Prevalence of fibromyalgia among patients with chronic hepatitis C infection
The association between chronic hepatitis C and fibromyalgia still remains controversial. What we know is a high prevalence of fibromyalgia has been found in patients infected with Hepatitis C, especially women.
There is a strong association between fibromyalgia and many diseases rheumatologists treat (RA, osteoarthritis, Sjogrens syndrome, lupus and certain infections Hepatitis C and lyme disease.
Studies have shown that Hepatitis C can be associated with arthritis ; it can also cause arthralgias, which is joint pain without swelling.
There are also many other illnesses which can be associated with so-called secondary fibromyalgia.
The fact remains in rare cases several forms of arthritis have been linked to HCV infection. One of the most commonly types of arthritis associated with hepatitis C is rheumatoid arthritis (RA).
The relationship between RA and the hepatitis c virus results in antibodies starting to attack normal body tissue, although some physicians feel it may be more closely related to liver damage and share the argument the condition usually affects people with cirrhosis.
October 9 2012
The Hepatitis-Fibromyalgia Connection
Fibromyalgia and chronic hepatitis C infection share many clinical features including prominent somatic complaints such as musculoskeletal pain and fatigue. In fact, some medical experts believe that the symptoms and presenting patterns in common between hepatitis C and fibromyalgia are not coincidental. There is the possibility that hepatitis C may be a trigger of fibromyalgia....
The risk factors for fibromylagia syndrome (FBS) among Hepatitis C
**Abstract Following Article
Mohammad, A., et al., Prevalence of fibromyalgia among patients with chronic
hepatitis C infection: relationship to viral characteristics and quality of
life. J Clin Gastroenterol, 2012. 46(5): p. 407-12.
A study out of Ireland on the risk factors for fibromylagia syndrome (FBS) among
chronic Hepatitis C patients.
Brief Summary: Many patients with chronic Hepatitis C can manifest many
different types of symptoms such as fatigue, myalgia, and fibromylagia
syndrome (FBS). FBS is a medical disorder characterized with widespread
muscle, tissue or joint pain. The main objective of this study was to identify
the observational factors which are associated with patients who have
FBS vs. no-FBS in chronic Hepatitis C patients.
A total of 185 Hepatitis C patients were recruited and a wide variety of observatioal
factors were collected and recorded such as gender, age, pain intensity,
functional impairment, etc.
Results: The authors found the following factors to be risk factors for FBS among
the patients with chronic Hepatitis C patients: age 45 years or more, female sex,
living alone, history of depression, acquisition of HCV through blood transfusion,
and presence of HCV genotype 1.
Implications for Practice: Chronic Hepatitis C Patients who show the corresponding
risk factors may have a higher likelihood of having FBS.
Discussion: As the authors mentioned, the pathogenesis of FBS is not completely
understood. Thus, observational studies like this which identify risk factors can
be used to further elucidate the cause of FBS. I obviously have not had the opportunity
to read up on past papers related to this subject, but just from the author’s discussion
section, it would seem as if there is a strong interaction between several variables – both
environmental and genetic which can cause FBS. There are just so many
follow-up studies that could be done on a project such as this.
Commentary on Statistics and Study Design:
I have some constructive suggestions for the authors related to the statistics and
study design of the investigation. The main objective of the investigation was
to identify risk factors for patients who either have FBS or do not have FBS.
Since the main desire was to identify independent risk factors, conducting a
univariate logistic regression model fulfills this need. However, it would also
be helpful to identify risk factors in a dependent fashion. In order to do
this, the author’s could have constructed a multi-variate logisticregression
model with the outcome variable (as before) being whether the patient had FBS or
not, and then the predictor variables would have been all the risk factors. By
doing this, the investigator could determine whether a given risk factor (or
variable) is statistically associated with the outcome variable while
controlling for (or ‘keeping constant’) all other variables in the
investigation. This could help the investigator in narrowing down the risk
factors which are most associataed with the outcome variable, and this is
information which could be very useful.
For instance, gender was found to be independantly associated with the outcome
variable (FBS vs. no-FBS) in the univariate analysis. However, gender may not
be associated with the outcome variable while controlling for – say – blood transfusion.
In other words, blood transfusion has a much stronger association with the outcome variable
than gender, and this would be useful to know. In this instance, gender is not
really associated with the outcome variable – it may only been because more
males than females happened to have FBS in the recruitment than males. So, the
author’s could have done a multi-variate analysis and only reported those risk
factors which were associated with the outcome variable in a dependant fashion.
In short, whenever there are multiple predictor variables in a problem, you
always want to run a multi-variate regression problem (for the reasons just stated)
instead of a univariate approach. Also, by using a multi-variate regression problem,
one could have tested the effect of various interactions among the different
variables (ask me if you don’t know what this is).
Also, the author’s identified 4 different genotypes among the HC patients. However,
in the final analysis, the investigators only made a comparative difference between
genotype 1 vs. every other genotypes. It may have been helpful to do a comparative
analysis between all the genotypes simultaneously (ex. genotypes 2 vs. 3, 2 vs. 4, 1 vs. 4),
and there are statistical techniques to do this. It seems as if there were plenty
of data samples for genotypes 2 through 4 to do this. Using the multi-variate
regression idea, the investigator could have coded the genotypes variable as a
qualitiatve class variable, and this would have allowed the comparison of all 4
groups against themselves (again, ask if you don’t know how to do this). This
could have been really interesting to look at.
A big thanks for our friends from Ireland for running this study.
Prevalence of fibromyalgia among patients with chronic hepatitis C infection: relationship to viral
characteristics and quality of life.
J Clin Gastroenterol. 2012 May;46(5):407-12
Mohammad A, Carey JJ, Storan E, Scarry M, Coughlan RJ, Lee JM.
*Department of Rheumatology, Merlin Park University Hospital Departments of
‡Gastroenterology §Hepatology/Gastroenterology, Galway University Hospitals, Galway, Ireland.
We determined the prevalence of fibromyalgia syndrome (FMS) in a cohort of subjects with chronic hepatitis C virus (HCV),
and the relationship to subject demographics, viral characteristics, and quality of life.
In a cross-sectional study of a cohort of HCV-infected individuals, all subjects underwent a standard assessment including history, clinical examination, and functional assessments for pain and disability.
A total of 185 subjects met the inclusion criteria. Median age was 48.7 years, and 110
(59%) were women. A total of 106 (57%) of the subjects met criteria for the presence of FMS. Widespread pain and ≥11 tender points were present in all of the subjects with FMS, fatigue in 98 (92%), and depression in 60 (57%).
Among those with FMS, mean pain score was 70±11.78 and 36% reported some functional impairment on (HAQ-DI>0), with 17% reporting moderate-to-severe functional impairment (HAQ-DI≥1.5).
This study reveals a high prevalence of FMS (57%) among subjects with chronic HCV infection, one third of whom reported some degree of functional impairment. Recognition and management of this condition in such patients will help improve their quality of life.
Arthritis & Rheumatism, Volume 62,
November 2010 Abstract
Supplement Abstracts of the American College of Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
The Prevalence of Fibromyalgia in Patients with Chronic Hepatitis C Infection.
Mohammad1, Ausaf, Carey4, John J., Storan2, Eoin R., Scarry2,
Margaret, Keane2, Mary B., Moore2, Angela, Lyons2, Ann
Department of Hepatology and Rheumatology, Galway University Hospital, Ireland Galway University HospitalHepatology Galway University Hospital Rheumatology Merlin Park University Hospital
Chronic HCV infection is associated with rheumatologic conditions including arthritis and vasculitis. Previous studies have not specifically addressed the presence of fibromyalgia syndrome (FMS) in this population. In this study we assessed the prevalence of fibromyalgia in a cohort of subjects with chronic HCV and its relationship to subject demographics, viral characteristics and quality of life.
Cross-sectional study of a cohort of HCV infected individuals at our university hospital. Study was approved by local I.R.B. and all subjects gave written informed consent prior to participation. Patients with decompensated liver disease, concomitant autoimmune liver disease, arthritis, vasculitis, co-infection with hepatitis B or D, or HIV, end-stage renal failure, organ transplantation, cancer and those patients who were currently receiving anti-viral treatment were excluded. All subjects underwent a single interview including a fibromyalgia impact questionnaire, pain assessment measured on a 100-mm visual analogue scale (VAS) and the Stanford Health Assessment Questionnaire 20-Item Disability Scale (HAQ-DI). All patients underwent clinical examination including a standard assessment for fibromyalgia tender points.
Additional details were recorded from the medical record including information about their HCV infection and its treatment, laboratory data including antibody profiles, other illnesses and medications.
185 patients attending the hepatology unit consented to participate. 110 (59%) were females with a mean age of 46.7 years. 106 (57%) subjects met criteria for the presence of FMS. Widespread pain and >=11 tender points were
present in all of the subjects with fibromyalgia, fatigue in 98 (92%), depression in 60 (57%), and arthralgia/ joint stiffness in 16 (15%). Among those with FMS mean pain score was 70 ± 11.78 and 36% reported some functional impairment on HAQ-DI (>0), with 17% reporting moderate-severe functional impairment (HAQ-DI >=1.5). Compared to subjects who did not meet criteria for fibromyalgia, patients with fibromyalgia were more likely to be older, females, living alone, smokers, have
a history of depression, had acquired HCV via a blood transfusion, and had HCV genotype-1(table 1, p <0.005 for all categories).
The prevalence of FMS was very high (57%) among subjects with HCV infection, one third of whom reported some degree of functional impairment. Further research is needed to better understand FMS in patients with HCV.
To cite this abstract, please use the following
Mohammad, Ausaf, Carey, John J., Storan, Eoin R., Scarry,
Margaret, Keane, Mary B., Moore, Angela, et al; The Prevalence of Fibromyalgia
in Patients with Chronic Hepatitis C Infection. [abstract]. Arthritis Rheum
2010;62 Suppl 10 :817
From Fibromyalgia Frontiers • 2010 (Volume 18, Number 1
2010 Fibromyalgia Pathophysiology and Treatment
There is a strong association between fibromyalgia and many diseases rheumatologists treat (RA,
osteoarthritis, Sjogrens syndrome, lupus and certain infections Hepatitis C and lyme disease.
Download Complete PDF