NEW YORK (Reuters Health) Sep 18 - Neurologic signs are common in fibromyalgia patients and support the possibility that their symptoms have a neuroanatomical cause, according to an article in the September issue of Arthritis and Rheumatism.
Dr. Nathaniel F. Watson, of the University of Washington Medicine Sleep Institute at Harborview, Seattle, and colleagues assessed the type and frequency of neurologic signs and symptoms in166 patients with fibromyalgia and 66 pain-free controls, all of whom were examined by a neurologist unaware of disease status. Participants also completed a standard questionnaire on neurologic symptoms.
In 27 of 29 neurological categories tested, significantly more neurologic symptoms were observed in the fibromyalgia group than in the control group. The greatest differences were found for photophobia (70% versus 6%; p<0.01), poor balance (63% versus 4%; p<0.01), and weakness (58% versus 2%; p<0.01) and tingling (54% versus 4%; p<0.01) in the arms or legs.
In addition, those with fibromyalgia had greater dysfunction than controls in cranial nerves IX and X (42% versus 8%; p<0.01), and more sensory findings (65% versus 25%; p<0.01), motor abnormalities (33% versus 3%; p<0.01), and gait problems (28% versus 7%; p<0.01).
Within the fibromyalgia group, there were significant correlations between several signs and symptoms. For example, numbness in any part of the body (p=0.03) or tingling in the arms or legs (p= 0.05) were correlated with appropriate neurologic examination findings. Poor balance (p=0.01), poor coordination (p=0.01) and weakness in the arms or legs (p=0.03) were also correlated with objective findings.
"This observation underscores the need to perform careful neurological examinations in all fibromyalgia patients, particularly those with neurological complaints," Dr. Watson told Reuters Health.
"These findings suggest that in some fibromyalgia patients it may be beneficial to evaluate them for a possible neuroanatomical cause for their fibromyalgia, if their neurological examination findings are positive," he added. But, he pointed out, as of now "no study has reported the results of neurological examinations, radiological, and neuroimaging data that would permit recommendations to be made regarding which patients should be evaluated for neuroanatomical conditions."
Dr. Watson cautioned that this study does not confirm a neuroanatomical basis for fibromyalgia and that much more work is necessary before this can be known with certainty.
"Carefully performed neuroradiological studies are necessary, and these studies have not been done," Dr. Watson said. "The current study suggests that performing these future studies will be helpful to our understanding of this disease."
Arthritis Rheum 2009;60:2839-2844.