Session Information
Session Title: Fibromyalgia, Soft Tissue Disorders and Pain I
Session Type: Abstract Submissions (ACR)
Background/Purpose: Some illnesses, such as hypothyroidism or small fiber neuropathy, may present similarly to fibromyalgia (FM), or may in turn lead to an augmented polysymptomatic distress, mimicking FM, by concomitant illness. Primary hyperparathyroidism (HPT), diagnosed biochemically by the measurement of parathyroid hormone in the context of serum calcium and phosphate levels, has a reported general population prevalence in the order of 0.1%. Its symptoms of musculoskeletal pain, fatigue, mood disorders, and sleep disturbances closely mimic those of FM. Given the commonality of symptoms and possible underdiagnosis of HPT, we have examined the prevalence of HPT in a pilot study of FM patients.
Methods: A retrospective chart review of a convenience sample of FM patients attending a tertiary care multidisciplinary pain center was undertaken to assess parathyroid and calcium status. Consecutive patients attending the clinic between December 2012 and March 2013, had a primary diagnosis of FM as defined by clinical criteria, and had routine biochemistry screening during the preceding year. Routine blood tests included measurements for bone health, vitamin D, parathyroid hormone, calcium and phosphate levels. Hyperparathyroidism was diagnosed by the following biochemical parameters: parathyroid hormone (PTH) level > 9.3 pmol/L (93 pg/mL) with inappropriately non-suppressed calcium (true HPT or normocalcemic HPT), and/or an elevated serum ionized calcium > 1.32 mmol/L (5.3 mg/dL) with inappropriately high PTH levels (normohormonal HPT).
Results: Thirty-eight patients, 35 female, with a mean ± standard deviation of age 51.6 ±10.6 years, and similar disease duration comprised the cohort. Based on their constellation of biochemical indices, 4 patients of the cohort, representing 10.5% of subjects studied, were diagnosed with hyperparathyroidism.
Conclusion: In this small exploratory study, we have identified that unsuspected hyperparathyroidism in diagnosed FM patients has a prevalence of greater than 10%, as compared to 0.1% in the general population, representing a 100-fold difference. As no previous study has examined HPT in FM patients, these preliminary findings call for a more thorough study of parathyroid hormonal status in FM.
Disclosure:
M. Tsoukas,
None;
P. A. Ste-Marie,
None;
Y. Shir,
Purdue Pharma L.P.,
8,
Paladin Labs,
8,
Paladin Labs,
5;
M. A. Fitzcharles,
Purdue Pharma L.P.,
5,
Eli Lilly and Company,
5,
Pfizer Inc,
5,
Valeant,
5;
E. Mitmaker,
None.
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