Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20190057
Brazilian Journal of Pain
Original Article

Clinical evaluation and prevalence of fibromyalgia in hepatitis C patients

Avaliação clínica e prevalência de fibromialgia em pacientes portadores de hepatite C

João Batista Santos Garcia; Silvia Amália de Melo Moura; Durval Campos Kraychete; Anita Perpetua Carvalho Rocha Castro; Marilia Arrais Garcia

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Abstract

BACKGROUND AND OBJECTIVES: The worldwide distribution and etiology of fibromyalgia are poorly understood. It is believed that different factors are involved, such as hepatitis C virus infection. The aim of this study was to estimate the prevalence of fibromyalgia in hepatitis C virus infected patients, trying to identify the occurrence of liver injury, extrahepatic clinical manifestations, anxiety, depression, and the impact on the quality of life.

METHODS: This is a cross-sectional study of patients (n=118) with hepatitis C virus infection who were compared with a group of clinically stable patients not infected with the hepatitis C virus (n=118). The Anxiety and Depression Questionnaire was applied, and for those diagnosed with fibromyalgia, the Fibromyalgia Impact Questionnaire. Liver biopsies were analyzed according to the METAVIR classification. The Schirmer test was performed to investigate abnormal tear production in the studied patients. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) software, v.10.0.

RESULTS: The prevalence of fibromyalgia in infected patients was 7.6%. In patients infected with fibromyalgia, a significant prevalence of anxiety and depression was observed. Fibromyalgia Impact Questionnaire scores were higher in infected patients with fibromyalgia. When comparing the complementary tests in infected patients with and without fibromyalgia, no significant differences were found for the Schirmer test, viral genotype, and degree of fibrosis and liver inflammation.

CONCLUSION: In females, there was a positive relationship between hepatitis C virus infection, fibromyalgia, and extrahepatic symptoms, which translates into a higher prevalence of anxiety and depression and impaired quality of life.

Keywords

Chronic pain, Fibromyalgia, Hepatitis C

Resumo

JUSTIFICATIVA E OBJETIVOS: A fibromialgia tem distribuição mundial e etiologia pouco comprendida. Acredita-se no envolvimento de diferentes fatores, como a infecção pelo vírus da hepatite C. O objetivo deste estudo foi estimar a prevalência de fibromialgia em pacientes infectados pelo vírus da hepatite C, procurando identificar a ocorrência de lesão hepática, manifestações clínicas extra-hepáticas, ansiedade, depressão e o impacto na qualidade de vida.

MÉTODOS: Trata-se de um estudo de corte transversal com pacientes (n=118) portadores de infecção pelo vírus da hepatite C que foram comparados a um grupo composto de pacientes clinicamente estáveis e não infectados pelo vírus da hepatite C (n=118). Foi aplicado o Questionário de Ansiedade e Depressão, e para os que obtivessem o diagnóstico de fibromialgia, o Questionário de Impacto da Fibromialgia. As biopsias hepáticas foram analisadas de acordo com a classificação METAVIR. Foi realizado o teste de Schirmer para a pesquisa de lacrimejamento anormal nos pacientes estudados. A análise dos dados foi realizada através do programa Statistical Package for Social Sciences (SPSS) v.10.0.

RESULTADOS: A prevalência de fibromialgia em pacientes infectados foi de 7,6%. Nos pacientes infectados com fibromialgia observou-se prevalência significativa de ansiedade e depressão. A pontuação do Questionário de Impacto da Fibromialgia foi maior nos pacientes infectados e com fibromialgia. Quando se relacionou os exames complementares em infectados com e sem fibromialgia, não foram constatadas diferenças significativas para o teste de Schirmer, genótipo viral e grau de fibrose e inflamação hepática.

CONCLUSÃO: Nos indivíduos do sexo feminino, observou-se uma relação positiva entre a infecção pelo vírus da hepatite C, fibromialgia e sintomas extra-hepáticos, que se traduz em maior prevalência de ansiedade e depressão e em comprometimento na qualidade de vida.

Palavras-chave

Dor crônica, Fibromialgia, Hepatite C

References

Marques AP, Santo ASDE, Berssaneti AA, Matsutani LA, Yuan SLK. Prevalence of fibromyalgia: Literature review update. Rev Bras Reumatol. 2017;57(4):356-63.

Senna ER, De Barros AL, Silva EO, Costa IF, Pereira LV, Ciconelli RM. Prevalence of rheumatic diseases in Brazil: a study using the COPCORD approach. J Rheumatol. 2004;31(3):594-7.

Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL. The American College of Rheumatology 1990 Criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33(2):160-72.

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600-10.

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011;38(6):1113-22.

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016;46(3):319-29.

Häuser W, Ablin J, Perrot S, Fitzcharles MA. Management of fibromyalgia: practical guides from recent evidence-based guidelines. Pol Arch Intern Med. 2017;127(1):47-56.

Häuser W, Fitzcharles MA. Facts and myths pertaining to fibromyalgia. Dialogues Clin Neurosci. 2018;20(1):53-62.

Sluka KA, Clauw DJ. Neurobiology of fibromyalgia and chronic widespreas pain. Neuroscience. 2016;338:114-29.

Ribeiro LS, Proietti FA. Fibromialgia e estresse infeccioso: possíveis associações entre a síndrome de fibromialgia e infecções viróticas crônicas. Rev Bras Reumatol. 2005;45(1):20-9.

Weidebach WF. Fibromyalgia: evidence of a neurophysiologic substrate. Rev Assoc Med Bras. 2002;48(4):275-96.

Scheel TK, Rice CM. Understanding the hepatitis C virus life cycle paves the way for highly effective therapies. Nat Med. 2013;19(7):837-49.

Palazzi C, D'Amico E, D'Angelo S, Gilio M, Olivieri I. Rheumatic manifestations of hepatitis C virus chronic infection: indications for a correct diagnosis. World J Gastroenterol. 2016;22(4):1405-10.

Cacoub P, Poynard T, Ghillani P, Charlotte F, Olivi M, Piette JC. Extrahepatic manifestations of chronic hepatitis C. Arthritis Rheum. 1999;42(10):2204-12.

Buskila D, Shnaider A, Neumann L, Zilberman D, Hilzenrat N, Sikuler E. Fibromyalgia in hepatitis C virus infection. Another infectious disease relationship. Arch Intern Med. 1997;157(21):2497-500.

Rivera J, de Diego A, Trinchet M, García Monforte A. Fibromyalgia-associated hepatitis C virus infection. Br J Rheumatol. 1997;36(9):981-5.

Goulding C, O'Connell P, Murray FE. Prevalence of fibromyalgia, anxiety and depression in chronic hepatitis C virus infection: relationship to RT-PCR status and mode of acquisition. Eur J Gastroenterol Hepatol. 2001;13(5):507-11.

Rogal SS, Bielefeldt K, Wasan AD, Szigethy E, Lotrich F, DiMartini AF. Fibromyalgia symptoms and cirrhosis. Dig Dis Sci. 2015;60(5):1482-9.

Kozanoglu E, Canataroglu A, Abayli B, Colakoglu S, Goncu K. Fibromyalgia syndrome in patients with hepatitis C infection. Rheumatol Int. 2003;23(5):248-51.

Theoharides TC, Tsilioni I, Arbetman L, Panagiotidou S, Stewart JM, Gleason RM. Fibromyalgia syndrome in need of effective treatments. J Pharmacol Exp Ther. 2015;335(2):255-63.

Mohammad A, Carey JJ, Storan E, Scarry M, Coughlan RJ, Lee JM. Prevalence of fibromyalgia among patients with chronic hepatitis C infection: relationship to viral characteristics and quality of life. J Clin Gastroenterol. 2012;46(5):407-12.

Narváez J, Nolla JM, Valverde-García J. Lack of association of fibromyalgia with hepatitis C virus infection. J Rheumatol. 2005;32(6):1118-21.

Heymann RE, Paiva ES, Martinez JE, Helfenstein Jr M, Rezende MC, Provenza JR. New guidelines for the diagnosis of fibromyalgia. Rev Bras Reumatol. 2017;57(^sSuppl 2):467-76.

Loureiro M, Belloto E, Christmann RM, Corbellini M, Schafranski MD, Pedroso ML. Prevalência de fibromialgia em pacientes infectados com o vírus da hepatite C. Rev Bras Reumatol. 2002;1:38-41.

Farris RL, Gilbard JP, Stuchell RN, Mandel ID. Diagnostic tests in keratoconjunctivitis sicca. Clao J. 1983;9(1):23-8.

Bennet R. The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clin Exp Rheumatol. 2005;23(5 Suppl 39):S154-62.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70.

Marcolino JA, Mathias LA, Piccinini Filho L, Guaratini AA, Suzuki FM, Alli LA. Hospital Anxiety and Depression Scale: a study on the validation of the Criteria and reliability on preoperative patients. Rev Bras Anestesiol. 2007;57(1):52-62.

Marques AP, Santos AM, Assumpção A, Matsutani LA, Lage LV, Pereira CA. Validação brasileira do Fibromyalgia Impact Questionnaire (FIQ). Rev Bras Reumatol. 2006;46(1):24-31.

Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001;344(7):495-500.

Strauss E. Hepatite C. Rev Soc Bras Med Trop. 2001;34(1):69-82.

Hanus JS, Ceretta LB, Simões PW, Tuon L. Incidence of hepatitis C in Brazil. Rev Soc Bras Med Trop. 2015;48(6):665-73.

Silberbogen AK, Janke EA, Hebenstreit C. A closer look at pain and hepatitis C: preliminary data from a veteran population. J Rehabil Res Dev. 2007;44(2):231-44.

Poynard T, Cacoub P, Ratziu V, Myers RP, Dezailles MH, Mercadier A. Fatigue in patients with chronic hepatitis C. J Viral Hepat. 2002;9(4):295-303.

Lormeau C, Falgarone G, Roulot D, Boissier MC. Rheumatologic manifestations of chronic hepatitis C infection. Joint Bone Spine. 2006;73(6):633-8.

Silberbogen AK, Janke EA, Hebenstreit C. A closer look at pain and hepatitis C: preliminary data from a veteran population. J Rehabil Res Dev. 2007;44(2):231-44.

Thompson ME, Barkhuizen A. Fibromyalgia, hepatitis C infection, and the cytokine connection. Curr Pain Headache Rep. 2003;7(5):342-7.

Chemello L, Alberti A, Rose K, Simmonds P. Hepatitis C serotype and response to interferon therapy. N Engl J Med. 1994;330(2):143.

Ribeiro LS, Coelho AM, Pádua AF, Dias LL, Azevedo DC, Moura FM. Fibromialgia e infecção crônica pelo vírus C: ausência de associação em duas amostras. Rev Bras Reumatol. 2007;47(2):97-105.

Silva MB, Skare TL, Magro CE, Guidolin F, Esmanhoto L. Fibromialgia e hepatite C. Rev Med Paraná. 2005;63(1):16-8.

Wallace DJ, Linker-Israeli M, Hallegua D, Silverman S, Silver D, Weisman MH. Cytokines play an aetiopathogenetic role in fibromyalgia: a hypothesis and pilot study. Rheumatology. 2001;40(7):743-9.

Marotte H, Fontanges E, Bailly F, Zoulim F, Trepo C. Miossec P. Etanercept treatment for three months is safe in patients with rheumatological manifestations associated with hepatitis C virus. Rheumatology. 2007;46(1):97-9.


Submitted date:
05/08/2019

Accepted date:
10/09/2019

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