A prospective study of tender points & fibromyalgia (FM) during & after an acute viral infection

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

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