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A subset of fibromyalgia patients have findings
suggestive of chronic inflammatory demyelinating polyneuropathy and
appear to respond to IVIg.
Rheumatology (Oxford). 2008 Feb;47(2):208-11.
Caro XJ, Winter EF, Dumas AJ.
Division of Rheumatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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OBJECTIVES:
The aetiopathogenesis of the fibromyalgia syndrome (FMS) remains
unknown. Recent reports, however, suggest that a subgroup of FMS
subjects has an immune-mediated disease. Therefore, our primary
objective was to study FMS subjects for evidence of an immune-mediated
demyelinating polyneuropathy. Our secondary objective was to determine
the effects of treating these FMS subjects with the immune modulator,
intravenous immunoglobulin (IVIg).
METHODS: Fifty-eight FMS subjects,
26 rheumatic non-FMS subjects and 52 non-rheumatic non-FMS subjects
were studied. Subjective measures of paraesthesias, weakness, stocking
hypaesthesia, pain, fatigue and stiffness were made. Objective measures
of tenderness, proximal muscle strength and electrodiagnostic (EDX)
evidence of polyneuropathy and demyelination were also made. Eleven
other FMS subjects underwent sural nerve biopsy. RESULTS:
Paraesthesias, subjective weakness and stocking hypaesthesia were more
common in FMS than in rheumatic non-FMS (P < or = 0.0001). Proximal
muscle strength was less in FMS than in rheumatic non-FMS (P < or =
0.0001). EDX demonstrated a distal demyelinating polyneuropathy,
suggestive of chronic inflammatory demyelinating polyneuropathy (CIDP),
in 33% of FMS subjects. No rheumatic non-FMS subject had polyneuropathy
(P = 0.005), or demyelination (P = 0.05). Fifteen FMS/CIDP subjects
were subsequently treated with IVIg (400 mg/kg each day for 5 days).
Pain (P = 0.01), tenderness (P = 0.001) and strength (P = 0.04)
improved significantly. Fatigue and stiffness trended towards
improvement. CONCLUSIONS: A significant subset of FMS subjects have
clinical and EDX findings suggestive of CIDP. IVIg treatment shows
promise in treating this subset. These observations have implications
for better understanding and treating some FMS patients.
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