Fibromiyalji hastalarında kan vitamin D düzeyleri ve D vitamini tedavisinin etkinliği

Amaç: Fibromiyalji hastalarında D vitamini düzeyini ölç- mek, etyopatogenez ile olan ilişkisini belirlemek. Yöntemler: Bu çalışmaya; 2012 yılında Haziran ve Aralık ayları arasında Metin Sabancı Baltalimanı Kemik Hastalıkları Eğitim ve Araştırma Hastanesi Fizik Tedavi Polikliniğine başvuran 141 hasta alındı. Hastalarda fibromiyalji tanısı, American Collage of Rheumatology kriterlerine göre konuldu. Sistemik ve diğer romatolojik hastalıkların elimine edilebilmesi için, C-reaktif protein (CRP), eritrosit sedimentasyon hızı, serum kalsiyum (Ca), fosfor (P), alkalen fosfataz (ALP), parathormon (PTH), T3, T4, TSH düzeylerine bakıldı. Serumda D vitamini düzeyi ölçüldü. 20 ng/ml ve altındaki D vitamini değerleri, D vitamini eksikliği olarak kabul edildi. 21-29 ng/ml arasındaki değerler D vitamini yetersizliği, 30 ng/ml ve üzerindeki değerler normal kabul edildi. Bulgular: Hastaların yaş ortalaması 45.70±14.10 bulundu. Ortalama D vitamini düzeyi 17,52±18,02 ng/ml idi. Hastaların %76,6sında (n=108) D vitamini eksikliği olup bu hastalardaki ortalama D vitamini düzeyi 12,23±10,24 ng/ml olarak saptandı. Hastaların %14,2sinde (n=20) D vitamini yetersizliği mevcut olup, ortalama D vitamini dü- zeyi 23,83±2,76 ng/ml olarak bulundu. En düşük D vitamini düzeyi, 45 yaş altındaki hastalarımızda görüldü. Bu hastaların ortalama D vitamini düzeyi 14,91±10,75 ng/ml idi. Sonuç: Fibromiyalji hastalarında sıklıkla D vitamini eksikliği görülmektedir ve D vitamini tedavisi ile hastaların semptomlarında gerileme olmaktadır.

Blood vitamin D levels in patients with fibromyalgia and the effectiveness of vitamin D treatment

Objective: The aim of this study was determination the level of vitamin D in patients diagnosed with fibromyalgia and investigation the relationship with etiopathogenesis of the disease. Methods: In this study, between the months of June and December in 2012, Metin Sabancı Bone Diseases Training and Research Hospital, Physical Therapy Outpatient Clinics, 141 patients diagnosed with fibromyalgia were included. The patients were diagnosed according to American College of Rheumatology criteria. Levels of C-reactive protein (CRP), serum calcium (Ca), phosphor (P), alkaline phosphatase (ALP), PTH, T3, T4, TSH, and vitamin D were analyzed in the blood of patients, for exclusion of a systemic illness. Deficiency of vitamin D is determined as ≤20 ng/ml and insufficiency of vitamin D is determined 21-29 ng/ml. Normal level of vitamin D is accepted as equal or ≥30 ng/ml. Results: The mean age of patients was found as 45.70±14.10 years old. Mean vitamin D level was 17.51±18.02 ng/ml. 76.6% (n=108) of all patients with fibromyalgia had vitamin D deficiency and their mean vitamin D level was detected as 12.23±10.24 ng/ml. Twenty (14.2%) of all patients had vitamin D insufficiency and their mean vitamin D level was found as 23.83±2.76 ng/ ml. The lower vitamin D level was seen in patients with age less than 45 years-old and their mean vitamin D level was 14.91±10.75 ng/ml. Conclusion: Vitamin D deficiency is frequently seen in patients diagnosed with fibromyalgia and treatment with vitamin D may cause regression of the disease.

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1. Mease P. Fibromyalgia syndrome: Review of clinical presentation, pathogenesis, outcome measures, and treatment. J Rheumatol Suppl 2005;75:16-21.
2. Gervin RD. A review of myofacial pain and fibromyalgia factors that promotic their persistence. Acupuncture Med 2005;23:121-134.
3. Gervin RD. Myofacial and visceral pain syndromes: visceral and somatic pain representations. J Musculoskeletal Pain 2002;10:165-175.
4. Al Allaf AW, Mole PA, Paterson CR, Pullar T. Bone health in patients with fibromyalgia. Rheumatology 2003;42:1202- 1206.
5. Cantorna MT, Zhu Y, Froicu M, et al. 1,25 dihydroxyvitamin D, and the immune system. Am J Clin Nutr 2004;80:1717- 1720.
6. Cantorna MT, Mahon BD. Mouning evidence for vitamin D as an environmental factor affecting autoimmune disease prevalence. Exp Biol Med (Maywood) 2004;229:1136- 1142.
7. Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006;81:353-373.
8. Bischoff-Ferrari HA, Giovannucci E, Willett WC, et al. Estimation of otimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 2006;357:266-281.
9. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266-281.
10. Marwaha RK, Tandon N, Reddy DR, et al. Vitamin D and bone mineral density status of healthy schoolchilden in northern India. Am J Clin Nutr 2005;82:477-482.
11. Sedrani SH. Low 25-hydroxyvitamin D and normal serum calcium concentrations in Saudi Arabia: Riyadh region. Ann Nutr Metab 1984;28:181-185.
12. Armstrog DJ, Meenagh GK, Bickle I, et al. Vitamin D deficiency is associated with anxiety and depression in fibromyalgia. Clin Rheumatol 2007;26:551-554.
13. Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc 2003;78:1463-1470.
14. Bhatty SA, Shaikh NA, Irfan M, et al. Vitamin D deficiency in fibromyalgia. J Pak Med Assoc 2010;60:949-951.
15. Holick MF, Chen TC. Vitamin D deficiency: a wordwide problem with health concequences. Am J Clin Nutr 2008;87:1080-1086.
16. Iqbal R, Khan AH. Possible causses of vitamin D deficiency (VDD) in Pakistani population residing in Pakistan. J Pak Med Assoc 2010;60:1-2.
17. Turner MK, Hooten WM, Schmidt JE, et al. Prevalence and Clinical Correlates of Vitamin D İnadequency among Patients with Chronic Pain. Pain Med 2008;9:979-984.
18. Holick MF. Sunlight and vitamin d for bone health and prevantion of otoimmune diseases, cancers, and cardiovasculer disease. Am J Clin Nutr 2004;158:531-537.
19. Zuberi LM, Haque N, Jabbar A, Habib A. Vitamin D Deficiency in Ambulatory patients. J Pac Med Assoc 2008;58:482-484.
20. Gordon CM, DePeter KC, Feldman HA, et al. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med 2004;158:531-537.
21. Sullivan SS, Rosen CJ. Halteman WA, et al. Adolescent girls in Maine are at risk for vitamin D insufficiency. J Am Diet Assoc 2005;105: 71-974.
22. Shinchuk LM, Holick MF. Viamin D and rehabilitation: improving functional outcomes. Nutr Clin Pract 2007;22:297- 304.
23. Holick MF. The vitamin D epidemic and its health consequences. J Nutr 2005;135:2739-2748.