Are there differences in quality of life, symptomatology and functional capacity among different obesity classes in women with fibromyalgia? The al-Ándalus project

Fibromyalgia: Associations Between Fat Infiltration, Physical Capacity, and Clinical Variables

Background

Obesity is a risk factor for the development of fibromyalgia (FM) and generally most studies report increased Body Mass Index (BMI) in FM. Obesity in FM is associated with a worse clinical presentation. FM patients have low physical conditioning and obesity further exacerbates these aspects. Hitherto studies of FM have focused upon a surrogate for overall measure of fat content, ie, BMI. This study is motivated by that ectopic fat and adipose tissues are rarely investigated in FM including their relationships to physical capacity variables. Moreover, their relationships to clinical variables including are not known. Aims were to 1) compare body composition between FM and healthy controls and 2) investigate if significant associations exist between body composition and physical capacity aspects and important clinical variables.

Methods

FM patients (n = 32) and healthy controls (CON; n = 30) underwent a clinical examination that included pressure pain thresholds and physical tests. They completed a health questionnaire and participated in whole-body magnetic resonance imaging (MRI) to determine body composition aspects.

Results

Abdominal adipose tissues, muscle fat, and BMI were significantly higher in FM, whereas muscle volumes of quadriceps were smaller. Physical capacity variables correlated negatively with body composition variables in FM. Both body composition and physical capacity variables were significant regressors of group belonging; the physical capacity variables alone showed stronger relationships with group membership. A mix of body composition variables and physical capacity variables were significant regressors of pain intensity and impact in FM. Body composition variables were the strongest regressors of blood pressures, which were increased in FM.

Conclusion

Obesity has a negative influence on FM symptomatology and increases the risk for other serious conditions. Hence, obesity, dietary habits, and physical activity should be considered when developing clinical management plans for patients with FM.

Prevalence and Clinical Significance of Metabolic Syndrome in Fibromyalgia Patients

Background and Objective Fibromyalgia syndrome (FMS) is a distressing clinical condition. Metabolic syndrome (MetS) is a biochemical and clinical condition characterised by visceral obesity, dyslipidaemia, hyperglycaemia and hypertension. The relation between the two conditions is rarely discussed. This study aimed to determine the prevalence of MetS in FMS patients and to uncover its association with the clinical severity of FMS.

Patients and Methods This cross-sectional study included 200 patients with newly diagnosed FMS. The diagnosis of FMS was established on the basis of the American College of Rheumatology (ACR) 2016 revised criteria. Patients were assessed using the validated Arabic version of Fibromyalgia Impact Questionnaire (FIQ). FMS severity was categorised according to FIQ scores into mild (≤45), moderate (>46 and≤65), and severe (>65).

Results The study included 200 FMS patients. They comprised 180 females (90.0%) and 20 males (10.0%). Among the studied patients, there were 96 patients (48.0%) who fulfilled the criteria of MetS diagnosis. A comparison between FMS patients with MetS and patients without MetS revealed a significantly higher Widespread Pain Index (WPI) [median (IQR): 12.0 (10.0–17.0) vs. 9.0 (6.0–11.0), p<0.001], a higher Symptoms Severity Scale (SSS) (10.5±1.04 vs. 8.1±1.8, p<0.001) and a higher FIQ (58.8±20.7 vs. 45.4±16.6) in patients with MetS. Patients with MetS had a significantly higher frequency of severe FMS (31.2 vs. 10.6%, p<0.001). Using binary logistic regression analysis, significant predictors of severe FMS included WPI, SSS and MetS in a univariate analysis. However, in a multivariate analysis, only WPI and SSS remained significant.

ConclusionsThis study found that MetS is prevalent in FMS patients and it may be associated with more severe forms of the disease.

Fibromyalgia and obesity: A comprehensive systematic review and meta-analysis

INTRODUCTION

Obesity has been associated with several complications, including musculoskeletal disorders. Aim of the present systematic review was to identify all available evidence on the relationship between fibromyalgia (FM) and obesity, including epidemiological association, impact of obesity on FM severity and effect of weight loss strategies on FM symptoms.

METHODS

MedLine, Cochrane Central Register of Controlled Trials and Web of Science databases were searched up to September 2020 to identify eligible articles. Data from studies reporting the prevalence of obesity in FM patients were pooled using a random-effects model.

RESULTS

After removal of duplicate records, 393 studies proceeded to review. A total of 41 articles were deemed eligible for inclusion in final synthesis. Quality assessment revealed that the overall risk of bias was high. The overall prevalence of obesity in FM was 35.7% (95% CI: 31.8 - 39.9%), with higher figures reported for USA. The majority of studies included demonstrated that obesity is associated with different domains of the disorder, including composite measures of activity, pain severity, tender point count, stiffness, fatigue, physical functioning/disability, sleep, cognitive dysfunction, and quality of life; the strength of correlation was weak on average. Inconsistent data were available regarding the correlation with depression and anxiety. Only few studies addressed the effect of therapeutic weight loss in FM, either by bariatric surgery, diet/exercise combination or behavioral weight loss, providing preliminary evidence for a potential benefit of weight loss in ameliorating FM symptoms.

CONCLUSIONS

Available data support a potential interplay between obesity and FM-related symptoms. Weight management should be encouraged in patients with FM.

The association between body mass index and fibromyalgia severity: data from a cross-sectional survey of 2339 patients

Objective

Various studies have shown that overweight and obesity are central features of FM, but the real impact of a high BMI on clinical severity in patients with FM is still controversial. The aim of this study was to analyse the relationships between BMI categories and measures of symptom severity and functional impairment using data from a Web-based registry of patients with FM.

Methods

Adult patients with an ACR 2010/2011 diagnosis of FM underwent a complete physical examination and laboratory tests and were asked to complete a package of questionnaires covering their sociodemographic and treatment details, in addition to the following disease-specific questionnaires: the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromyalgia Assessment Status questionnaire (ModFAS) and the Polysymptomatic Distress Scale (PDS).

Results

A total of 2339 patients were recruited and divided into two weight categories, underweight/normal (U/N, n = 1127, 48.2%) and overweight/obese (O/O, n = 1212, 51.8%). The total and subscales of FIQR, ModFAS and PSD scores were significantly higher in the O/O patients, as were all the mean scores of the individual FIQR items (P < 0.001 for all).

Conclusion

Our findings demonstrate that O/O patients with FM are significantly more impaired than U/N patients in all the symptomatological and functional domains as measured using the FIQR, ModFAS and PDS, thus suggesting that being O/O has an additional effect on symptoms and function.

Alteration of Postural Balance in Patients with Fibromyalgia Syndrome-A Systematic Review and Meta-Analysis

Balance problems are one of the most frequent symptoms in patients with Fibromyalgia Syndrome (FMS). However, the extent and nature of this balance disorder are not known. The objective of this work was to determine the best evidence for the alteration of postural balance in patients with FMS and analyze differences with healthy controls. To meet this objective, a systematic review with meta-analysis was performed. A bibliographical search was carried out in PubMed Medline, Scopus, Web of Science, CINAHL and SciELO. Observational studies that assessed postural balance in patients with FMS compared to healthy subjects in baseline conditions, were selected. In a random-effect model, the pooled effect was calculated with the Standardized Mean Difference (SMD) and its 95% confidence interval (CI). Nineteen studies reporting data of 2347 participants (95% female) were included. FMS patients showed poor balance with a large effect on static (SMD = 1.578; 95% CI = 1.164, 1.992), dynamic (SMD = 0.946; 95% CI = 0.598, 1.294), functional balance (SMD = 1.138; 95% CI = 0.689, 1.588) and on balance confidence (SMD = 1.194; 95% CI = 0.914, 1.473). Analysis of the Sensory Organization Test showed large alteration of vestibular (SMD = 1.631; 95% CI = 0.467, 2.795) and visual scores (SMD = 1.317; 95% CI = 0.153, 2.481) compared to healthy controls. Patients with FMS showed worse scores for different measures of postural balance compared to healthy controls. Concretely, FMS patients appear to have poor vestibular and visual scores with a possible somatosensory dependence.

Lower Fatigue in Fit and Positive Women with Fibromyalgia: The al-Ándalus Project

OBJECTIVE

To analyze 1) the independent association of physical fitness, positive affect, and negative affect with the different dimensions of fatigue (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue) and 2) whether the interactions of physical fitness, positive affect, and negative affect were associated with fatigue over and above the independent association.

DESIGN

Cross-sectional study in 420 women with fibromyalgia.

SETTING

Fibromyalgia associations from southern Spain.

METHODS

Physical fitness was measured by performance-based tests, and questionnaires were used to measure positive affect, negative affect, and different dimensions of fatigue (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue). Age, body mass index, and current pain level were included as potential confounders in all analyses.

RESULTS

Physical fitness was independently associated with general fatigue, physical fatigue, and reduced activity (all P ≤ 0.02). Positive affect was independently associated with all fatigue dimensions (all P < 0.001). Negative affect was independently associated with general fatigue, physical fatigue, reduced motivation, and mental fatigue (all P ≤ 0.04). The interaction of overall physical fitness and positive affect was related to general fatigue and physical fatigue (all P ≤ 0.02). Women with fibromyalgia with higher levels of overall physical fitness and positive affect showed the lowest general fatigue and physical fatigue.

CONCLUSIONS

In women with fibromyalgia, positive affect was independently and consistently associated with all dimensions of fatigue. The combination of higher levels of overall physical fitness and positive affect might serve as a buffer against general and physical fatigue in women with fibromyalgia.

Functional Status and Body Mass Index in Postmenopausal Women with Fibromyalgia: A Case-control Study

Reduced functional capacity is a common characteristic of fibromyalgia (FMS). We aimed to investigate the relationship between functional status and body mass index (BMI) in a population with and without FMS. A pilot case–control study was performed in 34 women with FMS and 22 healthy controls which were classified according to their BMI. The main outcome measures were: Balance (MiniBestest, One Leg Stance Test), functional mobility (Timed up and Go), physical disability (Health Assessment Questionnaire Disability Index), spinal range of motion (Spinal Mouse), level of physical activity at work (Leisure Time Physical Activity Instrument), and home and leisure time (Physical Activity at Home and Work). Statistical differences were observed between overweight/obese healthy controls and women with FMS for several indicators of functional capacity. FMS patients reported worse dynamic (p = 0.001) and static balance (right: p = 0.002, left: p = 0.001), poorer functional mobility (p = 0.008), and higher levels of physical disability (p = 0.001). Functional status is altered in FMS women compared to the healthy control group, independently of nutritional status; therefore, BMI is unlikely to play a main role in functional capacity indicators in postmenopausal FMS women. Only dynamic balance seems to reduce the obesity status in this population.

Sedentary Time, Physical Activity, and Sleep Duration: Associations with Body Composition in Fibromyalgia. The Al-Andalus Project

To explore the individual–independent relationships of sedentary time (ST) and physical activity (PA) (light and moderate-to-vigorous intensity (MVPA)), with sleep duration and body composition (waist circumference, body mass index (BMI), body fat percentage, and muscle mass index) in women with fibromyalgia, and to determine whether these associations are independent of physical fitness. This cross-sectional study involved 385 women with fibromyalgia. ST and PA were assessed by triaxial accelerometry, sleep duration was self-reported. Waist circumference was measured using an anthropometric tape, and body weight, body fat percentage, and muscle mass were estimated using a bio-impedance analyzer. In individual regression models, ST and sleep were directly associated with waist circumference, BMI, and body fat percentage (β between 0.10 and 0.25; all p < 0.05). Light PA and MVPA were inversely associated with waist circumference, BMI, and body fat percentage (β between −0.23 and −0.12; all p < 0.05). In multiple linear regression models, ST (β between 0.17 and 0.23), light PA (β between −0.16 and −0.21), and sleep duration (β between 0.11 and 0.14) were independently associated with waist circumference, BMI, and body fat percentage (all p < 0.05). MVPA was associated with waist circumference independent of light physical activity (LPA) and sleep duration (β = −0.11; p < 0.05). Except for MVPA, these associations were independent of physical fitness. These results suggest that longer ST and sleep duration, and lower PA levels (especially light intensity PA), are independently associated with greater adiposity, but not muscle mass, in women with fibromyalgia. These associations are, overall, independent of physical fitness.

Features of mood associated with high body weight in females with fibromyalgia

BACKGROUND

Fibromyalgia (FM) is a common syndrome whose main characteristic is chronic widespread musculoskeletal pain, the severity of which is frequently worsened by concomitant obesity. Major depression (MD), particularly as part of a bipolar spectrum disorder (BSD), is associated with both obesity and FM.

OBJECTIVE

To evaluate the relationship between lifetime MD, hypomanic symptoms and the body mass index (BMI) in patients with FM.

METHOD

Of the 115 patients originally screened, 87 women with FM finally entered the study. Forty-nine patients (57%) had a lifetime diagnosis of MD, assessed by a structured clinical interview based on DSM-IV criteria, and four of them (4.6%) had a current MD episode. Lifetime hypomanic symptoms were measured by means of the self-rated Hypomania Checklist. According to the international criteria for BMI, FM patients were classified as under/normal-weight (61%), overweight (30%) and obese (9%).

RESULTS

62 patients (71.2%) with FM had a bipolar spectrum disorder (BSD). Thirty (48.3%) of them met criteria for bipolar II disorder, 32 (51,6%) for bipolar disorder NOS (18 FM patients with MD associated to sub-syndromal hypomanic syndrome and 14 with hypomanic syndrome without MD). No patient had a bipolar I disorder. Only one patient met the criteria for a major depressive disorder (MDD). There was no significant difference in mean BMI between the patients with and without a lifetime diagnosis of MD, but there was a positive association between the level of hypomanic symptoms and BMI values (p<0.009). When hypomania was considered categorically as hypomanic syndrome there was no significant effect on BMI.

CONCLUSIONS

Our finding adds to previous evidence indicating that hypomanic symptoms are a central feature of FM. In the case of the early identification of high-level hypomanic symptoms, body weight should be closely monitored in order to prevent obesity and its detrimental impact on females with FM.

Biodanza Reduces Acute Pain Severity in Women with Fibromyalgia

Biodanza is a useful therapy for the fibromyalgia management; however, there is no evidence of its effectiveness on acute pain. The objectives of the present study were: to determine the changes of a 3-month Biodanza program on acute pain severity (before vs. after session) and cumulative pain severity in women with fibromyalgia; and to check the associations of acute pain severity reduction with presession pain severity, body fat percentage, and satisfaction with the session. This was a 3-month low-moderate intensity (rate of perceived exertion around 12, based on a 6-20 point scale) Biodanza intervention study (1 session/week). Twenty-seven women with fibromyalgia (54.2 ± 6.2 years) participated. Pain severity was assessed before and after each single session with a visual analog scale. There were immediate changes in all sessions (p = .001-.028), except in the first, second, and fourth sessions. An overall 16% decrease of acute pain severity before and after each session was noted (mean presession pain vs. postsession pain, 5.8 ± 2.1 vs. 4.9 ± 2.4; respectively). There was an independent association of pain severity reduction (presession-postsession) with presession pain severity (unstandardized coefficient B = .21 ± .05; standardized coefficient β = .25; p < .001), body fat percentage (B = -.05 ± .02; β = -.18; p = .003), and satisfaction with the session (B = .40 ± .15; β = .16; p = .007). There was a significant cumulative effect decrease in postsession pain severity (p < .001; 95% confidence interval [CI] = -.14, -.05) and presession-postsession pain severity (p = .007; 95% CI = .02, .12) along the 3-month intervention. No significant cumulative effect in presession pain severity was identified (p > .05). In conclusion, Biodanza is an alternative therapy that reduced acute pain severity in women with fibromyalgia. The intervention also yielded cumulative pain severity reduction, which were higher in those women with fibromyalgia presenting higher presession pain severity and lower body fat percentage. The satisfaction with the session was also a key factor positively associated with pain reduction.

Physical fitness reference standards in fibromyalgia: The al-Ándalus project

We aimed (1) to report age-specific physical fitness levels in people with fibromyalgia of a representative sample from Andalusia; and (2) to compare the fitness levels of people with fibromyalgia with non-fibromyalgia controls. This cross-sectional study included 468 (21 men) patients with fibromyalgia and 360 (55 men) controls. The fibromyalgia sample was geographically representative from southern Spain. Physical fitness was assessed with the Senior Fitness Test battery plus the handgrip test. We applied the Generalized Additive Model for Location, Scale and Shape to calculate percentile curves for women and fitted mean curves using a linear regression for men. Our results show that people with fibromyalgia reached worse performance in all fitness tests than controls (P < 0.001) in all age ranges (P < 0.001). This study provides a comprehensive description of age-specific physical fitness levels among patients with fibromyalgia and controls in a large sample of patients with fibromyalgia from southern of Spain. Physical fitness levels of people with fibromyalgia from Andalusia are very low in comparison with age-matched healthy controls. This information could be useful to correctly interpret physical fitness assessments and helping health care providers to identify individuals at risk for losing physical independence.

Independent and joint associations of physical activity and fitness with fibromyalgia symptoms and severity: The al-Ándalus project

We examined independent and joint associations of objectively measured physical activity (PA) and physical fitness (PF) with pain, fatigue and the overall impact of fibromyalgia in 386 fibromyalgia women aged 51.2 ± 7.6 years. Levels of PA (light, moderate and vigorous) and PF were measured with triaxial accelerometry and the Senior Fitness Test, respectively. We used the Short-Form health survey-36 pain sub-scale and the Multidimensional Fatigue Inventory to assess pain and multiple dimensions of fatigue, respectively. The impact of fibromyalgia was studied with the Revised Fibromyalgia Impact Questionnaire (FIQR). Both, total PA and global PF were independently associated with pain pressure threshold, SF-36 pain, reduced activity, reduced motivation and FIQR total score (all, P ≤ 0.027). The associations between total PA and symptoms were weaker than those observed between global PF and symptoms. Overall, unfit patients with low PA showed a worse profile that fit patients with high PA (all, P ≤ 0.001). In summary, PA and PF are independently associated with pain, fatigue and the overall impact of fibromyalgia in women. Although PF presented greater associations with symptoms, the results suggest that both being physically active and keep adequate fitness levels might be convenient for fibromyalgia women.

The association of total and central body fat with pain, fatigue and the impact of fibromyalgia in women; role of physical fitness

BACKGROUND

The relationship between estimates of total and central body fat with fibromyalgia pain, fatigue and overall impact has not been fully described. We aimed to assess the individual and combined association of body fat (total and central) with pain, fatigue and the overall impact in fibromyalgia women; and to study the possible mediation role of physical fitness in these associations.

METHODS

A total of 486 fibromyalgia women with a mean (standard deviation) age of 52.2 (8.0) years participated. Pain was measured with self-reported measures and algometry, whereas fatigue with the Multidimensional Fatigue Inventory. The impact of fibromyalgia was measured with the Revised Fibromyalgia Impact Questionnaire (FIQR) total score. Total and central body fat were assessed by means of bioelectrical impedance and waist circumference, respectively. The Functional Senior Fitness Test battery and the handgrip strength test were used to assess physical fitness.

RESULTS

Total and central body fat were positively associated with pain- and fatigue-related measures and the FIQR total score (β from 0.10 to 0.25; all, p < 0.05). A combined effect of total and central body fat was observed on pain (FIQR and 36-item Short-Form Health Survey), general and physical-related fatigue and FIQR total score (all, overall p < 0.05), so that the group with no total and central obesity had more favourable results than those with total and central obesity. Cardiorespiratory fitness partially mediated (between 22-40% of the total effect) the associations between total and central body fat with pain, general fatigue, physical fatigue and reduced activity, and largely mediated (80%) the association of central body fat with the FIQR total score.

CONCLUSIONS

Physical fitness might potentially explain the association between obesity and fibromyalgia symptoms.

Electronic medical record data to identify variables associated with a fibromyalgia diagnosis: importance of health care resource utilization

BACKGROUND

Diagnosis of fibromyalgia (FM) is often challenging. Identifying factors associated with an FM diagnosis may guide health care providers in implementing appropriate diagnostic and management strategies.

METHODS

This retrospective study used the de-identified Humedica electronic medical record (EMR) database to identify variables associated with an FM diagnosis. Cases (n=4,296) were subjects ≥18 years old with ≥2 International Classification of Diseases, Ninth Revision (ICD-9) codes for FM (729.1) ≥30 days apart during 2012, associated with an integrated delivery network, with ≥1 encounter with a health care provider in 2011 and 2012. Controls without FM (no-FM; n=583,665) did not have the ICD-9 codes for FM. Demographic, clinical, and health care resource utilization variables were extracted from structured EMR data. Univariate analysis identified variables showing significant differences between the cohorts based on odds ratios (ORs).

RESULTS

Consistent with FM epidemiology, FM subjects were predominantly female (78.7% vs 64.5%; P<0.0001) and slightly older (mean age 53.3 vs 52.7 years; P=0.0318). Relative to the no-FM cohort, the FM cohort was characterized by a higher prevalence of nearly all evaluated comorbidities; the ORs suggested a higher likelihood of an FM diagnosis (P<0.0001), especially for musculoskeletal and neuropathic pain conditions (OR 3.1 for each condition). Variables potentially associated with an FM diagnosis included higher levels of use of specific health care resources including emergency-room visits, outpatient visits, hospitalizations, and medications. Units used per subject for emergency-room visits, outpatient visits, hospitalizations, and medications were also significantly higher in the FM cohort (P<0.0001), confirming resource utilization as an important variable associated with an FM diagnosis.

CONCLUSION

Significant differences between the FM and no-FM cohorts were observed for nearly all the demographic, clinical, and health care resource variables, suggesting an association with FM diagnosis. These results also support use of EMR data for identifying variables associated with FM, which may help in the diagnosis and management of this condition.