Session Information
Title: Fibromyalgia, Soft Tissue Disorders, Regional and Specific Clinical Pain Syndromes: Research Focus
Session Type: Abstract Submissions (ACR)
Background/Purpose
Previous studies suggest heterogeneity in the presentation of fibromyalgia (FM) with differences in biological variables including elevated sedimentation rate (ESR), cytokine profile, and hormone levels. Whether these variables identify subgroups within FM population remains to be established. We have previously reported primary FM patients with elevated inflammatory markers( Metyas SK, et al. Ann Rheum Dis, 2007;66(Suppl II):625.)
The diagnosis of FM is largely clinical, and specific biomarkers have yet to be identified. Vectra®DA is a multi-biomarker disease activity score, validated to measure disease activity in rheumatoid arthritis (RA). It is a commercially available test designed to measure serum concentrations of 12 biomarkers in RA.
The purpose of the study is to measure biomarkers using the Vectra®DA in FM patients with elevated inflammatory markers.
Methods
A cross-sectional, prospective study of 33 patients seen in an outpatient-based rheumatology practice in Los Angeles County was undertaken. Each met the 2010 ACR classification criteria for FM and had elevated ESR and/or CRP. None had clinical evidence of RA or other systemic rheumatic disease. Tests were negative for rheumatoid factor, anti-CCP antibodies, and HLA-B27. Serum specimens were tested using the Vectra®DA.
Results
Mean age was 43.5 years, 94% were female and 6% were male. The Vectra®DA was elevated for all patients with a mean score of 46.5 (range 30 to 84, or moderate to high activity). Among the twelve biomarkers (including IL-6 and CRP) serum concentrations were within the range reported in RA except leptin. 45% of subjects had leptin concentrations exceeding the range reported in RA (1-45 ng/mL). The mean leptin was 42.3 ng/mL (range 30-81 ng/mL).
There was a positive correlation between leptin concentration and BMI in the entire cohort; however, this correlation was not observed in the patient subgroup with leptin levels above the range in RA (P= 0.6). CRP but not ESR was positively correlated with the Vectra®DA score.
Conclusion
We have identified a subset of FM patients with elevated ESR and/or CRP. The elevated Vectra®DA scores support the concept of an associated inflammatory process in this subset of patients. The elevated levels of leptin in this subset, independent of BMI, suggest that factors other than obesity may account for this elevation. The emerging evidence that leptin plays a significant pro-inflammatory and immunomodulatory role warrants further investigation in the pathogenesis of this clinical subset of FM. Understanding this clinical subset may lead to different diagnostic and therapeutic strategies in FM.
Disclosure:
A. Quismorio,
None;
J. Solyman,
None;
L. Asfahani,
None;
S. Metyas,
Crescendo Bioscience,
8.
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