Is fibromyalgia accompanying Behçet's disease more severe than primary fibromyalgia?

Year 2020, Volume: 6 Issue: 6, 631 - 639, 04.11.2020

Koray Ayar , Burcu Metin Ökmen , Lale Altan , Esra Kösegil Öztürk

https://doi.org/10.18621/eurj.753015

Abstract

Objectives: Although there are studies in the literature about how Behçet's disease is affected in the presence of fibromyalgia, there is no information about how the severity of fibromyalgia is in the presence of Behçet's disease. This study aims to evaluate the severity of fibromyalgia by comparing the impact of fibromyalgia and pain thresholds between fibromyalgia patients with and without Behçet's disease.

Methods: Twenty-five fibromyalgia patients with Behçet's disease and 34 primary fibromyalgia patients were included in this cross-sectional study. All participants completed the fibromyalgia impact questionnaire, and pain thresholds were measured at 18 tender points using algometry.

Results: The mean fibromyalgia impact questionnaire scores in fibromyalgia patients with and without Behçet's disease were 66.6 ± 18.4 and 60.4 ± 14.5, respectively (p = 0.157). Pain thresholds were not different between the groups in 15 of the 18 tender points (TP). In fibromyalgia patients with Behçet's disease, pain thresholds in TP-15, TP-16 and TP-17 were 11.44 ± 4.84, 11.92 ± 5.00 and 15.16 ± 4.89 pounds, respectively, while in primary fibromyalgia patients those were 8.41 ± 2.68, 8.14 ± 2.76 and 12.14 ± 4.06 pounds respectively. Pain thresholds in TP-15, TP-16 and TP-17 were significantly different between the groups (p = 0.003, p = 0.003, p = 0.014, respectively).

Conclusions: According to the literature data, although fibromyalgia has an effect on Behçet's disease, especially in cases associated with central sensitization syndromes, the severity of fibromyalgia was not found to be different in fibromyalgia patients with and without Behçet's disease in this study. There may be a relationship between Behçet's disease and fibromyalgia due to non-inflammatory causes such as central sensitization.

Keywords

Behçet's disease, fibromyalgia, pain thresholds

References

• 1. Gowans SE, deHueck A, Voss S, Richardson M. A randomized, controlled trial of exercise and education for individuals with fibromyalgia. Arthritis Care Res 1999;12:120-8.
• 2. Goldenberg DL, Mossey CJ, Schmid CH. A model to assess severity and impact of fibromyalgia. J Rheumatol 1995;22:2313-8.
• 3. Rooks DS, Silverman CB, Kantrowitz FG. The effects of progressive strength training and aerobic exercise on muscle strength and cardiovascular fitness in women with fibromyalgia: a pilot study. Arthritis Rheum 2002;47:22-8.
• 4. Lee JH, Cho KI, Kim SM, Lee HG, Kim TI. Arterial stiffness in female patients with fibromyalgia and its relationship to chronic emotional and physical stress. Korean Circ J 2011;41:596-602.
• 5. Consoli G, Marazziti D, Ciapparelli A, Bazzichi L, Massimetti G, Giacomelli C, et al. The impact of mood, anxiety, and sleep disorders on fibromyalgia. Compr Psychiatry 2012;53:962-7.
• 6. Mendieta D, De la Cruz-Aguilera DL, Barrera-Villalpando MI, Becerril-Villanueva E, Arreola R, Hernandez-Ferreira E, et al. IL-8 and IL-6 primarily mediate the inflammatory response in fibromyalgia patients. J Neuroimmunol 2016;290:22-5.
• 7. Correa-Rodriguez M, Casas-Barragan A, Gonzalez-Jimenez E, Schmidt-RioValle J, Molina F, Aguilar-Ferrandiz ME. Dietary inflammatory index scores are associated with pressure pain hypersensitivity in women with fibromyalgia. Pain Med 2020;21:586-94.
• 8. Turkoglu G, Selvi Y. The relationship between chronotype, sleep disturbance, severity of fibromyalgia, and quality of life in patients with fibromyalgia. Chronobiol Int 2020;37:68-81.
• 9. Kocyigit BF, Okyay RA. The relationship between body mass index and pain, disease activity, depression and anxiety in women with fibromyalgia. PeerJ 2018;6:e4917.
• 10. Xiao Y, Haynes WL, Michalek JE, Russell IJ. Elevated serum high-sensitivity C-reactive protein levels in fibromyalgia syndrome patients correlate with body mass index, interleukin-6, interleukin-8, erythrocyte sedimentation rate. Rheumatol Int 2013;33:1259-64.
• 11. Backryd E, Tanum L, Lind AL, Larsson A, Gordh T. Evidence of both systemic inflammation and neuroinflammation in fibromyalgia patients, as assessed by a multiplex protein panel applied to the cerebrospinal fluid and to plasma. J Pain Res 2017;10:515-25.
• 12. Vincent A, Lahr BD, Wolfe F, Clauw DJ, Whipple MO, Oh TH, et al. Prevalence of fibromyalgia: a population-based study in Olmsted County, Minnesota, utilizing the Rochester Epidemiology Project. Arthritis Care Res (Hoboken) 2013;65:786-92.
• 13. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995;38:19-28.
• 14. Jones GT, Atzeni F, Beasley M, Fluss E, Sarzi-Puttini P, Macfarlane GJ. The prevalence of fibromyalgia in the general population: a comparison of the American College of Rheumatology 1990, 2010, and modified 2010 classification criteria. Arthritis Rheumatol 2015;67:568-75.
• 15. Walitt B, Nahin RL, Katz RS, Bergman MJ, Wolfe F. The prevalence and characteristics of fibromyalgia in the 2012 National Health Interview Survey. PLoS One 2015;10:e0138024.
• 16. Wolfe F, Hauser W, Hassett AL, Katz RS, Walitt BT. The development of fibromyalgia--I: examination of rates and predictors in patients with rheumatoid arthritis (RA). Pain 2011;152:291-9.
• 17. Lee YC, Lu B, Boire G, Haraoui BP, Hitchon CA, Pope JE, et al. Incidence and predictors of secondary fibromyalgia in an early arthritis cohort. Ann Rheum Dis 2013;72:949-54.
• 18. Karaaslan Y, Ozturk M, Haznedaroglu S. Secondary fibromyalgia in Turkish patients with rheumatologic disorders. Lupus 1999;8:486.
• 19. Jobanputra C, Richey RH, Nair J, Moots RJ, Goebel A. Fibromyalgia in Behcet's disease: a narrative review. Br J Pain 2017;11:97-101.
• 20. Lee SS, Yoon HJ, Chang HK, Park KS. Fibromyalgia in Behcet's disease is associated with anxiety and depression, and not with disease activity. Clin Exp Rheumatol 2005;23(4 Suppl 38):S15-9.
• 21. Toprak M, Erden M, Alpayci M, Ediz L, Yazmalar L, Hiz O, et al. The frequency and effect of fibromyalgia in patients with Behcet's disease. Turk J Phys Med Rehabil 2017;63:160-4.
• 22. Criteria for diagnosis of Behcet's disease. International Study Group for Behcet's Disease. Lancet 1990;335:1078-80.
• 23. Bennett RM, Friend R, Marcus D, Bernstein C, Han BK, Yachoui R, et al. Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria. Arthritis Care Res (Hoboken) 2014;66:1364-73.
• 24. Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. J Rheumatol 1991;18:728-33.
• 25. Altan L, Celiker R, Ercan I, Birtane M, Akgun K, Zateri C, et al. The reliability and validity of the Turkish version of the Fibromyalgia Participation Questionnaire. Eur J Rheumatol 2018;5:40-4.
• 26. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:160-72.
• 27. de Araujo AL, Paliares IC, de Araujo MI, Novo NF, Cadaval RA, Martinez JE. [The association of fibromyalgia and systemic lupus erythematosus change the presentation and severity of both diseases?]. Rev Bras Reumatol 2015;55:37-42. [Article in Portuguese]
• 28. Jiao J, Davis III JM, Cha SS, Luedtke CA, Vincent A, Oh TH. Association of rheumatic diseases with symptom severity, quality of life, and treatment outcome in patients with fibromyalgia. Scand J Rheumatol 2016;45:49-56.
• 29. Gunturk EE, Ekiz T, Akkaya H. Evaluation of carotid-femoral pulse wave velocity, aortic stiffness index, and aortic distensibility in patients with fibromyalgia. Clin Rheumatol 2019;38:1731-5.
• 30. Ranzolin A, Duarte AL, Bredemeier M, da Costa Neto CA, Ascoli BM, Wollenhaupt-Aguiar B, et al. Evaluation of cytokines, oxidative stress markers and brain-derived neurotrophic factor in patients with fibromyalgia - A controlled cross-sectional study. Cytokine 2016;84:25-8.
• 31. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain 2011;152(3 Suppl):S2-15.
• 32. Ostuni P, Botsios C, Sfriso P, Bertagnin A, Cozzi F, Doria A, et al. [Prevalence and clinical features of fibromyalgia in systemic lupus erythematosus, systemic sclerosis and Sjogren's syndrome]. Minerva Med 2002;93:203-9. [Article in Italian]
• 33. Kukidome D, Nishikawa T, Sato M, Igata M, Kawashima J, Shimoda S, et al. Measurement of small fibre pain threshold values for the early detection of diabetic polyneuropathy. Diabet Med 2016;33:62-9.
• 34. Massara A, Bonazza S, Castellino G, Caniatti L, Trotta F, Borrelli M, et al. Central nervous system involvement in Sjogren's syndrome: unusual, but not unremarkable--clinical, serological characteristics and outcomes in a large cohort of Italian patients. Rheumatology (Oxford) 2010;49:1540-9.
• 35. Akman-Demir G, Serdaroglu P, Tasci B. Clinical patterns of neurological involvement in Behcet's disease: evaluation of 200 patients. The Neuro-Behcet Study Group. Brain 1999;122(Pt 11):2171-82.
• 36. Jaskolska M, Chylinska M, Masiak A, Nowicka-Sauer K, Sieminski M, Zietkiewicz M, et al. Peripheral neuropathy and health-related quality of life in patients with primary Sjogren's syndrome: a preliminary report. Rheumatol Int 2020;40:1267-74.
• 37. Melikoglu M, Melikoglu MA. The prevalence of fibromyalgia in patients with Behcet's disease and its relation with disease activity. Rheumatol Int 2013;33:1219-22.