The relation of chronic idiopathic urticaria with Fibromyalgia, sleep disturbance and anxiety

Abstract

Aim: Fibromyalgia syndrome (FMS) and chronic idiopathic urticaria (CIU) are closely related due to peripheral neurogenic inflammation (neuropeptide secretion), immune dysfunction, and somatic complaints such as fatigue, pain, anxiety, and sleep disturbance. This study aimed to reveal the relationship of CIU with FMS, sleep disturbance and anxiety.

Materials and Methods: A total of 51 patients with CIU aged 18–64 years (36.2±10.4) and 45 sex- and age-matched healthy controls were included. Urticaria activity score (UAS) was assessed for the severity of urticaria.  The 2010 American College of Rheumatology classification criteria were used for FMS diagnosis. The participants were evaluated with visual analog scale (VAS), fibromyalgia impact questionnaire (FIQ), Pittsburgh sleep quality index (PSQI), and Beck anxiety inventory (BAI).

Results: The presence of FMS and body mass index (BMI) were significantly higher in the urticaria group compared with the control group. The mean FIQ and UAS of the urticaria group were 47.0 ± 22.1 and 1.3 ± 0.9, respectively.  UAS was positively correlated with FIQ, PSQI, BAI and VAS (rho=0.411 p=0.004; rho=0.310 p=0.034; rho=0.419 p=0.004; rho=0.414 p=0.004; respectively).  The presence of FMS was found to be significantly associated with high BMI (p = 0.04).

Conclusions: The prevalence of FMS was higher in patients with CIU than control group. Also, FMS was more severe, general pain and fatigue, sleep disturbance and anxiety were higher in patients with high urticarial activity. 

Keywords

• Anxiety disorder,fibromyalgia syndrome,sleep disturbance,urticaria

Kronik idiopatik ürtiker ile Fibromyalji, uyku bozukluğu ve anksiyete ilişkisi

Abstract

Amaç: Fibromiyalji sendromu (FMS) ve kronik idiyopatik ürtiker (CIU), periferik nörojenik inflamasyon (nöropeptid salınımı), immün işlev bozukluğu ve yaygın halsizlik, ağrı, anksiyete ve uyku bozukluğu gibi somatik şikayet nedeniyle yakından ilişkilidir. Bu çalışmada CIU ile FMS, uyku bozukluğu ve anksiyete ilişkisini ortaya koymak amaçlandı.

Gereç ve Yöntem: Yaşları 18-64 arasında değişen (36.2 ± 10.4) CIU'lu 51 hasta ile cinsiyet ve yaşa uygun 45 sağlıklı kontrol alındı. Ürtiker aktivite skoru (UAS) ürtiker şiddeti açısından değerlendirildi. FMS tanısı için 2010 Amerikan Romatoloji Cemiyeti sınıflandırma kriterleri kullanılmıştır. Katılımcılar görsel analog skala (VAS), fibromiyalji etkisi anketi (FIQ), Pittsburgh uyku kalitesi indeksi (PSQI) ve Beck anksiyete envanteri (BAI) ile değerlendirildi.

 

Bulgular: Ürtiker grubunda FMS ve vücut kütle indeksi (VKİ) kontrol grubuna göre anlamlı derecede yüksekti. Ürtiker grubunun FIQ ve UAS ortalaması sırasıyla 47.0 ± 22.1 ve 1.3 ± 0.9 idi. UAS ile FIQ, PSQI, BAI ve VAS pozitif korele idi (rho=0.411 p=0.004; rho=0.310 p=0.034; rho=0.419 p=0.004; rho=0.414 p=0.004; sırasıyla). FMS varlığı VKİ ile anlamlı ilişkiliydi (p = 0.04).

Sonuç: FMS prevalansı kontrol grubuna göre CIU olan hastalarda daha yüksekti. Ayrıca, yüksek ürtikeryel aktivite gösteren kişilerde FMS daha şiddetli, genel ağrı ve yorgunluk, uyku bozukluğu ve anksiyete daha yüksek idi. 

Keywords

• Anksiyete bozukluğu,fibromyalji sendromu,uyku bozukluğu,ürtiker

References

1. 1. Maurer M, Church MK, Marsland AM, Sussman G, Siebenhaar F, Vestergaard C, et al. Questions and answers in chronic urticaria: where do we stand and where do we go? J Eur Acad Dermatol Venereol 2016;30(5):7-15. doi: 10.1111/jdv.13695.
2. 2.Sumpton JE, Moulin DE. Fibromyalgia. Handb Clin Neurol 2014;119:513-27. doi: 10.1016/B978-0-7020-4086-3.00033-3.
3. 3. Koca TT, Tugan CB, Koçyiğit BF, Nacitarhan V. Fibromyalgia awareness in women agedbetween 18 and 75 years: a current view to fibromyalgia. J Public Health (Berl.) 2018. doi: 10.1007/s10389-018-0970-0
4. 4. Criado PR, Criado RF, Maruta CW, Reis VM. Chronic urticaria in adults: state-of-the-art in the new millennium. An Bras Dermatol 2015;90(1):74-89. doi: 10.1590/abd1806-4841.20153509.
5. 5. Zuberbier T, Bindslev-Jensen C, Canonica W et al: EAACI/GA2LEN/EDF guide¬line: definition, classification and diagnosis of urticaria. Allergy 2006; 61:316–20 6. Wolfe F, Smythe HA, Yunus MB 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
6. 7. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a . new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193–213.
7. 8. Agargun MY, Kara H, Anlar O. Pittsburgh uyku kalitesi indeksinin geçerliliği ve güvenilirliği. Turk Psik Der 1996;7:107–15.
8. 9. Soria A, Francès C. [Urticaria: diagnosis and treatment]. Rev Med Interne 2014;35(9):586-94. doi: 10.1016/j.revmed.2014.01.008. Epub 2014 Feb 25.

9. 10. Jafilan L, James C. Urticaria and Allergy-Mediated Conditions. Prim Care 2015;42(4):473-83. doi: 10.1016/j.pop.2015.08.002.
10. 11. Tulay KT, Emrullah T, Aydin A, Ciledag OF. The effect of fibromyalgia syndrome to gravidity, parity and duration of breastfeeding; A prospective study from Turkey. Pak J Med Sci 2016;32(3):545-9. doi: 10.12669/pjms.323.9574.
11. 12. Rodriguez-Pintó I, Agmon-Levin N, Howard A, Shoenfeld Y. Fibromyalgia and cytokines. Immunol Lett 2014;161(2):200-3. doi: 10.1016/j.imlet.2014.01.009. 10.1038/nrrheum.2015.100.
12. 14. Mahmut Yener, Ijlal Erturan, Ali Murat Ceyhan, Esra Erkol Inal, Oya Oylum Kazanoglu, The evaluation of prevalence of fibromyalgia in patients with chronic urticaria. Med Sci Monit 2013;19:757-761. doi:10.12659/MSM.889626
13. 15. Torresani C, Bellafiore S, De Panfilis G. Chronic urticaria is usually associated with fibromyalgia syndrome. Acta Derm Venereol 2009;89(4):389-92. doi: 10.2340/00015555-0653.
14. 16. Wiffen PJ, Derry S, Moore RA, Kalso EA. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2014;(4):CD005451. doi: 10.1002/14651858.CD005451.pub3.
15. 17. Engin B, Uguz F, Yilmaz E, Ozdemir M, Mevlitoglu I. The levels of depression, anxiety and quality of life in patients with chronic idiopathic urticaria. J Eur Acad Dermatol Venereol 2008;22(1):36-40. doi: 10.1111/j.1468-3083.2007.02324.x.
16. 18. Staubach P, Eckhardt-Henn A, Dechene M, Vonend A, Metz M, Magerl M, et al. Quality of life in patients with chronic urticaria is differentially impaired and determined by psychiatric comorbidity. Br J Dermatol 2006;154(2):294-8.
17. 19. O'Donnell BF. Urticaria: impact on quality of life and economic cost. Immunol Allergy Clin North Am. 2014;34(1):89-104. doi: 10.1016/j.iac.2013.09.011.
18. 20. Chinn S, Caldwell W, Gritsenko K. Fibromyalgia Pathogenesis and Treatment Options Update. Curr Pain Headache Rep 2016;20:25. 21. Koca TT, Karaca Acet G, Tanrıkut E, Talu B. Evaluation of sleep disorder and its effect on sexual dysfunction in patients with Fibromyalgia syndrome. Turk J Obstet Gynecol 2016;13(4):167-171. doi: 10.4274/tjod.17047.
19. 22. Palagini L, Carmassi C, Conversano C, Gesi C, Bazzichi L, Giacomelli C, et al. Transdiagnostic factors across fibromyalgia and mental disorders: sleep disturbances may play a key role. A clinical review. Clin Exp Rheumatol 2016;34:S140–4.
20. 23. Choi DH, Kim HS. Quantitative analysis of nailfold capillary morphology in patients with fibromyalgia. Korean J Intern Med 2015;30(4):531-7. doi: 10.3904/kjim.2015.30.4.531.
21. 24. Morf S, Amann-Vesti B, Forster A, Franzeck UK, Koppensteiner R, Uebelhart D,Sprott H. Microcirculation abnormalities in patients with fibromyalgia – measured by capillary microscopy and laser fluxmetry. Arthritis Res Ther 2005;7(2):R209-16.