Background/Purpose: In a questionnaire-based case series, we described the clinical features of 45 patients who had the onset of a chronic illness soon after HPV vaccination. Fifty three percent of them fulfilled the 2010 ACR fibromyalgia diagnostic criteria (Clin Rheumatol 2015;34:1981). The objective of the present report is to correlate fibromyalgia severity with dysautonomia severity in an enlarged cohort of patients who developed a chronic ailment soon after HPV vaccination.

Methods: We e-mailed the 2010 ACR fibromyalgia diagnostic criteria questionnaire and a validated dysautonomia questionnaire (COMPASS-31) to individuals who had the onset of a chronic illness after HPV vaccination. Those subjects who had a disease onset within the following three months after HPV immunization are included in this report. We correlate the total COMPASS-31 score with the following 2010 ACR fibromyalgia diagnostic criteria domains: Polysymptomatic Distress Scale, Widespread Pain Index values, and Symptoms Severity Scale.

Results: Fifty five eligible patients filled out both questionnaires. Thirty five (63 %) of them fulfilled the 2010 ACR fibromyalgia diagnostic criteria. At vaccination time, those patients who fulfilled the 2010 ACR fibromyalgia diagnostic criteria were older than those who did not (17 +/- 8 year old vs. 14 +/- 5 year old. P = 0 0.038). Twenty three percent of all post HPV vaccine fibromyalgia girls had their disease onset within 24 hours after vaccination. In the fibromyalgia group COMPASS-31 score was 52-4 +/- 17-8, reflecting widespread dysautonomia symptoms. Likewise fibromyalgia domain scores were high, implying the presence of severe fibromyalgia (table). COMPASS-31 score correlated with the three 2010 fibromyalgia diagnostic criteria domains: With Polysymptomatic Distress Scale (rho=0.642, p<0.0001), with Widespread Pain Index (rho=0.550, p=0.001) and with Symptoms Severity Scale (rho=0.633, p<0.0001). After a mean period of 4.5 years after vaccination, none of the immunized girls with fibromyalgia was able to work or attend school on a regular basis.

Conclusion: This questionnaire-based case series sub-analysis suggests that in young girls, disabling fibromyalgia may follow HPV vaccination. Correlations between Compass-31 scores and the 2010 fibromyalgia diagnostic criteria questionnaire suggest that in this group of HPV vaccinated girls, fibromyalgia and dysautonomia may share clinical and pathogenetic features. Table

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/human-papilloma-virus-vaccination-fibromyalgia-and-dysautonomia/