The relationship between fibromyalgia syndrome and inflammation parameters in hemodialysis patients

Abstract

Objectives: Diagnosing fibromyalgia, a condition characterized by widespread body pain of unknown origin accompanied by various additional symptoms, poses a challenge in hemodialysis patients, who frequently experience musculoskeletal disorders. To investigate the relationship between fibromyalgia syndrome and inflammation parameters in hemodialysis patients.

Methods: The study enrolled 311 hemodialysis patients undergoing treatment for over three months. Demographic characteristics, complete blood count, and biochemical values were documented as part of the study. To assess fibromyalgia, the researchers recorded the patients scores on the Generalized Pain Scale and Symptom Severity Scale based on data provided by the American College of Rheumatology. The patients were then divided into two groups: those with fibromyalgia and those without fibromyalgia, and their laboratory values and rates were compared. Inflammatory parameters such as erythrocyte sedimentation rate, c reactive protein, monocyte-to-lymphocyte ratio, lymphocyte-to-c reactive protein ratio, and c reactive protein to albumin ratio were recorded.

Results: The study included 311 patients on hemodialysis for more than three months. Among the study participants, 48.9% of the patients and 62.9% of those with fibromyalgia were women. The mean age was 54±26 years and was significantly higher in patients with fibromyalgia (P<0.001). Monocyte (P<0.03), C-reactive protein (P<0.01), erythrocyte sedimentation rate (P<0.02), Monocyte to lymphocyte ratio (P=0.028), c reactive protein to albumin ratio (P<0.005) were significantly higher, lymphocyte to c reactive protein ratio (P<0.004) and albumin (P=0.018) were significantly lower in the fibromyalgia group.

Conclusions: Fibromyalgia should be considered in the presence of high inflammation parameters in hemodialysis patients with diffuse musculoskeletal pain.

Keywords

• Fibromyalgia
• hemodialysis
• inflammation parameters
• hematological indices

References

1. 1. Levey AS, Eckardt KU, Dorman NM, et al. Nomenclature for Kidney Function and Disease: Executive Summary and Glossary From a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney Med. 2020;2(4):373-376. doi: 10.1016/j.xkme.2020.05.003.
2. 2. Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015;385(9981):1975-1982. doi: 10.1016/S0140-6736(14)61601-9.
3. 3. Maffei ME. Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies. Int J Mol Sci. 2020;21(21):7877. doi: 10.3390/ijms21217877.
4. 4. Sarzi-Puttini P, Atzeni F, Masala IF, Salaffi F, Chapman J, Choy E. Are the ACR 2010 diagnostic criteria for fibromyalgia better than the 1990 criteria? Autoimmun Rev. 2018;17(1):33-35. doi: 10.1016/j.autrev.2017.11.007.
5. 5. Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547-55. doi: 10.1001/jama.2014.3266.
6. 6. Wang SM, Han C, Lee SJ, Patkar AA, Masand PS, Pae CU. Fibromyalgia diagnosis: a review of the past, present and future. Expert Rev Neurother. 2015;15(6):667-679. doi: 10.1586/14737175.2015.1046841.
7. 7. Yuceturk TE, Yucel AE, Yuceturk H, et al. Fibromyalgia: its prevalence in haemodialysis patients and its relationships with clinical and laboratory parameters. Nephrol Dial Transplant. 2005;20(11):2485-2488. doi: 10.1093/ndt/gfi028.
8. 8. Cuyul-Vásquez I, Araya-Quintanilla F, Gutiérrez-Espinoza H. Comment on Siracusa et al. Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Int. J. Mol. Sci. 2021,22, 3891. Int J Mol Sci. 2021;22(16):9075. doi: 10.3390/ijms22169075.

9. 9. Germolec DR, Shipkowski KA, Frawley RP, Evans E. Markers of Inflammation. Methods Mol Biol. 2018;1803:57-79. doi: 10.1007/978-1-4939-8549-4_5.
10. 10. Khamisy-Farah R, Fund E, Raibman-Spector S, Adawi M. Inflammatory Markers in the Diagnosis of Fibromyalgia. Isr Med Assoc J. 2021;23(12):801-804.
11. 11. Varim C, Çelik F, Sunu C, et al. Inflammatory cell rations in the patients with fibromyalgia. Georgian Med News 2021;(315):108-113.
12. 12. Metyas SK, Solyman JS, Arkfeld DG. Inflammatory Fibromyalgia: Is it Real? Curr Rheumatol Rev. 2015;11(1):15-17. doi: 10.2174/1573397111666150522095004.
13. 13. Coskun Benlidayi I. Role of inflammation in the pathogenesis and treatment of fibromyalgia. Rheumatol Int. 2019;39(5):781-791. doi: 10.1007/s00296-019-04251-6.
14. 14. Taylor AG, Fischer-White TG, Anderson JG, et al. Stress, Inflammation and Pain: A Potential Role for Monocytes in Fibromyalgia-related Symptom Severity. Stress Health. 2016;32(5):503-513. doi: 10.1002/smi.2648.
15. 15. Rajaram Jayakrishnan AK, Easwar SV, Thattil J, et al. Studying the Relation Between Fibromyalgia Severity and Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Mean Platelet Volume. Cureus. 2022;14(5):e24847. doi: 10.7759/cureus.24847.
16. 16. Aktürk S, Büyükavcı R. Evaluation of blood neutrophil-lymphocyte ratio and platelet distribution width as inflammatory markers in patients with fibromyalgia. Clin Rheumatol. 2017;36(8):1885-1889. doi: 10.1007/s10067-017-3647-0.
17. 17. Al-Nimer MSM, Mohammad TAM. Correlation of hematological indices and ratios derived from them with FIQR scores in fibromyalgia. Pak J Med Sci. 2018;34(5):1219-1224. doi: 10.12669/pjms.345.15169.
18. 18. Feinberg T, Sambamoorthi U, Lilly C, Innes KK. Potential Mediators between Fibromyalgia and C-Reactive protein: Results from a Large U.S. Community Survey. BMC Musculoskelet Disord. 2017;18(1):294. doi: 10.1186/s12891-017-1641-y.
19. 19. Haliloğlu S, Carlioglu A, Sahiner E, Karaaslan Y, Kosar A. Mean platelet volume in patients with fibromyalgia. Z Rheumatol. 2014;73(8):742-745. doi: 10.1007/s00393-013-1330-7.
20. 20. Korniluk A, Koper-Lenkiewicz OM, Kamińska J, Kemona H, Dymicka-Piekarska V. Mean Platelet Volume (MPV): New Perspectives for an Old Marker in the Course and Prognosis of Inflammatory Conditions. Mediators Inflamm. 2019;2019:9213074. doi: 10.1155/2019/9213074.
21. 21. Çağlıyan Türk A, Özkurt S, Doğan İ, Şahin F. Fibromyalgia syndrome and related factors in hemodialysis, peritoneal dialysis, and renal transplant patients: A cross-sectional study. Arch Rheumatol. 2021;37(1):67-76. doi: 10.46497/ArchRheumatol.2022.8227.
22. 22.Öztürk NÜ, Nergis-Ural R. Relationship Between Renal Inflammation and Some Current Dietary Components in Chronic Kidney Disease. Turkish J Nephrol. 2018;27(1):14-25. doi:10.5262/tndt.2018.1001.02.
23. 23. Akchurin OM, Kaskel F. Update on inflammation in chronic kidney disease. Blood Purif. 2015;39(1-3):84-92. doi: 10.1159/000368940.
24. 24. Yazici S, Yazici M, Erer B, et al. The platelet indices in patients with rheumatoid arthritis: mean platelet volume reflects disease activity. Platelets. 2010;21(2):122-125. doi: 10.3109/09537100903474373.