New epidemiological data suggests patients suffering from chronic osteomyelitis (COM), which causes chronic inflammation, may be at increased risk of being diagnosed with fibromyalgia (FM).
By Thomas G. Ciccone
Interview with Don L. Goldenberg, MD
A recent study suggests chronic osteomyelitis (COM) could be a risk factor for developing fibromyalgia (FM).
COM is a condition marked by infection of the bone by bacteria or fungus that can lead to chronic inflammation. The study, which has been published in The Journal of Pain,1 is the first epidemiological evidence to suggest the condition could be a noted risk factor for the development of FM.
As researchers continue to investigate the pathogenesis for FM, it has been shown that central or peripheral inflammation could trigger pain pathways in the brain (central sensitization), which could potentiate changes in the central nervous system (CNS), known as centralized pain. According to investigators, this could lead to altered neuroendocrine function, varied neurotransmitter metabolism, and other factors that may enhance a patient’s risk for FM.2-5
How the Study Was Performed
The study, which was conducted in Taiwan using the country’s national database for health insurance claims from 1999 through 2010, used data from over 1 million enrollees. The researchers specifically looked at 1,244 patients, who had been diagnosed with COM but did not have any prior history of FM. Another 4,976 patients randomly selected as controls.
Researchers then traced these cases to the end of 2011, examining how FM may have developed over time for these patients. The researcher’s theory was that people suffering from COM statistically were more likely to be diagnosed with FM.
In general, the researchers found men were more likely than women to have COM (66.3% vs 33.7%, respectively). The researchers also found that a number of risk factors for FM were far more common in patients with COM than without. These included diabetes (P < 0.0001), hypertension (P < 0.0001), sleep disorder (P < 0.0001), depression (P < 0.007), and anxiety (P < 0.0001).
The overall incidence of FM (per 1000 person-years) was also notably higher in the COM cohort compared to the control cohort (25.4 vs 18.8, respectively). However, there was a marked connection between younger patients with COM subsequently developing FM: adjusted hazard ratios (aHRs) were the highest for the youngest subgroup of patients (<35 years), at 1.58 (95% CI, 1.03–2.44), which appeared to decrease with older subgroups of patients (>60 years), at 1.03 (95% CI, .78–1.36). Inflammation and severity of the disease was also linked: the aHR of FM reached its largest point in patients that had a severe case of COM rather than a mild one, at 5.29 (95% CI, 3.65–7.66) versus .94 (95% CI, .77–1.15), respectively.
Flaws in the Study
Considering the lack of therapies for treating FM, save for symptom-relieving treatments,6 the necessity for screening patients with known risk factors for the disease is now a significant aim for doctors. But whether establishing the connection between COM and FM will have any clinical impact on patient outcomes is difficult to determine, according to Don L. Goldenberg, MD, a rheumatologist at the department of medicine and the school of nursing at Oregon Health Services University in Portland, Oregon.
For Dr. Goldenberg, the study makes a valuable connection between COM and FM but also has some notable flaws in its analysis. For instance, the researchers classified other diseases, like hypertension and diabetes, as traditional risk factors for FM, something “which is not true,” Dr. Goldenberg told Practical Pain Management.
“This also confounds issues of co-morbidity in this cohort, which is older and includes more males than in the general FM population,” Dr. Goldenberg noted. “The bottom line is that various chronic infections may increase the risk for FM, and we can now add COM to that group.”
However, whether this insight will have a clinical impact on actually preventing FM is “a big stretch,” Dr. Goldenberg noted. “The prevailing thought is that all chronic stressors, be they physical (like chronic infection or rheumatoid arthritis), emotional, like chronic depression, or traumatic, are risk factors for FM and the longer they go unidentified/untreated, the more likely the FM,” Dr. Goldenberg explained.
This study was supported by the National Health Research Institutes in Taiwan, which provided the insurance claims data for analysis. The study also was supported by the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence, China Medical University Hospital, Academia Sinica Taiwan Biobank, Stroke Biosignature Project, NRPB Stroke Clinical Trial Consortium, and CMU under the Aim for Top University Plan of the Ministry of Education, Taiwan. The authors had no conflicts of interest to declare.
- Chen JH, Muo CH, Kao CH, et al. Increased risk of new-onset fibromyalgia among chronic osteomyelitis patients: Evidence from a Taiwan cohort study.J Pain. 2017;18(2):222-227.
- Ablin J, Neumann L, Buskila D. Pathogenesis of fibromyalgia: a review.J Bone Spine. 2008;75:273-279.
- Bradley LA. Pathophysiology of fibromyalgia.Am J Med. 2009;122:S22-S30.
- Ji RR, Xu ZZ, Strichartz G, et al. Emerging roles of resolvins in the resolution of inflammation and pain.Trends Neurosci. 2011;34:599-609.
- Rodriguez-Pintò I, Agmon-Levin N, Howard A, et al. Fibromyalgia and cytokines.Immunol Lett. 2014;161:200-203.
- Mease PJ, Dundon K, Sarzi-Puttini P. Pharmacotherapy of fibromyalgia.Best Pract Res Clin Rheumatol. 2011;25:285-297.