psikojenik nedenlerle ilişkili olabileceği düşünülen bir romatizmal hastalıktır. Çalışmamızda kronik ürtiker hastalarında FMS sıklığı ve şiddetini araştırmayı ve kronik ürtikere eşlik eden fibromiyalji varlığının klinik özelliklere ve dermatoloji yaşam kalitesine etkisini değerlendirmeyi planladık.

Araçlar ve Yöntem: Çalışmaya kronik ürtiker tanısı almış ve sistemik hastalık öyküsü olmayan 100 hasta, yaş ve cinsiyet açısından eşleştirilmiş 100 sağlıklı kontrol dahil edildi. Ürtiker şiddeti dermatoloji yaşam kalite indeksi skorları (DYKI) hesaplanarak değerlendirildi. Klinik şiddet ve fonksiyonel disabilite durumları vizuel analog skala (VAS) ve fibromiyalji etki anketi (FIQ) ile değerlendirildi.

Bulgular: Hasta grubunun yaş ortalaması 37.7±1.32, kontrol grubunun ise 40.7±11.2 olarak saptandı (p=0.09). Hasta grubundaki FMS sıklığı (%45) kontrol grubundan (%13) istatistiksel olarak anlamlı şekilde yüksekti (p=0.00). Kronik ürtiker süresi FMS'li hastalarda istatistiksel olarak anlamlı derecede yüksek bulundu(p=0.001). FIQ ve DLQI değerleri arasında istatistiksel olarak anlamlı korelasyon saptandı (p=0.019). Hasta ve kontrol grubunda FMS süreleri, VAS ve FIQ açısından istatistiksel olarak anlamlı fark saptanmadı (p=0.432, p=0.201, p=0.332).

Sonuç: Kronik ürtiker hastalarında FMS sıklığının artmış olduğunu görülmektedir. Bu sonuç kronik ürtiker patogenezindeki nöromediatörlerin kronik dönemdeki etkileriyle ilişkili olabilir.

Keywords

fibromiyalji, kaşıntı, kronik ürtiker, nörojenik inflamasyon, yaşam kalitesi

Project Number

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References

• 1. Wedi B, Wieczorek D, Raap U, Kapp A. Urticaria. J Dtsch Dermatol Ges. 2014;12(11):997-1009.
• 2. Öztürk S, Erel F, Çalışkaner AZ, Karaayvaz M, Güleç M, Kartal Ö. Kronik İdiopatik Ürtiker’de Katkı Maddeli Gıdalar ile Doğal Gıdalarda Bulunan Vazoaktif Maddelerin Rolü. Kor. Hek. 2007;6(5):351-356.
• 3. Schocket AL. Chronic urticaria: pathophysiology and etiology, or the what and why. In Allergy Asthma Proc. 2006;27(2):90-95.
• 4. Colgecen E, Ozyurt K, Gul AI, Utas S. Evaluation of etiological factors in patients with chronic urticaria. Acta Dermatovenerologica Croat. 2015;23(1): 36-36.
• 5. Mathkhor AJ, Mohammed JQ. Prevalence of fibromyalgia syndrome in chronic urticaria. Middle East J Fam Med. 2020;7(10):102.
• 6. Torresani C, Bellafiore S, De Panfilis G. "Chronic urticaria is usually associated with fibromyalgia syndrome." Actaderm-venereol. 2009;89(4):389-392.
• 7. Oktayoglu P, Ucmak D, Caglayan M et al. Is there an association between chronic urticaria and fibromyalgia syndrome? Arch Rheumatol. 2014;29(1):28-34.
• 8. Steinhoff M, Stander S, Seeliger S et al. Modern aspects of cutaneous neurogenic inflammation. Arch Dermatol. 2003;39(11):1479-1488.
• 9. Littlejohn GO, Weinstein C, Helme RD. Increased neurogenic inflammation in fibrositis syndrome. J Rheumatol. 1987;14(5):1022-1025.
• 10. Eneström S, Bengtsson A, Frödin T. Dermal IgG deposits and increase of mast cells in patients with fibromyalgia relevant findings or epiphenomena? Scand J Rheumatol. 1997;26(4):308-313.
• 11. Hapa A, Ozdemir O, Evans SE et al. Evaluation of the frequency of fibromyalgia in patients with chronic urticarial. Turkderm. 2012;46(4):202-205.
• 12. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19(3):210-216.
• 13. Oztürkcan S, Ermertcan AT, Eser E, Sahin MT. Cross validation of the Turkish version of dermatology life quality index. Int J Dermatol. 2006;45(11):1300-1307.
• 14. Jones KR, Vojir CP, Hutt E, Fink R. Determining mild, moderate, and severe pain, equivalency across pain-intensity tools in nursing home residents. J Rehabil Res Dev. 2007;44(2):305.
• 15. Paul SM, Zelman, DC, Smith M, Miaskowski C. Categorizing the severity of cancer pain: further exploration of the establishment of cutpoints. Pain. 2005;113 (1-2):37-44.
• 16. Wolfe F, Clauw DJ, Fitzcharles M-A, et al., 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin. Arthritis Rheum. 2016;46(3):319-329.
• 17. Sarmer S, Ergin S, Yavuzer G. The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatol Int. 2000;20(1):9-12.
• 18. Bennett R. The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clin Exp Rheumatol. 2005;23(39):154-162.
• 19. Antai-Otong D. The art of prescribing. Depression and fibromyalgia syndrome (FMS): pharmacologic considerations. Perspect Psychiatr Care. 2005;41(3):146-148.
• 20. Erdogan HK, Sas S, Acer E, Bulur I, Altunay IK, Erdem HR. Cutaneous findings in fibromyalgia syndrome and their effect on quality of life. Dermatol Sin. 2016;34(3):131-134.
• 21. Kim SH. Skin biopsy findings: implications for the pathophysiology of fibromyalgia. Med Hypotheses 2007;69(1):141-144.
• 22. Maggi CA. Tachykinins and calcitonin generelated peptide (CGRP) as cotransmitters released from peripheral endings of sensory nerves. Prog Neurobiol. 1995;45(1):1-98.
• 23. Slominski AT, Zmijewski MA, Zbytek B, Tobin DJ, Theoharides TC, Rivier J. Key role of CRF in the skin stress response system. Endocr Rev. 2013;34(6):827-884.
• 24. Theoharides TC, Singh LK, Boucher W et al. Corticotropin-releasing hormone induces skin mast cell degranulation and increased vascular permeability, a possible explanation for its proinflammatory effects. Endocrinology. 1998;139(1):403-413.
• 25. Arck P, Paus R. From the brain-skin connection: the neuroendocrine immune misalliance of stres and itch. Neuroimmunomodulation. 2006;13(5-6):347-356.
• 26. Basak PY, Erturan I, Yuksel O, Kazanoglu OO, Vural H. Evaluation of serum neuropeptide levels in patients with chronic urticaria. Indian J Dermatol Venereol Leprol. 2014;80(5):483-483.
• 27. Rossing K, Novak N, Mommert S, et al. Brain-derived neurotrophic factor is increased in serum and skin levels of patients with chronic spontaneous urticaria. Clin Exp Allergy. 2011;41(10):1392-1399.
• 28. Gözübüyükoğulları A, Onan DT, Allı N. Fibromyalgia syndrome in chronic urticaria patients. Turkderm. 2014;48(4):215-218.
• 29. Leznoff A, Josse RG, Denburg J, Dolovich J. Association of chronic urticaria and angioedema with thyroid autoimmunity. Arch Dermatol. 1983;119(8):636-640.
• 30. Tong LJ, Balakrishnan G, Kochan JP, Kinet JP, Kaplan AP. Assessment of autoimmunity in patients with chronic urticaria. J Allergy Clin Immunol. 1997; 99(4):461-465.
• 31. Bazzichi L, Rosso A, Giuliano T, et al. Association between thyroid autoimmunity and fibromyalgic disease severity. Clin Rheumatol. 2007;26(12):2115-2120.
• 32. Yener M, Erturan I, Ceyhan AM, Inal EE, Kazanoglu OO. The evaluation of prevalence of fibromyalgia in patients with chronic urticaria. Med Sci Monit: Int. J. Clin. Exp. Med. 2013;19:757-761.
• 33. Beyazal MS, Tüfekçi A, Kırbaş S, Topaloğlu MS. The impact of fibromyalgia on disability, anxiety, depression, sleep disturbance and quality of life in patients with migraine. Arch Neuropsychiatr. 2018;55(2):140-145.