What is fibromyalgia?
Symptoms
Living with fibromyalgia can be an exhaustive and difficult process (Figure 1), as it is chronic illness characterized by widespread pain and soreness throughout the musculoskeletal system. Affecting 2% of the general population, this illness disproportionately affects women at a rate of 85% of cases [1,2]. Unlike other acute and localized pain disorders, fibromyalgia persists in a wide range of symptoms. These may include pain, anxiety, concentration and memory problems called "fibro-fog", depression and mood disorders, fatigue, headches, sleep problems, numbness, tender points and urinary symptoms [2,3]. Additionally, women with fibromyalgia have been shown to have reduced quality of life relative to women with rheumatoid arthritis, osteoarthritis, permanent ostomies, chronic obstructive pulmonary disease, and insulin-dependent diabetes [4]. Diagnosis
Because fibromyalgia has an array of symptoms which are not definitive or exclusive to the disease, it has historically been difficult to identify, diagnose and treat in patients. A series of false diagnoses is common in fibromyalgia patients (illustrated in Figure 2). Often a body-wide survey may be used to identify tender points commonly associated with fibromyalgia, in which 11 of 18 inflamed positions secures a positive diagnosis [2,3]. Treatment
Though there is no cure for fibromyalgia, a care regiment that assuages both mind and bodily symptoms is often recommended by physicians. Drug treatments may be elected to treat the pain and sleeping disorders associated with fibromyaligia. FDA approved treatments include an anticovulsant and SNRI anti-depressants, though off-label pain relievers and other anti-depressants may also be prescribed. Many patients with fibromyalgia find additional success in alternative treatments, which may include acupuncture, heat treatments, relaxation, massage, stretching and physical therapy [5]. Vegetarian diets have been thought to improve fibromyalgia by higher intake of antioxidants. However, vegetarian and vegan diets have shown contradictory results in their improvement of fibromyalgia symptoms [6,7]. One study which looked at the effect of a "strict, low-salt, uncooked vegan diet rich in lactobacteria" showed improved symptoms, however it also reported a reduction in BMI in participants [7]. Patients with fibromyalgia have shown a 40% higher rate of obesity, but little is known if this is a symptom or cause of the disease [8]. The severity of fibromyalgia has been shown to improve with weight loss [8], which could be implicated in the success of vegetarian and vegan diets. |
This page was created as an assignment for Gen 677 at UW-Madison Spring 2013.
Figure 1. Award-winning video describing the diagnosis and challenges of living with fibromyaglia.
Figure 2. An illustration of the diagnosis of fibromyalgia.
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Genetic Association of Fibromyalgia
Though the etiology of fibromyalgia has not been conclusively determined, both environmental cues and genetics are likely to play a role in the development of the disorder. Some known environmental cues include exercise, excess movement, and stress. Some genes that have been implicated in fibromyalgia include HLA-DR4 genes which have been implicated in arthritis [9]; a number of neurotransmitter systems [9]; and recently, the inflammasome protein, MEFV [10].
Correlation with MEFV In a recent study, one variant of the Mediterranean fever gene was associated with FMS patients when compared to a healthy control group [10]. This gene, MEFV, is named for it's association with a heritable disease condition called Familial Mediterranean Fever (FMF). The clinical comparison of FMS and FMF reveals some overlapping symptoms, such as chronic lower body pain, points of tenderness, and widespread pain [10]. This may suggest MEFV is affecting a similar pathway in both disease conditions. |
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References
[1] Wolfe, F, Ross, K, Anderson, J, Russell, IJ and Hebert, L. (1995) The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 38: 19-25. [2] Chakrabarty, S, and Zoorob, R. (2007). Fibromyalgia. Am Fam Physcian. 76(2):247-254. [3] Fibromyalgia. PubMed Health. Last reviewed 2 Feb 2012. [4] Burckhardt CS, Clark SR, and Bennett RM. (1993) Fibromyalgia and quality of life: a comparative analysis. The Journal of Rheumatology 20(3):475-479. [5] Fibromyalgia Treatments. WebMD. (accessed 13 Mar 2013) [6] Azad, KA, Alam, MN, Hag, SA, Nahar, S, Chowdhury, MA, Ali, SM and Ullah AK. (2000) Vegetarian diet in the treatment of fibromyalgia. Bangladesh Med Res Counc Bull. 26(2):41-7. [7] Kaartinen, K, Lammi, K, Hypen, M, Nenonen, M, Hänninen, O, and Rauma AL. (2000) Vegan diet alleviates fibromyalgia symptoms. Scandanavian Journal or Rheumatology 29(5): 308-313. [8] Ursini, F, Naty, S, and Grembiale, RD. (2011) Fibromyalgia and obesity: the hidden link. Rheumatol Int. 31(11):1403-1408. [9] Buskila, D and Sarzi-Puttini P. (2006) Biology and therapy of fibromyalgia. Genetic aspects of fibromyalgia syndrome. Arthritis Research and Therapy 8(5): 1-5. [10] Karakus, N, Yigit, S, Inanir, A, Inanir, S, Toprak, H and Okan, S. (2012) Association between sequence variations of the Mediterranean fever gene and fibromyalgia syndrome in a cohort of Turkish patients. Clinica Chimica Acta 414 (24):36-40. [11] MEFV. Genetics Home Reference. (last reviewed Sept 2008). |
This web page was produced as an assignment for Gen 677 at UW-Madison Spring 2013.
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