Immune System May Play Role In Fibromyalgia

Researchers have found evidence suggesting the involvement of the immune system in fibromyalgia.

Three molecules that affect the immune system may be associated with the risk of fibromyalgia, according to this research.

These three molecules are called CCL11, CCL4 and MEFV. They are created by inherited mutations in genes.

The study is called “SNPs in inflammatory genes CCL11, CCL4 and MEFV in a fibromyalgia family study.”

SNPs (Single Nucleotide Polymorphisms) are variations in the genetic sequence and are associated with disease. When SNPs occur within a gene or in a regulatory region near a gene, they may play a more direct role in disease by affecting the function of the gene.

The study was approved by the Institutional Review Board of City of Hope National Medical Center, City of Hope, Duarte, CA, United States of America.

Some earlier studies have suggested that there is a genetic component to Fibromyalgia and this study has built on that.

Participants

A total of 220 patients with fibromyalgia and their parents were recruited into the study.

Patients were diagnosed using American College of Rheumatology criteria including musculoskeletal pain that exists for over three months, associated with fatigue, depression, cognitive difficulty and irritable bowel. Patients with rheumatoid arthritis and systemic lupus erythematosus were excluded from the study.

Fibromyalgia (FM) is a chronic pain syndrome with a high incidence in females that may involve activation of the immune system. We performed exome sequencing on chemokine genes in a region of chromosome 17 identified in a genome-wide family association study.

This sequencing on the genes was done on DNA from blood immune cells. Scientists analyzed the four SNPs from parents to fibromyalgia patients, and found only one of them in the CCL11 gene, was associated with a risk of the disease. After further analysis they noted that the levels of CCL11 protein were statistically higher in most of fibromyalgia patients.

“While the elevated expression of CCL11 is a common event, the inability to generate a robust CCL11 response predisposes up to 36% of patients with a higher likelihood of FM."

Conclusions

“This study provides evidence that rs1129844 in CCL11 may be a useful marker for FM and that the high frequency of this SNP in FM patients (36.8%) argues for an underlying immune connection.”

SNPs with significant TDTs were found in 36% of the cohort for CCL11 and 12% for MEFV, along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM.

Discussion

In summary, we present evidence at both the genetic and functional level that the immune system may be involved in FM in roughly half of a cohort of 220 FM patients for which SNPs in CCL11 and MEFV gave significant TDTs. Considering that activation of the immune system is often associated with neurological systems such as pain, the involvement of the immune system in FM does not rule out the prevailing hypothesis that FM is predominantly a pain syndrome. With this in mind, further studies on larger number of patients may help to validate the link between pain and the immune system in FM.

What causes fibromyalgia

What do we know about the causes of fibromyalgia?

Fibromyalgia is a chronic pain condition that causes pain throughout the whole body. It involves fatigue, memory and concentration problems, sleep issues, and other symptoms.

There has been an increase, in recent years, in research on the causes of fibromyalgia. It is thought that a combination of different factors play a role in its development.

Doing this research must be difficult. One reason for this would be that a lot of people who have fibromyalgia also have other medical conditions such as thyroid conditions, lupus, other pain disorders or depression. So it would not be easy to decide which symptoms are caused by fibromyalgia or one of the other conditions. 

Fibromyalgia is thought to be caused by changes in the way that pain messages are processed in the brain. Researchers think this is set off  by a combination of genetic factors and physical or emotional stress.

Stress

Many people feel that their fibromyalgia symptoms developed after a physically or emotionally stressful event.  Others feel it was not one specific distressing or traumatic event but long term exposure to stress for many years. 

Genetics

A fibromyalgia gene has not yet been discovered but fibromyalgia does certainly run in some families. Through research certain types of genes have been found to be more common in people who have fibromyalgia than in control groups. These genes play a role in the nervous system's response to pain. Some of the same genes are associated with depression and anxiety, which may be the reason why certain antidepressant medications help reduce fibromyalgia symptoms.

Pain processing

Many experts agree that fibromyalgia is the result of an abnormality in the central nervous system that increases sensitivity to pain. 

"Most researchers accept that fibromyalgia is caused by increased sensitivity within the pain-related nervous system. The majority of clinicians — myself included — believe that the condition is “top-down” in that it is driven by a change in the modulating factors of the brain." Dr G. Littlejohn

Sleep problems

This is a bit of a case of which came first the chicken or the egg because researchers aren’t sure if this is a symptom or a cause of fibromyalgia. Problems getting to sleep and getting into the deepest stages of sleep are common in Fibromyalgia. 

"Some people who have disorders affecting sleep, such as sleep apnea and restless leg syndrome (RLS), are more likely to have the condition." Healthline

People with Fibromyalgia live in the hope that research, into the cause of this condition will enable them to treat it properly and prevent others from getting it.

You may also be interested in my other articles on The causes of Fibromyalgia  or

criteria for diagnosing fibromyalgia

Association between endometriosis, fibromyalgia and autoimmune diseases

Women with both endometriosis and fibromyalgia have a higher risk of having autoimmune diseases, anxiety, or depression as well as more hospitalizations, a study reports.

Evidence for an association between endometriosis, fibromyalgia and autoimmune diseases, was published in the American Journal of Reproductive Immunology in January 2019.

Fibromyalgia is a disorder characterized by widespread musculoskeletal chronic pain and many symptoms including painful menstrual cycles.

Endometriosis is a painful condition that affects a woman's reproductive organs.

Autoimmune disease occurs when the immune system attacks healthy organs and tissues within the body. There are over 80 autoimmune diseases. 

AIM

The aim of this study was to investigate the prevalence of and the association between endometriosis, fibromyalgia and autoimmune disease (AID) in a large population.

METHODS

To investigate the prevalence of and the association among endometriosis, fibromyalgia, and autoimmune diseases, a group of researchers did a retrospective analysis of data from the Maccabi Healthcare Services (MHS), a large healthcare plan in Israel.

The analysis included women diagnosed with endometriosis and/or fibromyalgia and a control group of women without either of the conditions.

In total, 781,571 adult women were considered eligible for the study, of whom 6,647 had endometriosis and 25,425 had fibromyalgia. Existence of both conditions was detected in 401 of the cases.

RESULTS

Women with both fibromyalgia and endometriosis had:

• a high prevalence rate of AID compared to women with no diagnosis of endometriosis/fibromyalgia 
• an increased healthcare resource utilization (HCRU)
• an increased history of depression or anxiety
• inflammatory bowel disease (IBD) in 6.2% 
• other autoimmune diseases including systemic lupus erythematosus and Sjögren syndrome.

Interestingly many of the women with both conditions were diagnosed with fibromyalgia before endometriosis. 

The existence of fibromyalgia was significantly higher in women with endometriosis than in the control group.

Women with both conditions had a higher rate of hospitalizations, than the control group, highlighting the negative impact of these disorders on quality of life.

This study shows that the existence of autoimmune diseases is higher in women with endometriosis and fibromyalgia. These findings support the hypothesis that both endometriosis and fibromyalgia have an autoimmune component.

Hopefully these results contribute to developing a more thorough approach to managing the complex needs of these women.

Diagnosing either or both conditions should raise the possibility of the existence of autoimmune diseases. 

CONCLUSION

Co‐occurrence of endometriosis and fibromyalgia is associated with a high burden of autoimmune disease, anxiety/depression, and HCRU.