USA
From the April issue of The Fibromyalgia Network Newsletter :
"Investigating abnormalities in the immune system of people with fibromyalgia is what Xavier Caro, M.D., a researcher and rheumatologist at Northridge Medical Center in California, has been doing for more than 20 years, Caro and his colleagues Earl Winter, Ph.D., and Armen Dumas, M.D., have noticed a significant subset of FM patients who also have an immune mediated component to their illness.
For example, the blood vessels leak fluid and proteins into the surrounding tissues, which is often considered the first sign of a lesion or injury to the immune system. Cytokines, a group of communicating substances produced by immune cells, are elevated in the blood and skin. And, natural killer cell function, one of the immune system's first lines of defense is reduced.
Many symptoms of FM also appear to be neuropathic or neurological in nature. Numbness or tingling sensations, as well as perceived muscle weakness both point to possible problems with the function of the peripheral nervous system (e.g., the nerves that communicate between the spine and the tissures in the arms, legs, etc).
Caro sought to determine how many FM patients had evidence of immune mediated injury of the peripheral nervous system. In particular, he secreened a series of consecutive patients for the presence of chronic inflammatory demylinating polyneuropathy or CIDP. This condition is caused by immunological factors that lead to impaired function of the peripheral nerves.
To be diagnosed with a CIDP like illness, study subjects had to meet all of the following:
1. Reduced sensation of touch in the lower extremeties (stocking hypaesthesia).
2. Weakness in at least two extremities.
3. Electrodiagnostic abnormalities consistent with a demylinating polyneuropathy diease, such as abnormally slow nerve signal transmission speeds in at least two fo the five nerves tested.
'CIDP is one of the umost underdiagnosed neurological conditions in medicine,' says Caro. Why? It requires a certain amount of expertise and sensitivity on the part of the examning physician . In addition, doctors need to work closely with the person performing the electrodiagnostic tests.
76% of the FM group and 20 % of the rheumatic non-FM group of patients experienced symptoms of numbness and tingling sensations in the extremities. MOre objective sensory testing of the feet revealed a high prevalence of a new physical finding in FM. Stocking hypaesthesia was identified in 88% of the FM group but was not present in any of the rheumatic non FM group.
90% of the FM group versus 13 % of the rheumatic non-FM group experienced muscle weakness. In a strength test of the arms and legs, the FM group showed substantially less muscle strength compared to the rheumatic non-FM group.
Electrodiagnostic abnormalities consistent with CIDP like illnesses occurred in 33% of the FM patients and only 5% of the 52 non-FM, non rheumatic subjects. Noe of the rheumatic non-FM group had abnormal findings on this test.
33% of the FM patients met the criteria for a CIDP like illness. 11 other FM patients who also met the criteria for a CIDP like illness agreed to undergo a nerve biopsy, which confirmed the CIDP diagnosis. 'There was no other good explanation for what we were seeing except CIDP or a CIDP like illness,' says Carol. 'The importance of this observation is that CIDP is thought to be an immune mediated disorder.'
One of the standard texbook treatments for CIDP is intravenous immunoglobulin G (IVIg), which is a biological agent known to benefit people with this condition. Caro took the next logical step and treated 15 of his FM/CIDP patients with IVIg over a five day period to minimize side effects. Patients were evaluated before the treatment and two to four weeks later, The average muscle tenderness was decreased to half the initial values while overall pain was reduced by 35 % and muscle strength in the extremities also significantly improved. Fatigue and stiffness were not apprciably affected, but keep in mind that this was a small trial looking at the one time effect of IVIg therapy
Keep in mind that IVIg is not an accepted therapy for treating FM without the diagnosis of a CIDP component. Also, this therapy carries the risk of many potential side effects, some quite serious. If you are diagnosed with DIDP and IVIg is proposed, you should seek the help of a specialist experience with administering this therapy.
'Fibromyalgia has a substantial number of scientific articles now backing up the involvement of an immune-related component,' says Caro. This does not , of course, preclude a CNS component. Bit, if FM is not an immune-related disorder, then what is it? At the very least the answer to that question wil have to apparently factor in the immune system."
sue in ohio
"Investigating abnormalities in the immune system of people with fibromyalgia is what Xavier Caro, M.D., a researcher and rheumatologist at Northridge Medical Center in California, has been doing for more than 20 years, Caro and his colleagues Earl Winter, Ph.D., and Armen Dumas, M.D., have noticed a significant subset of FM patients who also have an immune mediated component to their illness.
For example, the blood vessels leak fluid and proteins into the surrounding tissues, which is often considered the first sign of a lesion or injury to the immune system. Cytokines, a group of communicating substances produced by immune cells, are elevated in the blood and skin. And, natural killer cell function, one of the immune system's first lines of defense is reduced.
Many symptoms of FM also appear to be neuropathic or neurological in nature. Numbness or tingling sensations, as well as perceived muscle weakness both point to possible problems with the function of the peripheral nervous system (e.g., the nerves that communicate between the spine and the tissures in the arms, legs, etc).
Caro sought to determine how many FM patients had evidence of immune mediated injury of the peripheral nervous system. In particular, he secreened a series of consecutive patients for the presence of chronic inflammatory demylinating polyneuropathy or CIDP. This condition is caused by immunological factors that lead to impaired function of the peripheral nerves.
To be diagnosed with a CIDP like illness, study subjects had to meet all of the following:
1. Reduced sensation of touch in the lower extremeties (stocking hypaesthesia).
2. Weakness in at least two extremities.
3. Electrodiagnostic abnormalities consistent with a demylinating polyneuropathy diease, such as abnormally slow nerve signal transmission speeds in at least two fo the five nerves tested.
'CIDP is one of the umost underdiagnosed neurological conditions in medicine,' says Caro. Why? It requires a certain amount of expertise and sensitivity on the part of the examning physician . In addition, doctors need to work closely with the person performing the electrodiagnostic tests.
76% of the FM group and 20 % of the rheumatic non-FM group of patients experienced symptoms of numbness and tingling sensations in the extremities. MOre objective sensory testing of the feet revealed a high prevalence of a new physical finding in FM. Stocking hypaesthesia was identified in 88% of the FM group but was not present in any of the rheumatic non FM group.
90% of the FM group versus 13 % of the rheumatic non-FM group experienced muscle weakness. In a strength test of the arms and legs, the FM group showed substantially less muscle strength compared to the rheumatic non-FM group.
Electrodiagnostic abnormalities consistent with CIDP like illnesses occurred in 33% of the FM patients and only 5% of the 52 non-FM, non rheumatic subjects. Noe of the rheumatic non-FM group had abnormal findings on this test.
33% of the FM patients met the criteria for a CIDP like illness. 11 other FM patients who also met the criteria for a CIDP like illness agreed to undergo a nerve biopsy, which confirmed the CIDP diagnosis. 'There was no other good explanation for what we were seeing except CIDP or a CIDP like illness,' says Carol. 'The importance of this observation is that CIDP is thought to be an immune mediated disorder.'
One of the standard texbook treatments for CIDP is intravenous immunoglobulin G (IVIg), which is a biological agent known to benefit people with this condition. Caro took the next logical step and treated 15 of his FM/CIDP patients with IVIg over a five day period to minimize side effects. Patients were evaluated before the treatment and two to four weeks later, The average muscle tenderness was decreased to half the initial values while overall pain was reduced by 35 % and muscle strength in the extremities also significantly improved. Fatigue and stiffness were not apprciably affected, but keep in mind that this was a small trial looking at the one time effect of IVIg therapy
Keep in mind that IVIg is not an accepted therapy for treating FM without the diagnosis of a CIDP component. Also, this therapy carries the risk of many potential side effects, some quite serious. If you are diagnosed with DIDP and IVIg is proposed, you should seek the help of a specialist experience with administering this therapy.
'Fibromyalgia has a substantial number of scientific articles now backing up the involvement of an immune-related component,' says Caro. This does not , of course, preclude a CNS component. Bit, if FM is not an immune-related disorder, then what is it? At the very least the answer to that question wil have to apparently factor in the immune system."
sue in ohio
