Fibromyalgia in hepatitis C virus infection. Another infectious disease relationship
D. Buskila, A. Shnaider, L. Neumann, D. Zilberman, N. Hilzenrat and E. Sikuler
Department of Medicine B, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
BACKGROUND: Fibromyalgia syndrome (FS) is a common disorder of diffuse pain
in the muscles or joints accompanied by tenderness at specific tender
points and a constellation of related symptoms. The potential role of
infections in the pathogenesis of FS has only recently been investigated.
OBJECTIVES: To evaluate the prevalence of FS and to assess tenderness
thresholds in patients infected with hepatitis C virus (HCV). METHODS: The
study included 90 patients with HCV, 128 healthy, anti-HCV-negative
controls, and 32 patients with non-HCV-related cirrhosis. Tenderness was
measured by manual palpation (18 tender points) and with a dolorimeter.
Fibromyalgia syndrome was diagnosed according to the 1990 American College
of Rheumatology criteria. RESULTS: The diagnosis of FS was established in
14 patients (16%) with HCV, in 1 patient (3%) with non-HCV-related
cirrhosis, and in none of the healthy controls (P < .001). Thirteen of
the HCV-positive patients with FS were women. The patients with HCV had
significantly (P < .01) more tender points (mean [+/- SD] 3.6 +/- 5.3)
than the healthy controls (0.1 +/- 0.5) and the patients with
non-HCV-related cirrhosis (1.2 +/- 2.7). Specifically, the patients with
cirrhosis were most tender on both tenderness measures owing to the high
proportion of women in this group. Patients with FS were significantly more
tender than those without FS: their dolorimetry thresholds were 2.9 kg vs
6.0 kg (P < .001). CONCLUSIONS: A high prevalence of FS was observed in
patients infected with HCV, especially women. Recognizing FS in patients
with HCV will prevent misinterpretation of FS symptoms as part of the liver
disease and will enable the physician to reassure the patient about these
symptoms and to alleviate them.
