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Fibromyalgia as a comorbid phenomenon in autoinflammatory diseases
Med Clin (Barc). 2015;144(11):525–528
www.elsevier.es/medicinaclinica
Letters to the Editor Fibromyalgia as a comorbid phenomenon in autoinflammatory diseases夽 La fibromialgia como fenómeno comórbido en las enfermedades inmunoinflamatorias Dear Editor, In relation to the publication entitled: “Fibromyalgia: comorbidity indicative of vulnerability? (Fibromialgia, ¿comorbilidad marcadora de vulnerabilidad?)”, by Fernando Rico-Villademoros and Elena P. Calandre,1 in which they referred to the original article “Impact of fibromyalgia in the chronic fatigue syndrome (Impacto de la fibromialgia en el síndrome de fatiga crónica)” by Faro et al.,2 we would like to make the following comments: When we decided to conduct the aforementioned study, we aimed to assess whether patients with chronic fatigue syndrome (CFS), who fitted the criteria of the comorbid phenomenon of fibromyalgia (FM), developed a different profile in relation to the impact on their quality of life and occupational disability. Following the line of thought that considers CFS as a geneticbased immune-inflammatory entity, like rheumatoid arthritis and systemic lupus erythematosus, we consider appropriate the comment made by Yunus3–8 with regard to the assessment of the FM epiphenomenon in immune-based developments, where pain and fatigue can be observed by competent professionals within an immune primary disease outbreak, all of which wrongfully lead to an intensification of the treatment of a base disease, when, actually, the right course of action would be to diagnose and treat the FM. On the other hand, we think that the title of the publication is very confusing, since FM in CFS causes further physical and intellectual disability and leads to a major disruption of the patient’s quality of life.2 However, we do not believe that patients with CFS are more susceptible to any further developments because
See related content at doi:http://dx.doi.org/10.1016/j.medcli.2014.07.033 夽 Please cite this article as: Faro M, Alegre J. La fibromialgia como fenó-
meno comórbido en las enfermedades inmunoinflamatorias. Med Clin (Barc). 2015;144:525.
Reply夽 Respuesta Dear Editor, We are grateful for the interest shown and comments made on our publication by Dr. Faro and Dr. Alegre. What do we mean in our
See related content at doi:http://dx.doi.org/10.1016/j.medcle.2014.07.006 夽 Please cite this article as: Rico-Villademoros F, Calandre EP. Respuesta. Med Clin
(Barc). 2015;144:525. ˜ S.L.U. All rights reserved. 2387-0206/© 2014 Elsevier Espana,
they present FM, even though they are more likely to develop cancer,4 intracellular infections or ischaemic phenomena since FM is a process that increases metabolic and vascular risks.5 Lastly, we consider the central sensitisation theory to be a pathogenic mechanism in CFS and FM. Nevertheless, it is difficult to attribute all the symptoms of these entities to the so-called central sensitisation syndrome.6 Furthermore, we consider that in CFS, the foremost research is currently focused on genetic susceptibility, the study of triggers, the lymphoid cell processes involved and energetic metabolism.7 In FM, research is focused on different mechanisms involved in pain genesis, with neurobiochemical, electrophysiological and neuroimaging studies, among others.8 References 1. Rico-Villademoros F, Calandre EP. Fibromialgia: ¿comorbilidad marcadora de vulnerabilidad? Med Clin (Barc). 2014;142:538–9. 2. Faro M, Sáez-Francàs N, Castro-Marrero J, Aliste L, Collado A, Alegre J. Impacto de la fibromialgia en el síndrome de fatiga crónica. Med Clin (Barc). 2014;142:519–25. 3. Yunus MB. The prevalence of fibromyalgia in other chronic pain conditions. Pain Res Treat. 2012;2012:584573. 4. Chang CM, Warren JL, Engels EA. Chronic fatigue syndrome and subsequent risk of cancer among elderly US adults. Cancer. 2012;118:5929–36. 5. Maloney EM, Boneva RS, Lin JM, Reeves WC. Chronic fatigue syndrome is associated with metabolic syndrome: results from a case-control study in Georgia. Metabolism. 2010;59:1351–7. 6. Tanaka M, Ishii A, Watanabe Y. Neural mechanisms underlying chronic fatigue. Rev Neurosci. 2013;24:617–28. 7. Twisk FN. The status of and future research into myalgic encephalomyelitis and chronic fatigue syndrome: the need of accurate diagnosis, objective assessment, and acknowledging biological and clinical subgroups. Front Physiol. 2014;5:109. 8. Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311:1547–55.
Mònica Faro a,∗ , José Alegre b a
Equip d’Atenció Primària, Centre d’Atenció Primària Terrassa Nord, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain b Unidad de Fatiga Crónica, Institut de Recerca Vall d’Hebron, Hospital Universitario Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain ∗ Corresponding
author. E-mail address: [email protected] (M. Faro).
publication by “comorbidity indicative of vulnerability” in relation to fibromyalgia? Contrary to the authors’ indication of their letter, we are not stating that the presence of fibromyalgia in patients with chronic fatigue syndrome or other chronic painful developments “makes them more vulnerable to some other developments”. When we talk about “indicative”, we are proposing–not as a fact, but as a hypothesis–that the presence of fibromyalgia in patients with other chronic painful diseases might be a sign that people with this disease are more susceptible to increased comorbidities (particularly other painful developments or other central
www.elsevier.es/medicinaclinica
Letters to the Editor Fibromyalgia as a comorbid phenomenon in autoinflammatory diseases夽 La fibromialgia como fenómeno comórbido en las enfermedades inmunoinflamatorias Dear Editor, In relation to the publication entitled: “Fibromyalgia: comorbidity indicative of vulnerability? (Fibromialgia, ¿comorbilidad marcadora de vulnerabilidad?)”, by Fernando Rico-Villademoros and Elena P. Calandre,1 in which they referred to the original article “Impact of fibromyalgia in the chronic fatigue syndrome (Impacto de la fibromialgia en el síndrome de fatiga crónica)” by Faro et al.,2 we would like to make the following comments: When we decided to conduct the aforementioned study, we aimed to assess whether patients with chronic fatigue syndrome (CFS), who fitted the criteria of the comorbid phenomenon of fibromyalgia (FM), developed a different profile in relation to the impact on their quality of life and occupational disability. Following the line of thought that considers CFS as a geneticbased immune-inflammatory entity, like rheumatoid arthritis and systemic lupus erythematosus, we consider appropriate the comment made by Yunus3–8 with regard to the assessment of the FM epiphenomenon in immune-based developments, where pain and fatigue can be observed by competent professionals within an immune primary disease outbreak, all of which wrongfully lead to an intensification of the treatment of a base disease, when, actually, the right course of action would be to diagnose and treat the FM. On the other hand, we think that the title of the publication is very confusing, since FM in CFS causes further physical and intellectual disability and leads to a major disruption of the patient’s quality of life.2 However, we do not believe that patients with CFS are more susceptible to any further developments because
See related content at doi:http://dx.doi.org/10.1016/j.medcli.2014.07.033 夽 Please cite this article as: Faro M, Alegre J. La fibromialgia como fenó-
meno comórbido en las enfermedades inmunoinflamatorias. Med Clin (Barc). 2015;144:525.
Reply夽 Respuesta Dear Editor, We are grateful for the interest shown and comments made on our publication by Dr. Faro and Dr. Alegre. What do we mean in our
See related content at doi:http://dx.doi.org/10.1016/j.medcle.2014.07.006 夽 Please cite this article as: Rico-Villademoros F, Calandre EP. Respuesta. Med Clin
(Barc). 2015;144:525. ˜ S.L.U. All rights reserved. 2387-0206/© 2014 Elsevier Espana,
they present FM, even though they are more likely to develop cancer,4 intracellular infections or ischaemic phenomena since FM is a process that increases metabolic and vascular risks.5 Lastly, we consider the central sensitisation theory to be a pathogenic mechanism in CFS and FM. Nevertheless, it is difficult to attribute all the symptoms of these entities to the so-called central sensitisation syndrome.6 Furthermore, we consider that in CFS, the foremost research is currently focused on genetic susceptibility, the study of triggers, the lymphoid cell processes involved and energetic metabolism.7 In FM, research is focused on different mechanisms involved in pain genesis, with neurobiochemical, electrophysiological and neuroimaging studies, among others.8 References 1. Rico-Villademoros F, Calandre EP. Fibromialgia: ¿comorbilidad marcadora de vulnerabilidad? Med Clin (Barc). 2014;142:538–9. 2. Faro M, Sáez-Francàs N, Castro-Marrero J, Aliste L, Collado A, Alegre J. Impacto de la fibromialgia en el síndrome de fatiga crónica. Med Clin (Barc). 2014;142:519–25. 3. Yunus MB. The prevalence of fibromyalgia in other chronic pain conditions. Pain Res Treat. 2012;2012:584573. 4. Chang CM, Warren JL, Engels EA. Chronic fatigue syndrome and subsequent risk of cancer among elderly US adults. Cancer. 2012;118:5929–36. 5. Maloney EM, Boneva RS, Lin JM, Reeves WC. Chronic fatigue syndrome is associated with metabolic syndrome: results from a case-control study in Georgia. Metabolism. 2010;59:1351–7. 6. Tanaka M, Ishii A, Watanabe Y. Neural mechanisms underlying chronic fatigue. Rev Neurosci. 2013;24:617–28. 7. Twisk FN. The status of and future research into myalgic encephalomyelitis and chronic fatigue syndrome: the need of accurate diagnosis, objective assessment, and acknowledging biological and clinical subgroups. Front Physiol. 2014;5:109. 8. Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311:1547–55.
Mònica Faro a,∗ , José Alegre b a
Equip d’Atenció Primària, Centre d’Atenció Primària Terrassa Nord, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain b Unidad de Fatiga Crónica, Institut de Recerca Vall d’Hebron, Hospital Universitario Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain ∗ Corresponding
author. E-mail address: [email protected] (M. Faro).
publication by “comorbidity indicative of vulnerability” in relation to fibromyalgia? Contrary to the authors’ indication of their letter, we are not stating that the presence of fibromyalgia in patients with chronic fatigue syndrome or other chronic painful developments “makes them more vulnerable to some other developments”. When we talk about “indicative”, we are proposing–not as a fact, but as a hypothesis–that the presence of fibromyalgia in patients with other chronic painful diseases might be a sign that people with this disease are more susceptible to increased comorbidities (particularly other painful developments or other central