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Semin Arthritis Rheum. 2019 Apr;48(5):933-940. doi: 10.1016/j.semarthrit.2018.08.003. Epub 2018 Aug 23.

A systematic review and meta-analysis of the prevalence of small fiber pathology in fibromyalgia: Implications for a new paradigm in fibromyalgia etiopathogenesis.

Author information

1
Department of Eye & Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK.
2
Department of Eye & Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK; Department of Biostatistics, University of Liverpool, Liverpool, UK.
3
The Walton Centre NHS Foundation Trust, Liverpool, UK.
4
The Pain Research Institute, University of Liverpool and The Walton Centre NHS Foundation Trust, Liverpool, UK.
5
Department of Neurology, University of Würzburg, Würzburg, Germany.
6
Weill Cornell Medicine-Qatar, Doha, Qatar.
7
Department of Eye & Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK; Diabetes & Endocrinology Research & Pain Research Institute, Department of Eye & Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK; Department of Diabetes and Endocrinology, Royal Liverpool and Broadgreen University NHS Hospital Trust, Liverpool, UK; Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, UK. Electronic address: uazman.alam@liverpool.ac.uk.

Abstract

OBJECTIVES:

Fibromyalgia is a condition which exhibits chronic widespread pain with neuropathic pain features and has a major impact on health-related quality of life. The pathophysiology remains unclear, however, there is increasing evidence for involvement of the peripheral nervous system with a high prevalence of small fiber pathology (SFP). The aim of this systematic literature review is to establish the prevalence of SFP in fibromyalgia.

METHODS:

An electronic literature search was performed using MEDLINE, EMBASE, PubMed, Web of Science, CINAHL and the Cochrane Library databases. Published full-text, English language articles that provide SFP prevalence data in studies of fibromyalgia of patients over 18years old were included. All articles were screened by two independent reviewers using a priori criteria. Methodological quality and risk of bias were evaluated using the critical appraisal tool by Munn et al. Overall and subgroup pooled prevalence were calculated by random-effects meta-analysis with 95% CI.

RESULTS:

Database searches found 935 studies; 45 articles were screened of which 8 full text articles satisfied the inclusion criteria, providing data from 222 participants. The meta-analysis demonstrated the pooled prevalence of SFP in fibromyalgia is 49% (95% CI: 38-60%) with a moderate degree of heterogeneity, (I2= 68%). The prevalence estimate attained by a skin biopsy was 45% (95% CI: 32-59%, I2= 70%) and for corneal confocal microscopy it was 59% (95% CI: 40-78%, I2= 51%).

CONCLUSION:

There is a high prevalence of SFP in fibromyalgia. This study provides compelling evidence of a distinct phenotype involving SFP in fibromyalgia. Identifying SFP will aid in determining its relationship to pain and potentially facilitate the development of future interventions and pharmacotherapy.

KEYWORDS:

Corneal confocal microscopy; Fibromyalgia; Pain; Skin biopsy; Small nerve fibres

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