Fibromyalgia and refractory pain in rheumatic diseases

点击翻译按钮获取中文摘要

Fibromyalgia is one of the most common causes of chronic pain worldwide. There is no diagnostic test available, and patients are diagnosed based on how severe and widespread their pain is and whether they have other symptoms, such as fatigue, sleep problems and depression. Treatment of fibromyalgia is focused on exercise and education, which help patients become more active and cope better with pain. Drugs that are used to treat pain in fibromyalgia are effective in some patients, but often cause problematic side effects and regularly become less effective with time. Fibromyalgia has a severe impact on quality of life, but the fact that patients look healthy can make it difficult for them to qualify for benefits and to convince their environment about how they feel. Although fibromyalgia affects more than 1 in 50 people, the cause of disease remains unknown. A better understanding of the cause of fibromyalgia, is likely to dramatically accelerate development of improved treatments and invention of diagnostic tests. We have discovered that the body's normal defence mechanism, the immune system, is responsible for pain in fibromyalgia patients. Immune cells produce proteins called antibodies, which would normally be used to help us destroy bacteria and other parasites, thereby helping us fight infections, and to become immune to them. Our results show that fibromyalgia patients make antibodies that attack their own bodies, rather than infections. These antibodies stimulate pain-sensing nerves throughout the body, making patients too sensitive to pressure, temperature and thereby experiencing unrelenting pain. In our pilot experiments, we have purified antibodies from fibromyalgia patients (without other health conditions) and healthy volunteers and injected these to mice. Remarkably, mice that were given patient antibodies developed similar symptoms to the patients that the antibodies were taken from, whereas antibodies from healthy volunteers were without effect. While about 2% of the general population (mostly women) suffer from fibromyalgia, around 25% of people rheumatic disease suffer from this difficult chronic pain condition. Rheumatic disease can often be well controlled by drugs, but fibromyalgia and the pain it causes throughout the body does typically not improve by treatment. During this project we will determine whether fibromyalgia in rheumatic patients is also caused by antibodies that cause pain. Our results are very likely to lead to development of the first simple diagnostic tests, and this will dramatically reduce the stressful period of time, often a couple of years that it currently takes for patients to be diagnosed. It is also very likely that our work will lead to improved treatment of fibromyalgia, and some of the possible treatments are already used in other conditions caused by antibodies that attack our own bodies.