The Association of IGF-1 with Clinical Symptoms in Female Patients With Fibromyalgia Syndrome

Abstract

Introduction: Fibromyalgia syndrome (FMS) is a disease of unknown etiology, which is characterised by chronic pain. Disturbed growth hormone response, low serum insulin-like growth factor-1 (IGF-1) may play a role in etiopathogenesis of fibromyalgia and may be related to the severity of some symptom. The aim of this study is to investigate serum IGF-1 levels and relationship of clinical symptoms in female patients with fibromyalgia syndrome.

Materials and Methods: Thirty-seven patients with FMS and thirty healthy subjects were included in this study. All individuals were assessed for clinical findings, widespread pain (Visual Analogue Scale), functional disability and health state (health assesment questionnarie and fibromyalgia impact questionnarie), anxiety (anxiety State and Trait Anxiety Inventory) and depression (Beck depression inventory). Likert scale was used for evaluate morning stiffness, level of fatigue, pain, muscle spasm and tenderness.
Results: In this study, serum IGF-1 levels of patients with fibromyalgia were significantly lower compared to the control group (p=0.004). The IGF-1 levels were significantly correlated with age (r=-0.496; p<0.01), muscle spasm (r=-0.333; p<0.05), tender points (r=-456; p<0.01) and morning stiffness (r=-0.463; p<0.01).

Conclusion: Low levels of serum IGF-1 in female patients with fibromyalgia syndrome were associated with number of tender points, muscle spasm and stiffness. We have concluded that low levels of serum IGF-1 might play role in the pathogenesis of fibromyalgia and might be related to severity of symptoms.

Keywords

• Fibromyalgia syndrome (FMS),Insulin-like growth factor-1 (IGF-1),Growth hormone

Fibromiyalji Sendromlu Kadın Hastalarda IGF-1’in Klinik Semptomlarla İlişkisi

Öz

Amaç: Fibromiyalji sendromu (FMS), kronik ağrı ile karakterize, etiyolojisi bilinmeyen bir hastalıktır. Bozulmuş büyüme hormonu yanıtı, düşük serum insülin benzeri büyüme faktörü-1 (IGF-1) FMS etyopatogenezinde rol oynayabilir ve bazı semptomların şiddeti ile bağlantılı olabilir. Bu çalışmanın amacı fibromiyalji sendromlu kadın hastalarda serum IGF-1 düzeylerini ve klinik semptomlarla ilişkisini araştırmaktır.
Materyal ve Metot: Çalışmaya FMS’lu 37 kadın hasta ve 30 sağlıklı kadın dahil edildi. Tüm bireyler klinik bulgular, ağrı şiddeti (görsel ağrı skalası), fonksiyonel disabilite ve sağlık durumu (sağlık değerlendirme skalası ve fibromiyalji etki skalası), anksiyete (anlık ve sürekli anksiyete ölçeği) ve depresyon (Beck depresyon ölçeği) açısından değerlendirildi. Sabah sertliği, yorgunluk şiddeti, uykusuzluk şiddeti, ağrı şiddeti, kas spazmı şiddeti ve hassasiyet şiddetini değerlendirmek için Likert skalası kulanıldı.

Bulgular: Çalışmamızda FMS hastalar kontrol grubuyla kıyaslandığında serum IGF-1 düzeyleri belirgin olarak daha düşüktü (p=0,004). IGF-1 düzeyi ile yaş (r=-0,496; p<0,01), kas spazmı (r=-0,333; p<0,05), hassas nokta sayısı (r=-456; p<0,01) ve sabah tutukluğu (r=- 0.463; p<0.01) arasında belirgin korelasyon mevcuttu.
Sonuç: Fibromiyalji sendromlu kadın hastalarda serum IGF-1 düzeyi düşüklüğü, hassas nokta sayısı, kas spazmı ve tutukluk ile ilişkiliydi. Çalışmamızda serum IGF-1 düzeyindeki düşüklüğünün, fibromiyaljinin etyopatogenezinde rol alabileceğini ve semptomların şiddeti ile ilişkili olabileceği sonucuna vardık.

Anahtar Kelimeler

• Fibromiyalji sendromu (FMS),İnsülin-like growth factor-1 (IGF-1),fibromiyalji sendromu (FMS),Büyüme hormonu

Kaynakça

1. 1. Gupta A, Silman AJ. Psychological stress and fibromyalgia: a review of the evidence suggesting a neuroendocrine link. Arthritis Res Ther 2004;6:98-106.
2. 2. Goldenberg DL. Fibromyalgia end related sydromes. In Klippel JH Dieppe PA (eds) Rheumatology. London: Mosby;1998.
3. 3. Uveges JM, Parker JC, Smarr KL, et al. Psychological symtomps in primer fibromyalgia syndrome. Relationship to pain, life stres and sleep disturbance: Arthritis Rheum 1990;33(8):1279-83.
4. 4. Forseth KO, Gran JT, Husby GA. Population study of the incidence of fibromyalgia among women aged 26-55 yr. Br J Rheumatol 1997;36:1318-23.
5. 5. Solitar BM. Fibromyalgia: knowns, unknowns, and current treatment. Bull NYU Hosp Jt Dis 2010;68:157-61.
6. 6. Recla JM. New and emerging therapeutic agents for the treatment of fibromyalgia: an update. J Pain Res 2010;3:89-103.
7. 7. Jones GT, Nicholl BI, McBeth J, et al. Role of road traffic accidents and other traumatic events in the onset of chronic widespread pain: Results from a population-based prospective study. Arthritis Care Res (Hoboken), 2011;63:696-701.
8. 8. Spath M. Current experince with 5-HT3 receptor antagonists in fibromyalgia. Rheum Dis Clin North Am 2002;28(2):319-28.

9. 9. Güleç H, Sayar K, Güleç Yazıcı M. Fibromiyaljide Tedavi Arayışının Psikolojik Etkenlerle İlişkisi. Türk Psikiyatri Dergisi 2007;18:22-30.
10. 10. Engström BE, Karlsson FA, Wide L. Clin Chem 1999;45:1235-9.
11. 11. Bennet RM, Clark CR, Campbell SM, Burckhardt CS. Low levels of somatomedin C in patients with the fibromyalgia syndrome. A possible link between sleep and muscle pain. Arthritis Rheum 1992;35(10):1113-6. 12. Bjersing JL, Dehlin M, Erlandsson M, Bokarewa MI, Mannerkopi K. Changes in pain and IGF-1 in fibromyalgia during exercise: the involvement of cerebrospinal inflammatory factors and neuropeptides. Arthritis Research Teraphy 2012;14(4):R162 [Epub ahead of print].
12. 13. Cuatrecasas G, Alegre C, Casanueva FF. GH/IGF axis disturbances in the fibromyalgia syndrome: is there a rationale for GH treatment? Pituitary 2013, DOI 1007/s 11102-013-0486-0.
13. 14. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990: criteria for the classification of fibromyalgia: Report of the Multi-Center Criteria Committee. Arthritis Rheum 1990;33:160-72. 15. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. Beck Depression Inventory. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-71.
14. 16. Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. J Rheumatol 1991;18:728-33.
15. 17. Sarmer S, Ergin S, Yavuzer G. The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatol Int 2000; 20:9-12.
16. 18. Spielberger CD, Gorsuch RL, Lushene RE. Manual for the State-Trait Anxiety inventory. Palo-Alto: Consulting Psychologists Press; 1970.
17. 19. Wolfe F, Hawley DJ: Evidence of disordered symptom appraisal in fibromyalgia: Increased rates of reported comorbidity and comorbidity severity. Clin Exp Rheumatol 1999;17:297-303.
18. 20. Charles W, Denko C, Malemud J. Serum growth hormone and insulin but not insulin-like growth factor-1 levels are elevated in patients with fibromyalgia syndrome. Rheumatol Int 2005;25:146-51.
19. 21. McCall-Hosenfeld JS, Goldenberg DL, Hurwitz S, Adler GK. Growth hormone and insulin-like growth factor-1 concentrations in women with fibromyalgia. J Rheumatol 2003;30:809-14.
20. 22. Cuatrecasas G, Gonzalez MJ, Alegre C, et al. High prevalence of growth hormone deficiency in severe fibromyalgia syndromes. Clin Endocrinol Metab. 2010;95(9):4331-7. doi: 10.1210/jc.2010-0061. Epub 2010 Jul 14.
21. 23. Bagge E, Bengtsson B, Carlsson E, et al. Low growth hormone secretion in patients with fibromyalgia. A preliminary report on 10 patients and 10 controls. Am J Med 1998;104:227.
22. 24. Russell IJ. Neurochemical pathogenesis of fibromyalgia sydrome. J Muskuloskeletal Pain 1996;4:61-92.
23. 25. Krsrich-Shriwise S. Fibromyalgia syndrome: an overview. Phys Ther 1997;77(1):68-75.
24. 26. Okifuji A, Turk DC. Sex hormones and pain in regularly menstruating women with fibromyalgia syndrome. J Pain 2006;7:851-9.
25. 27. Katetoff D, Lampa J, Westman M, Anderrson M, Kosek E: Evidence of central inflammation in fibromyalgia-increased cerebspinal fluid interleukin-8 levels. J Neuroimmunol 2012;242:33-8.
26. 28. Armağan O, Sırmagül E, Ekim A, Sırmagül B, Taşçıoğlu F, Öner C. Levels of IGF-1 and Their Relationship with Bone Mineral Density in the Premenopausal Women with Fibromyalgia Syndrome. Romatizma 2008;23:118-23.
27. 29. Cuatrecasas G, Alegre C, Fernandez-Solà J, et al. Growth hormone treatment for sustained pain reduction and improvement in quality of life in severe fibromyalgia. Pain 2012; 153(7):1392-9.