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Abstract Number: 41

Human Papilloma Virus Vaccination, Fibromyalgia and Dysautonomia

Manuel Martínez-Lavín1, Paola-Kinara Reyes-Loyola2 and Laura-Aline Martinez-Martinez3, 1Rheumatology, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico, 2Rheumatology, National Institute of Cardiology, Mexico, Mexico, 3Rheumatology, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, TX, Mexico

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Autonomic disorders, Fibromyalgia and vaccines

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Session Information

Date: Sunday, November 13, 2016

Session Title: Fibromyalgia, Soft Tissue Disorders, Regional and Specific Clinical Pain Syndromes - Poster I: Basic Science Focus

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

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

Post HPV vaccination fibromyalgia patients (n = 35)
Age (years) 20 ± 8
Female 100 %
Age at first HPV dose 17 ± 8
Illness onset within 24 hr. after vaccination, n (%) 8 (22.9%)
Illness onset between 24 hours to 3 months, n (%) 27 (77.1%)
ACR 2010 FM Polysymptomatic Distress Scale 36 ± 13
ACR 2010 FM Widespread Pain Index 10 ± 5
ACR 2010 FM Symptoms Severity Scale 26 ± 9
COMPASS-31 scale value 52.4 ± 17.8

Disclosure: M. Martínez-Lavín, None; P. K. Reyes-Loyola, None; L. A. Martinez-Martinez, None.

To cite this abstract in AMA style:

Martínez-Lavín M, Reyes-Loyola PK, Martinez-Martinez LA. Human Papilloma Virus Vaccination, Fibromyalgia and Dysautonomia [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/human-papilloma-virus-vaccination-fibromyalgia-and-dysautonomia/. Accessed May 16, 2022.
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