Lipödem ile fibromiyalji birlikteliği; hastalık evresi, ağrı ve yaşam kalitesine etkileri

Year 2023, , 234 - 240, 28.06.2023

Mehmet Onat Çakıt , Busem Atar , Satı Zülal Ayaz , Ömer Faruk Çelik , Ayşe Güliz Gürdal , Burcu Duyur Çakıt

https://doi.org/10.47582/jompac.1301253

Abstract

Giriş ve Amaç:
Hem Fibromiyalji (FMS) hem de lipödem yumuşak dokuda ağrı ile karakterizedir ve klinik olarak benzer yönleri vardır. Bu çalışmanın amacı, lipödemli hastaların kaçının FMS tanı kriterlerini karşıladığını, lipödem ve FMS komorbiditesinin ağrı ve yaşam kalitesi üzerindeki etkisini ve ekstremite hacimleri, ultrasonografik olarak ölçülen yumuşak doku kalınlığı ve lipödem hastalık şiddeti ile ilişkisini belirlemektir.
Materyal ve Metod:
Çalışmaya lipödemli 53 kadın ve lipödemi olmayan 32 FMS hastası dahil edildi. FMS tanısı için semptom şiddet skalası, yaygın ağrı indeksi ve FMS şiddet skalası hesaplandı. Ağrı şiddeti görsel analog skala (GAS) ile belirlendi. Lipödem grubunda fibromiyalji sıklığı belirlendi. Her iki grubun alt ekstremite hacimleri çevresel ölçümlerle, uyluk ve pretibial yumuşak doku kalınlıkları ise ultrasonografik olarak ölçüldü. Her iki gruba da Kısa Form-36 yaşam kalitesi ölçeği uygulandı.
Bulgular:
Lipödemli 53 kadının yaş ortalaması 52±11.8, FMS'li 32 kadının yaş ortalaması 51.9±10.1 idi (p>0.05). Ekstremite hacimleri ve yumuşak doku kalınlıkları lipödem grubunda FMS grubuna göre daha yüksekti p<0,001). Lipödem grubunda 21 (%39,6) hasta FMS kriterlerini karşıladı.
Komorbid Lipödem ve FMS grubu FMS şiddet skorları FMS hastaları ile benzerdi (p=0,199). Bedensel ağrı ve VAS, Komorbid Lipödem ve FMS grubunda FMS ve FMS olmayan lipödem grubuna göre daha şiddetliydi (p<0.001). Genel olarak Kısa Form-36 bileşenleri, FMS'siz lipödem grubunda, Komorbid FMS ve FMS grubuna göre daha iyi bulundu (p<0.05).
Sonuç:
Hastalarda bu iki hastalığın birlikte görülmesi hastaların fiziksel ve mental fonksiyonlarını olumsuz etkilemektedir. Lipödem hastalarında FMS komorbiditesinin araştırılması ve tedavisi hastaların yaşam kalitelerine ve ağrılarına katkı sağlayabilir.

Keywords

Lipödem, Fibromiyalji, Yumuşak Doku Kalınlığı, Ultrasonografi, Yaşam Kalitesi, Ağrı

Comorbidity of lipedema and fibromyalgia; effects on disease severity, pain and health-related quality of life

Abstract

Aims: Both Fibromyalgia (FMS) and lipedema are characterized by pain in the soft tissue, and they have clinically similar aspects. The Aims of this study were to determine how many of the patients with lipedema met the diagnostic criteria for FMS, the effect of the comorbidity of lipedema and FMS on pain and quality of life, and their relationship with extremity volumes, ultrasonographically measured soft tissue thickness and lipedema disease severity.
Methods: 53 women with lipedema and 32 patients with FMS without lipedema were included in the study. Symptom severity scale, widespread pain index, and FMS severity scale were calculated for the diagnosis of FMS. Pain intensity was determined by visual analog scale (VAS). The frequency of fibromyalgia was determined in the lipedema group. Lower extremity volumes of both groups were calculated by circumferential measurements and thigh and pretibial soft tissue thicknesses were measured ultrasonographically. Short form-36 quality of life scale was applied to both groups.
Results: The mean age of the 53 females with lipedema was 52±11.8 years, and for the 32 females with FMS it was 51.9±10.1 years (p>0.05). The extremity volumes and soft tissue thicknesses were higher in lipedema group than FMS group p<0.001).In lipedema group, 21(39.6%) patients have fulfilled the FMS criteria. FMS severity scores of Comorbid Lipedema and FMS group were similar with FMS patients (p=0.199). Bodily pain and VAS were more severe in Comorbid Lipedema and FMS group than lipedema group without FMS and FMS group (p<0.001). Generally, Short form-36 components were better in lipedema without FMS group than Comorbid FMS and FMS group (p<0.05)
Conclusion: The comorbidity of these two diseases in patients negatively affect their physical and mental functions. Investigation and treatment of comorbid FMS in lipedema patients may contribute to their quality of life and pain.

Keywords

Lipedema, fibromyalgia, soft tissue thickness, ultrasonography

References

• Reich-Schupke S, Schmeller W, Brauer WJ, et al. S1 guidelines: lipedema. J Dtsch Dermatol Ges. 2017;15(7):758-767. doi:10.1111/ddg.13036
• Sarzi-Puttini P, Giorgi V, Marotto D, Atzeni F. Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol. 2020;16(11):645-660. doi:10.1038/s41584-020-00506-w
• Bertsch T, Erbacher G, Elwell R. Lipoedema: a paradigm shift and consensus. J Wound Care. 2020;29(Sup11b):1-51. doi:10.12968/jowc.2020.29.Sup11b.1
• Angst F, Benz T, Lehmann S, Sandor P, Wagner S. Common and contrasting characteristics of the chronic soft-tissue pain conditions fibromyalgia and lipedema. J Pain Res. 2021;14:2931-2941. doi:10.2147/JPR.S315736
• Wolfe F, Clauw DJ, Fitzcharles MA, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016;46(3):319-329. doi:10.1016/j.semarthrit.2016.08.012
• Aksoy H, Karadag AS, Wollina U. Cause and management of lipedema-associated pain. Dermatol Ther. 2021;34(1):e14364. doi:10.1111/dth.14364
• Halk AB, Damstra RJ. First Dutch guidelines on lipedema using the international classification of functioning, disability and health. Phlebology. 2017;32(3):152-159. doi:10.1177/0268355516639421
• Amato ACM, Saucedo DZ, Santos KDS, Benitti DA. Ultrasound criteria for lipedema diagnosis. Phlebology. 2021;36(8):651-658. doi:10.1177/02683555211002340
• Sitzia J. Volume measurement in lymphoedema treatment: examination of formulae. Eur J Cancer Care (Engl). 1995;4(1):11-16. doi:10.1111/j.1365-2354.1995.tb00047.x
• Koçyiğit H, Aydemir Ö, Fişek G, Ölmez N, Memiş A. Kısa form-36 (KF-36)’nın Türkçe versiyonunun güvenilirliği ve geçerliliği; romatizmal hastalığı olan bir grup hasta ile çalışma. İlaç Tedavi Derg. 1999; 12: 102-6.
• Chakraborty A, Crescenzi R, Usman TA, et al. Indications of peripheral pain, dermal hypersensitivity, and neurogenic inflammation in patients with lipedema. Int J Mol Sci. 2022;23(18):10313. doi:10.3390/ijms231810313
• Serra J, Collado A, Solà R, et al. Hyperexcitable C nociceptors in fibromyalgia. Ann Neurol. 2014;75(2):196-208. doi:10.1002/ana.24065
• Doppler K, Rittner HL, Deckart M, Sommer C. Reduced dermal nerve fiber diameter in skin biopsies of patients with fibromyalgia. Pain. 2015;156(11):2319-2325. doi:10.1097/j.pain.0000000000000285
• Rutkowski JM, Davis KE, Scherer PE. Mechanisms of obesity and related pathologies: the macro- and microcirculation of adipose tissue. FEBS J. 2009;276(20):5738-5746. doi:10.1111/j.1742-4658.2009.07303.x
• Crescenzi R, Marton A, Donahue PMC, et al. Tissue sodium content is elevated in the skin and subcutaneous adipose tissue in women with lipedema. Obesity (Silver Spring). 2018;26(2):310-317. doi:10.1002/oby.22090
• Hadker N, Garg S, Chandran AB, Crean SM, McNett MM, Silverman SL. Efficient practices associated with diagnosis, treatment and management of fibromyalgia among primary care physicians. Pain Res Manag. 2011;16(6):440-444. doi:10.1155/2011/367059
• Borchers AT, Gershwin ME. Fibromyalgia: a critical and comprehensive review. Clin Rev Allergy Immunol. 2015;49(2):100-151. doi:10.1007/s12016-015-8509-4
• Fan A, Pereira B, Tournadre A, et al. Frequency of concomitant fibromyalgia in rheumatic diseases: Monocentric study of 691 patients. Semin Arthritis Rheum. 2017;47(1):129-132. doi:10.1016/j.semarthrit.2017.01.005
• Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-S15. doi:10.1016/j.pain.2010.09.030
• Casale R, Sarzi-Puttini P, Botto R, et al. Fibromyalgia and the concept of resilience. Clin Exp Rheumatol. 2019;37 Suppl 116(1):105-113.
• González E, Elorza J, Failde I. Fibromyalgia and psychiatric comorbidity: their effect on the quality of life patients. Actas Esp Psiquiatr. 2010;38(5):295-300.
• Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095-3105. doi:10.1001/jama.289.23.3095
• Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-328. doi:10.1136/annrheumdis-2016-209724
• Erbacher G, Bertsch T. Lipoedema and pain: what is the role of the psyche? – results of a pilot study with 150 patients with lipoedema. Phlebologie. 2020; 49: 305-16.
• Slavich GM, Way BM, Eisenberger NI, Taylor SE. Neural sensitivity to social rejection is associated with inflammatory responses to social stress. Proc Natl Acad Sci U S A. 2010;107(33):14817-14822. doi:10.1073/pnas.1009164107
• Hori H, Kim Y. Inflammation and post-traumatic stress disorder. Psychiatry Clin Neurosci. 2019;73(4):143-153. doi:10.1111/pcn.12820