Fibromyalgia (FM) in hepatitis C virus infection. Another infectious disease relationship

BACKGROUND: Fibromyalgia syndrome (FS) is a common disorder of
diffuse pain in the muscles or joints accompanied by
tenderness at specific tender points and a constellation of
related symptoms. The potential role of infections in the
pathogenesis of FS has only recently been investigated.
OBJECTIVES: To evaluate the prevalence of FS and to assess
tenderness thresholds in patients infected with hepatitis C
virus (HCV).

METHODS: The study included 90 patients with HCV,
128 healthy, anti-HCV-negative controls, and 32 patients with
non-HCV-related cirrhosis. Tenderness was measured by manual
palpation (18 tender points) and with a dolorimeter.
Fibromyalgia syndrome was diagnosed according to the 1990
American College of Rheumatology criteria.

RESULTS: The diagnosis of FS was established in 14 patients
(16%) with HCV, in 1 patient (3%) with non-HCV-related cirrhosis,
and in none of the healthy controls (P < .001). Thirteen of the
HCV-positive patients with FS were women. The patients with
HCV had significantly (P < .01) more tender points (mean [+/-
SD] 3.6 +/- 5.3) than the healthy controls (0.1 +/- 0.5) and
the patients with non-HCV-related cirrhosis (1.2 +/- 2.7).
Specifically, the patients with cirrhosis were most tender on
both tenderness measures owing to the high proportion of women
in this group. Patients with FS were significantly more tender
than those without FS: their dolorimetry thresholds were 2.9
kg vs 6.0 kg (P < .001).

CONCLUSIONS: A high prevalence of FS was observed in
patients infected with HCV, especially women. Recognizing FS in
patients with HCV will prevent misinterpretation of FS symptoms as
part of the liver disease and will enable the physician to reassure
the patient about these symptoms and to alleviate them.

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