AB1092
FIBROMYALGIA IN EGYPTAN PATIENTS ON HAEMODIALYSIS. DOES HEPATITIS C VIRAL INFECTION HAS A ROLE?
D. Abdel Mohsen 1,*H. M. Farouk 1N. O. El-Azizi 1H. A. R. A. R. Makey 2
1Internal Medicine - Rheumatology Division, Ain Shams University - Cairo - Egypt, Cairo, 2Internal Medicine - dialysis unit, Aswan teaching hospital, Aswan, Egypt
Background: Fibromyalgia syndrome (FMS) is characterized by widespread musculoskeletal pain. The prevalence of FS appeared to be similar in chronic hemodialysis (HD) patients and the general population (1). Environmental and genetic factors play a role in the pathogenesis of FMS including trauma and stress as well as infections, may precipitate the development of FMS. Certain infections including hepatitis C virus has been associated with the development of FMS (2).
Objectives: The aim of this study is to determine the role of HCV infection in the occurrence of FMS in chronic HD patients.
Methods: This study included a number of seventy five patients divided into three groups: Group I (case group): Twenty five HCV infected patients with chronic renal failure on haemodialysis, Group II (control group 1): Twenty five patients with chronic renal failure on haemodialysis without HCV infection and Group III (control group 2): Twenty five patients with HCV infection and normal renal functions. FMS was diagnosed when chronic widespread pain for at least 3 months and pain in 11 out of 18 tender points by digital palpation were present (3). HCV antibodies were detected by ELISA test and hemodialysis was done in 4 hourly thrice weekly session for each patient with renal failure.
Results: 7 out of the 75 patients (9.33%) had fibromyalgia; 4/25 in group 1 (16%), 2/25 in group 2 (8%) and 1/25 in group 3 (16%). There were no statistically significant difference between all groups (p> 0.05). Fibromyalgia occurred in 5 of the total HCV infected patients with or without renal failure (5/50; 10%) and occurred in 5 of the total chronic renal failure hemodialized patients with or without HCV infection (6/50; 12%) and the difference were also non statistically significant (p> 0.05). In the 7 patients with fibromyalgia, 6 were female (6/7; 85.7%) and one was a male (1/7; 14.3%). The most frequent associating symptoms in all patients with FMS are -in addition to bony pains- headache, insomnia and irritable bowel syndrome (7/7; 100%) and the least frequent associated symptom was frequent urination and muscle twitching 1/7: 14.29%). Serum alkaline phosphatase was statistically significantly higher in patient with FMS than those without in all the studied group (154.9±47.9 vs 116.6±40; p < 0.05).
Conclusions: In conclusion, the prevalence of FMS was higher in HD patient with HCV infection than those with HCV infected patients aone or HD patients without HCV infection however the difference was statistically insignificant. also, the statistically significant increase in serum alkaline phosphatase inpatient with FMS than those without might indicate a role of vitamin D deficiency in the occurrence of this condition.
References: 1-Tolga Enver Yuceturk, Ahmet Eftal Yucel, Handan Yuceturk, Hamide Kart-Koseoglu, Ruhan Unuvar, Fatma Nurhan Ozdemir and Zafer Akcalý: "Fibromyalgia: its prevalence in haemodialysis patients and its relationships with clinical and laboratory parameters" Nephrol. Dial. Transplant. (November 2005) 20 (11): 2485-2488.
2-Dan Buskila, Fabiola Atzeni and Piercarlo Sarzi-Puttini: "Etiology of fibromyalgia: The possible role of infection and vaccination" Autoimmunity Reviews 8 (2008) 41–43
3- 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; 33:160–172.
Disclosure of Interest: None Declared