Erol AKTUNÇ, Şenay ÖZDOLAP ÇOBAN, Tuğçe KÖKSAL, Selda SARIKAYA

Fibromiyaljili Hastalarda D Vitamin Düzeylerinin Değerlendirilmesi ve Fonksiyonel Durum ile İlişkisi

Amaç: Fibromiyalji sendromu, yaygın ağrı, çok sayıda hassas nokta, eklemlerde katılık ve herhangi bir organik bozukluğa bağlanamayan sistemik semptomlarla karakterize, sık görülen bir kas iskelet sistemi bozukluğudur. Bu çalışmayı yapmaktaki başlangıç amacımız, fibromiyalji hastalarında D vitamini düzeylerini belirlemek ve sağlıklı bireylerdeki ile karşılaştırmaktı. Sonrasında fonksiyonel durum ve hastalık şiddeti ile D vitamin düzeyleri arasındaki bağıntıyı değerlendirdik. Gereç ve Yöntemler: Bu vaka-kontrol çalışmasında, 137 kadın fibromiyalji hastası ve 109 sağlıklı kadın birey karşılaştırıldı. Hasta grubunda ağrı şiddetini değerlendirmek için görsel analog skala ve fonksiyonel durumu değerlendirmek için “Fibromiyalji etki anketi” kullanıldı. Her iki gruba ait D vitamini düzeyleri karşılaştırıldı. Fibromiyaljili hastalarda D vitamini düzeyleri ile “Fibromiyalji etki anketi” skoru arasındaki bağıntı değerlendirildi. Bulgular: Gruplar arasında D vitamini ve parathormon düzeyleri bakımından anlamlı derecede fark yoktu(Sırasıyla p=0.858 , p=0.790). Hastalarda, ortalama “Fibromiyalji etki anketi” skoru ve ortanca görsel analog skala değeri, D vitamini düzeyinin eksik, yetersiz veya yeterli olması durumuna bağlı olarak anlamlı derecede bir değişim göstermedi(Sırasıyla p=0.548 , p=0.952). D vitamini düzeyleri ile “Fibromiyalji etki anketi” skoru arasında anlamlı bir ilişki izlenmedi(Spearman’s rho=0.056, p=0.513). Sonuç: Bu çalışmada fibromiyaljili hastalar ile sağlıklı bireyler arasında D vitamini düzeyleri bakımından anlamlı bir fark görülmedi. Fibromiyalji hastalarında D vitamini düzeyleri ile fonksiyonel durum ve hastalık şiddeti arasında anlamlı bir bağıntı yoktu.

Anahtar Kelimeler:

Fibromiyalji, D vitamin düzeyi, Fibromiyalji etki anketi

Evaluation of Vitamin D Levels in Fibromyalgia Patients and the Relation to Functional Status

Aim: Fibromyalgia syndrome is a common musculoskeletal disorder, characterized by chronic widespread pain, multiple tender points, joint stiffness, and systemic symptoms without any underlying organic disease. The initial aim of the present study was to determine the vitamin D levels in patients with fibromyalgia and compare these values to those found in healthy subjects. Then, correlations between functional status, clinical severity of the disease, and vitamin D levels were assessed. Material and Methods: This case-control study included 137 female fibromyalgia patients and 109 healthy female counterparts. The severity of pain was assessed by a visual analogue scale and the functional impact was evaluated through the Fibromyalgia Impact Questionnaire in the patient group. Vitamin D levels were compared between groups, and the correlation between vitamin D levels and questionnaire scores was determined. Results: Vitamin D and parathormone levels did not differ significantly between groups (p=0.858, p=0.790 respectively). The mean Fibromyalgia Impact Questionnaire scores and the medians for the visual analogue scale did not differ significantly among vitamin D deficient, insufficient, and sufficient patients (p=0.548 , p=0.952 respectively). In addition, no significant correlation between vitamin D levels and the Fibromyalgia Impact Questionnaire score was found(Spearman’s rho=0.056, p=0.513). Conclusion: This study did not show any significant differences between the vitamin D levels of fibromyalgia patients and those of healthy subjects. Further, in fibromyalgia patients, there was no correlation between vitamin D levels and functional status or disease severity

Keywords:

Fibromyalgia, vitamin D levels, fibromyalgia impact questionnaire,

PDF

___

1-Mease P. Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. J Rheumatol Suppl. 2005 Aug;75:6-21.
2- Neumann L, Buskila D. Epidemiology of fibromyalgia. Curr Pain Headache Rep. 2003 Oct;7(5):362-8.
3-Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995 Jan;38(1):19-28.
4-Buskila D, Sarzi-Puttini P. Biology and therapy of fibromyalgia. Genetic aspects of fibromyalgia syndrome. Arthritis Res Ther. 2006;8(5):218.
5-Holick MF. Biological Effects of Sunlight, Ultraviolet Radiation, Visible Light, Infrared Radiation and Vitamin D for Health. Anticancer Res. 2016 Mar;36(3):1345-56.
6-Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003 Dec;78(12):1463-70.
7-Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008 Apr;87(4):1080S-6S.
8-Tandeter H, Grynbaum M, Zuili I, Shany S, Shvartzman P. Serum 25-OH vitamin D levels in patients with fibromyalgia. Isr Med Assoc J. 2009 Jun;11(6):339-42.
9-de Rezende Pena C, Grillo LP, das Chagas Medeiros MM. Evaluation of 25-hydroxyvitamin D serum levels in patients with fibromyalgia. J Clin Rheumatol. 2010 Dec;16(8):365-9.
10-Jesus CA, Feder D, Peres MF. The role of vitamin D in pathophysiology and treatment of fibromyalgia. Curr Pain Headache Rep. 2013 Aug;17(8):355.
11-Okumus M, Koybası M, Tuncay F, Ceceli E, Ayhan F, Yorgancioglu R ,Borman P. Fibromyalgia syndrome: is it related to vitamin D deficiency in premenopausal female patients? Pain Manag Nurs. 2013 Dec;14(4):e156-63.
12- Özcan SD, Öken Ö, Aras M, Köseoğlu BF. Vitamin D Levels in Women with Fibromyalgia and Relationship between Pain, Depression, and Sleep. Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi 2014;60(4): 329-334.
13- Borman P, Çeliker R. A Comparative Analysis of Quality of Life in Rheumatoid Arthritis and Fibromyalgia. Journal of Musculoskeletal Pain 1999;7(4): 5-14.
14- Hsiao MY, Hung CY, Chang KV, Han DS, Wang TG. Is Serum Hypovitaminosis D Associated with Chronic Widespread Pain Including Fibromyalgia? A Meta-analysis of Observational Studies. Pain Physician. 2015 Sep-Oct;18(5):E877-87.
15- Armstrong DJ, Meenagh GK, Bickle I, Lee AS, Curran ES, Finch MB. Vitamin D deficiency is associated with anxiety and depression in fibromyalgia. Clin Rheumatol. 2007 Apr;26(4):551-4. Epub 2006 Jul 19.
16- Yılmaz H, Karaca G, Polat HAD, Akkurt HE. Comparison between Depression Levels of Women with Knee Osteoarthritis, Rheumatoid Arthritis, and Fibromyalgia Syndrome: A Controlled Study. Turkish Journal of Physical Medicine & Rehabilitation/Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi Turk J Phys Med Rehab 2015;61:197-202
17- Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P , Campbell SM, Abeles M , Clark P, Fam AG , Fiechtner JJ, Franklin CM , Gatter RA , Hamaty D, Lessard J , Lichtbroun AS , Masi AT ,Mccain GA, Reynolds WJ, Romano TJ, Russell IJ . Sheon RP .The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990 Feb;33(2):160-72.
18- Sarmer S, Ergin S, Yavuzer G. The validity and reliability of the turkish version of the fibromyalgia impact questionnaire. Rheumatology Int 2000:20;9-12
19- Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. J Rheumatol 1991:18;728-733
20- Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266-81
21- Le Goaziou MF, Kellou N, Flori M, Perdrix C, Dupraz C, Bodier E, Souweine G. Vitamin D supplementation for diffuse musculoskeletal pain: results of a before-and-after study. Eur J Gen Pract. 2014 Mar;20(1):3-9.
22- Wepner F, Scheuer R, Schuetz-Wieser B, Machacek P, Pieler-Bruha E, Cross HS, Hahne J , Friedrich M. Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial. Pain. 2014 Feb;155(2):261-8.
23- Shipton EA, Shipton EE. Vitamin D and Pain: Vitamin D and Its Role in the Aetiology and Maintenance of Chronic Pain States and Associated Comorbidities. Pain Res Treat 2015: 904967. doi: 10.1155/2015/904967.
24- Straube S, Derry S, Straube C, Moore RA. Vitamin D for the treatment of chronic painful conditions in adults. Cochrane Database Syst Rev. 2015 May 6;5:CD007771.
25- Mouyis M, Ostor AJ, Crisp AJ, Ginawi A, Halsall DJ, Shenker N, Poole KES . Hypovitaminosis D among rheumatology outpatients in clinical practice.Rheumatology (Oxford). 2008 Sep;47(9):1348-51.
26- Badsha H, Daher M, Ooi Kong K. Myalgias or non-specific muscle pain in Arab or Indo-Pakistani patients may indicate vitamin D deficiency. Clin Rheumatol 2009;28(8): 971-973
27- Bhatty SA, Shaikh NA, Irfan M, Kashif SM, Vaswani AS, Sumbhai A,Gunpat . Vitamin D deficiency in fibromyalgia. J Pak Med Assoc. 2010 Nov;60(11):949-51.
28-Akar N, Çaglar NS, Aytekin E, Akar A, Aksu Ö , Öz N. Low levels of serum vitamin D3 are associated with fibromyalgia syndrome in pre-menopausal women: A pilot study. Turkish journal of physical medicine and rehabilitation, 2020 ;66(1), 67
29- Block SR. Vitamin D deficiency is not associated with nonspecific musculoskeletal pain syndromes including fibromyalgia. Mayo Clin Proc 2004;79(12): 1585-1586; author reply 1586-1587
30- Daniel D, Pirotta MV. Fibromyalgia--should we be testing and treating for vitamin D deficiency? Aust Fam Physician. 2011 Sep;40(9):712-6.
31- Mateos F, Valero C, Olmos JM, Casanueva B, Castillo J, Martínez J, Hernández JL , Gonzalez Macias J . Bone mass and vitamin D levels in women with a diagnosis of fibromyalgia. Osteoporos Int 2014;25(2): 525-533
32- Ulusoy H, Sarica N, Arslan S, Ozyurt H, Cetin I, Birgul Ozer E, Yıldırım N. Serum vitamin D status and bone mineral density in fibromyalgia. Bratisl Lek Listy. 2010;111(11):604-9.
33- Heidari B, Shirvani JS, Firouzjahi A, Heidari P, Hajian-Tilaki KO. Association between nonspecific skeletal pain and vitamin D deficiency. Int J Rheum Dis 2010:13(4): 340-346
34- von Känel R, Müller-Hartmannsgruber V, Kokinogenis G, Egloff N. Vitamin D and central hypersensitivity in patients with chronic pain. Pain Med. 2014 Sep;15(9):1609-18.
35- Amin OA , Abouzeid SM , Ali SA , Amin BA ,Alswat KA. Clinical association of vitamin D and serotonin levels among patients with fibromyalgia syndrome. Neuropsychiatric Disease and Treatment, 2019 ; 15, 1421.