BACKGROUND: Tender points (TPs) and fibromyalgia (FM) may be
precipitated by infections, but the frequency, associated
characteristics, and predictors of these outcomes are unknown.
OBJECTIVES: To determine if acute infectious mononucleosis
(AIM) is associated with the development of TPs or FM acutely
or during the subsequent 6 months; if demographic, clinical,
or psychosocial features predict TPs or FM; and if TPs or FM
correlate with nonrecovery.
METHODS: A total of 150 subjects
diagnosed as having AIM were assessed with physical
examinations (including palpation of 18 TPs), laboratory
tests, and measures of psychosocial and somatic functioning at
enrollment and at 2 and 6 months. Subjects also completed a
structured psychiatric interview at the initial evaluation.
RESULTS: At presentation and at 2 and 6 months, the mean TP
counts were 7.5, 4.6, and 3.0, respectively; at these time
points, 19%, 3%, and 1% of subjects also met modified criteria
for FM. Tender points and degree of pain diminished over time
following AIM. Acutely, TPs were associated only with higher
temperature (P<.001). Baseline features that predicted more
TPs at 2 and 6 months were female sex, older age, less family
social support, and more TPs at presentation. Neither initial
laboratory tests nor psychiatric disease or distress predicted
TPs. Differences between those who had and had not recovered
at 6 months were found for the mean number of TPs (P<.008),
the proportion of subjects with 11 or more TPs (P<.002), and
the degree of pain.
CONCLUSIONS: Tender points are a common,
transient finding associated with AIM, but FM is an unusual
long-term outcome. Demographic, social, and physical
examination features predicted TPs.
Rea T, Russo J, Katon W, Ashley RL, Buchwald D