Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia.
Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia.
复制标题
DOI：
10.1016/j.pain.2013.06.001
复制
发表时间：
2013-11
期刊：
影响因子：
7.4
通讯作者：
Klein MM
中科院分区：
文献类型：
--
作者：
Oaklander AL;Herzog ZD;Downs HM;Klein MM
纤维肌痛是一种常见的致残综合征，包括慢性广泛性疼痛和其他各种症状。未发现特定的客观异常，排除了确定性检测、疾病改善治疗和原因识别。相比之下，小纤维多发性神经病（SFPN），尽管引起类似的症状，但定义上是由外周小纤维神经元的功能障碍和变性引起的疾病。SFPN已经确立了病因学，一些是可诊断的，也是可明确治疗的，例如，糖尿病为了评估一些标记为“纤维肌痛”的患者有未识别的SVPN导致其疾病症状的假设，我们分析了27名纤维肌痛患者和30名匹配的正常对照组的SVPN相关症状，体征，病理和生理标志物。纤维肌痛受试者必须满足美国流变学学会标准，并提供医生实际纤维肌痛诊断的书面证据。研究仪器包括密歇根州神经病筛查仪（MNSI）、犹他州早期神经病量表（UENS）、远端腿神经诊断皮肤活检以及自主功能测试（AFT）。纤维肌痛受试者41%的皮肤活检与对照受试者3%的活检诊断为SVPN，纤维肌痛受试者的MNSI和UENS评分高于对照受试者（均P ≤ 0.001）。异常的AFT同样普遍，这表明纤维肌痛相关的SFPN主要是躯体的。来自所有13名纤维肌痛受试者的血液测试与SVPN诊断皮肤活检提供了病因学的见解。所有葡萄糖耐量试验均正常，但8例受试者有免疫障碍标志物，2例有丙型肝炎血清学，1个家族有明显的遗传因果关系。这些发现表明，一些被标记为“纤维肌痛”的慢性疼痛患者患有未被识别的小纤维多发性神经病，这是一种独特的疾病，可以客观地进行测试，有时可以明确治疗。
Fibromyalgia is a common, disabling, syndrome that includes chronic widespread pain plus other diverse symptoms. No specific objective abnormalities have been identified, precluding definitive testing, disease-modifying treatments, and identification of causes. In contrast, small-fiber polyneuropathy (SFPN), despite causing similar symptoms, is definitionally a disease caused by dysfunction and degeneration of peripheral small-fiber neurons. SFPN has established etiologies, some diagnosable and definitively treatable, e.g., diabetes. To evaluate the hypothesis that some patients labeled with “fibromyalgia” have unrecognized SFPN causing their illness symptoms, we analyzed SFPN-associated symptoms, signs, and pathological and physiological markers in 27 fibromyalgia patients and 30 matched normal controls. Fibromyalgia subjects had to satisfy American College of Rheumatology criteria plus present documented evidence of a physician’s actual fibromyalgia diagnosis. Study instruments comprised the Michigan Neuropathy Screening Instrument (MNSI), the Utah Early Neuropathy Scale (UENS), distal-leg neurodiagnostic skin biopsies, plus autonomic-function testing (AFT). 41% of skin biopsies from fibromyalgia subjects vs. 3% of biopsies from control subjects were diagnostic for SFPN, and MNSI and UENS scores were higher among fibromyalgia than control subjects (all P ≤ 0.001). Abnormal AFTs were equally prevalent suggesting that fibromyalgia-associated SFPN is primarily somatic. Blood tests from all 13 fibromyalgia subjects with SFPN-diagnostic skin biopsies provided insights into etiologies. All glucose tolerance tests were normal, but eight subjects had dysimmune markers, 2 had hepatitis C serologies, and one family had apparent genetic causality. These findings suggest that some patients with chronic pain labeled as “fibromyalgia” have unrecognized small-fiber polyneuropathy, a distinct disease that can be objectively tested for and sometimes definitively treated.
登录
查看更多内容
影响因子：
11.3
作者：
Aalto, Anna-Mari;Elovainio, Marko;Pirkola, Sami
通讯作者：
Pirkola, Sami
影响因子：
11.2
作者：
Faber, Catharina G.;Hoeijmakers, Janneke G. J.;Merkies, Ingemar S. J.
通讯作者：
Merkies, Ingemar S. J.
控制情感障碍时，纤维肌痛和年龄匹配的健康受试者之间的灰质体积没有一致的差异。
影响因子：
7.4
作者：
Hsu MC;Harris RE;Sundgren PC;Welsh RC;Fernandes CR;Clauw DJ;Williams DA
通讯作者：
Williams DA
影响因子：
5.1
作者：
Lauria, G.;Hsieh, S. T.;Valls-Sole, J.
通讯作者：
Valls-Sole, J.
影响因子：
2.7
作者：
Holzer, Peter
通讯作者：
Holzer, Peter