Is Vitamin D Level Related to Disease Severity and Inflammatory Indicators in Patients with Fibromyalgia

Öz

In this study, it is aimed to evaluate the relationship between vitamin D levels and disease severity and inflammation parameters using neu-trophil lymphocyte ratio (N/L), platelet lymphocyte ratio (P/L), mean platelet volume (MPV), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in fibromyalgia patients and to examine the clinical significance of it. Patients with fibromyalgia and healthy controls who applied to SANKO University Research and Application Hospital Physical Therapy and Rehabilitation Outpatient Clinic were included. The Fibromyalgia Impact Questionnaire was used to evaluate the functional status of patients with fibromyalgia. The demographic and laboratory data of the patients were retrospectively obtained. There was no statistically significant difference in age (p=1.000, p = 0.074) and in gender fibromyalgia (n=51) and controls (n=46). There was no statistically significant difference between patients with fibromyalgia and healthy controls in platelet, MPV, neutrophil, lymphocyte, N/L, P/L values (p>0.05). Vitamin D deficiency and high CRP and ESR levels was statistically significant in fibromyalgia patients (p<0.001, p=0.009, p=0.036, respectively), but no significant correlation was found between vitamin D and disease severity (p=0.313). There was no statistically significant correlation between vitamin D with other parameters in both groups (p>0.05). There was no significant relationship between vitamin D deficiency and disease severity and platelet, MPV, N/L, P/L, ESR, CRP values of in both groups. Larger studies are needed to evaluate the relationship between vitamin D and inflammation markers and disease severity in fibromyalgia syndrome. 

Anahtar Kelimeler

• Fibromyalgia,Vitamin D,Inflammation

Fibromiyaljili Hastalarda D vitamini Düzeyi Hastalık Şiddeti ve Enflamatuar Göstergeler ile İlişkili midir?

Öz

Bu çalışmada fibromiyalji hastalarının D vitamini seviyeleri ile hastalık şiddeti ve enflamasyonla ilişkisini nötrofil lenfosit oranı (N/L), platelet lenfosit oranı (P/L), ortalama trombosit hacmi (OTH), eritrosit sedimentasyon hızı (ESH) ve C-reaktif protein (CRP) parametrelerini kullanarak değerlendirme ve klinik önemini araştırma amaçlanmıştır. Çalışmaya SANKO Üniversitesi Uygulama ve Araştırma Hastanesi Fizik Tedavi ve Rehabilitasyon Polikliniğine başvurmuş fibromiyaljili hastalar ve sağlıklı kontroller dahil edildi. Fibromiyalji hastalarının fonksiyonel durumunu değerlendirmek için Fibromiyalji Etki Anketi kullanıldı. Hastalara ait demografik ve laboratuvar bilgileri retrospektif olarak dosya taraması ile elde edildi. Fibromiyalji (n=51) ve kontrol (n=46) grubu arasında cinsiyet ve yaş bakımından istatistiksel olarak anlamlı bir fark yoktu (sırasıyla; p=1.000, p=0.074). Hasta ve kontrol gruplarının trombosit, OTH, nötrofil, lenfosit, N/L, P/L değerleri arasında istatistiksel olarak anlamlı bir fark bulunamadı (p>0.05). Fibromiyalji hastalarında D vitamini eksikliği, CRP ve ESH düzeylerinde-ki yükseklik istatistiksel olarak anlamlı bulunurken (sırasıyla p<0.001, p=0.009, p=0.036), D vitamini eksikliği ve hastalık şiddeti arasında anlamlı bir korelasyon bulunamadı (p=0.313). Her iki grupta D vitamini ve hastalık şiddeti ile diğer parametreler arasında da istatistiksel olarak anlamlı bir korelasyon saptanmamıştır (p>0.05). Çalışmamız her iki grupta D vitamini eksikliğinin hastalık şiddeti ve trombosit, OTH, N/L, P/L, ESH, CRP değerleri arasında anlamlı bir ilişki olmadığını ortaya koydu. Fibromiyalji sendromunda D vitamini ile enflamasyon belirteçlerinin ve hastalık şiddetinin arasındaki ilişkiyi değerlendirmek için daha geniş çaplı çalışmalara ihtiyaç vardır. 

Anahtar Kelimeler

• fibromiyalji,D vitamini,enflamasyon

Kaynakça

1. 1. Clauw DJ. Fibromyalgia: an overview. Am J Med 2009;122(12):3-13.
2. 2. Bellato E, Marini E, Castoldi F et al. Fibromyalgia syndrome: etiology, pathogenesis, diagnosis, and treatment. Pain Res Treat. 2012:11;426130.
3. 3. Smith HS, Harris R, Clauw D. Fibromyalgia: an afferent processing disorder leading to a complex pain generalized syndrome. Pain Physician. 2011;14(2):217-245.
4. 4. Marques AP, Santo ASDE, Berssaneti AA, Matsutani LA, Yuan SLK. Prevalence of fibromyalgia: literature review update. Rev Bras Reumatol Engl Ed. 2017;7-8;57(4):356-363.
5. 5. 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(5):1259-1264.
6. 6. Russell IJ, Larson AA. Neurophysiopathogenesis of fibromyalgia syndrome: a unified hypothesis. Rheum Dis Clin N Am. 2009;35:421-435.
7. 7. Masuko K. The multifaceted effects of vitamin D and its potential contribution to rheumatoid arthritis. British Journal of Medicine and Medical Research 2014;4(8): 1680-1690.
8. 8. Cantorna MT, Zhu Y, Froicu M, Wittke A. Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system. The American Journal of Clinical Nutrition. 2004; 80(6):1717-1720.

9. 9. Body JJ, Bergmann P, Boonen S, Devogelaer JP, Gielen E, Goemaere S, et al. Extraskeletal benefits and risks of calcium, vitamin D and anti-osteoporosis medications. Osteoporosis International. 2012;23(1):1-23.
10. 10. Matthana MH. The relation between vitamin D deficiency and fibromyalgia syndrome in women. Saudi Medical Journal. 2011;32(9):925-929.
11. 11. Olama SM, Senna MK, Elarman MM, Elhawary G. Serum vitamin D level and bone mineral density in premenopausal Egyptian women with fibromyalgia. Rheumatology International 2013;33(1):185-192.
12. 12. Okumus M, Koybası M, Tuncay F, Ceceli E, Ayhan F, Yorgancioglu R, Borman P. Fibromyalgia syndrome: is it related to vitamin D deficiency in premenopausal female patients? Pain Manag Nurs. 2013 Dec;14(4):156-163.
13. 13. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest. 2003;111(12):1805–12.
14. 14. Bath PM, Butterworth RJ. Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis 1996;7:157-161.
15. 15. Akbas EM, Gungor A, Ozcicek A, Akbas N, Askin S, Polat M. Vitamin D and inflammation: evaluation with neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio. Arch Med Sci. 2016 Aug 1;12(4):721-7.
16. 16. Briggs C. Quality counts: new parameters in blood cell counting. Int J Lab Hematol. 2009;31:277-297.
17. 17. D.J. Clauw. Fibromyalgia. JAMA, 2014;311: 1547.
18. 18. Frederıck Wolfe,Danıel J. Clauw, Mary-Ann Fıtzcharles, Don L. Goldenberg, Robert S. Katz, Phılıp Mease, Anthony S. Russell,I. Jon Russell, John B. Wınfıeld, Muhammad B. Yunus. The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care & Research. 2010;62(5):600–610.
19. 19. Ediz L, Hiz O, Toprak M, Tekeoglu I, Ercan S. The validity and reliability of the Turkish version of the Revised Fibromyalgia Impact Questionnaire. Clin Rheumatol. 2011;30(3):339-46.
20. 20. Wu Z, Malihi Z, Stewart AW, Lawes CM, Scragg R. The association between vitamin D concentration and pain: a systematic review and meta-analysis. Public Health Nutr. 2018 Aug;21(11):2022-2037.
21. 21. Yilmaz R, Salli A, Cingoz HT, Kucuksen S, Ugurlu H. Efficacy of vitamin D replacement therapy on patients with chronic nonspecific widespread musculoskeletal pain with vitamin D deficiency. Int J Rheum Dis. 2016 Dec;19(12):1255-1262.
22. 22. Voo VTF, O'Brien T, Butzkueven H, Monif M.The role of vitamin D and P2X7R in multiple sclerosis. J Neuroimmunol. 2019 May 15;330:159-169.
23. 23. Bellan M, Sainaghi PP, Pirisi M. Role of Vitamin D in Rheumatoid Arthritis. Adv Exp Med Biol. 2017;996:155-168.
24. 24. Hassanalilou T, Khalili L, Ghavamzadeh S, Shokri A, Payahoo L, Bishak YK. Role of vitamin D deficiency in systemic lupus erythematosus incidence and aggravation. Auto Immun Highlights. 2017 Dec 26;9(1):1.
25. 25. Metyas S, Rezk T, Arkfeld D, Leptich T. Autoinflammation and immunomodulation in inflammatory fibromyalgia syndrome- a review. Curr Rheumatol Rev. 2017;13:98–102.
26. 26. Littlejohn G, Guymer E. Neurogenic inflammation in fibromyalgia. Semin Immunopathol. 2018;40:291–300.
27. 27. Malhotra D, Saxena AK, Dar SA, Kumar V, Nasare N, Tripathi AK et al. Evaluation of cytokine levels in fibromyalgia syndrome patients and its relationship to the severity of chronic pain. J Musculoskelet Pain. 2012;20:164–169.
28. 28. Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102:5-14.
29. 29. Haliloğlu S, Carlioglu A, Sahiner E, Karaaslan Y, Kosar A. Mean platelet volume in patients with fibromyalgia. Z Rheumatol. 2014 Oct;73(8):742-5.
30. 30. Aktürk S, Büyükavcı R. Evaluation of blood neutrophil-lymphocyte ratio and platelet distribution width as inflammatory markers in patients with fibromyalgia. Clin Rheumatol. 2017 Aug;36(8):1885-1889.
31. 31. Boyraz I, Karakoyun A, Koç B. Fibromiyalji Sendromunda Enflamasyon Varlığının Nötrofil/Lenfosit ve Platelet/Lenfosit Oranlarıyla Saptanması. Eur J Health Sci. 2015;1(1):15-19.
32. 32. Ortega E, García JJ, Bote ME, Martín-Cordero L, Escalante Y, Saavedra JM, Northoff H, Giraldo E. Exercise in fibromyalgia and related inflammatory disorders: known effects and unknown chances. Exerc Immunol Rev. 2009;15:42-65.
33. 33. Mendieta D, De la Cruz-Aguilera DL, Barrera-Villalpando MI, Becerril-Villanueva E, Arreola R, Hernández-Ferreira E et al. IL-8 and IL-6 primarily mediate the inflammatory response in fibromyalgia patients. J Neuroimmunol. 2016 Jan 15;290:22-5.
34. 34. Bazzichi L, Rossi A, Massimetti G, Giannaccini G, Giuliano T, De Feo F et al. Cytokine patterns in fibromyalgia and their correlation with clinical manifestations. Clin Exp Rheumatol. 2007 Mar-Apr;25(2):225-30.