Date sent:      	Sun, 24 Jun 2001 

Lack of Correlation Between Hepatitis Markers and Fibromyalgia in Danish
Patients

Journal of Musculoskeletal Pain, Vol. 9(1) 2001, pp. 57-65

Irene Hechmann Wittrup, Bente Jensen, Henning Bliddal, Bente
Danneskiold-Samsøe, Allan Wiik

Irene Hechmann Wittrup, MD, is Research Associate, Bente
Jensen, MD, is Research Associate, and Henning Bliddal, DSc, is
Professor, Parker Institute of Research, Department of Rheumatology,
Frederiksberg University Hospital, Copenhagen, Denmark.
Bente Danneskiold-Samsøe, DSc, is Head of the Department of Rheumatology,
Frederiksberg University Hospital, Copenhagen, Denmark.
Allan Wiik, MD, DSc (Med), is Head of the Department of Autoimmunology,
Division of Diagnostics, Statens Seruminstitut, Copenhagen, Denmark.
Address correspondence to: Irene Hechmann Wittrup, Parker Research
Institute, Frederiksberg University Hospital, Nordre Fasanvej 57 DK-2000,
Copenhagen, Denmark.

The help of the group of bioanalysts who assisted in this project is
gratefully acknowledged.

Submitted: February 15, 2000.
Revision accepted: May 12, 2000.

ABSTRACT.
Background: The fibromyalgia syndrome [FMS] is a common disorder of
unknown etiology. Patients with FMS have diffuse muscle pain accompanied
by tenderness at specific points in the muscles and related symptoms from
both the nervous and the immune system. An association between FMS and
infections with hepatitis virus has been suggested, but findings have
been inconclusive.

Objective: To determine whether there might be a notable difference in
liver enzymes and an association between markers of hepatitis B [HBV] and
C virus [HCV] infection and FMS in Denmark.

Methods: The study included 39 patients with FMS, 19 with an acute onset
of FMS and 20 with a slow onset of symptoms. Fibromyalgia syndrome was
diagnosed according to the 1990 American College of Rheumatology
criteria.
Results: All patients showed negative tests for HBV and HCV and had
normal liver enzymes.

Conclusion: No correlation was found between infection with hepatitis B
or C and the prevalence of FMS in Danish patients.


KEYWORDS. Infection, hepatitis B and C virus, fibromyalgia


INTRODUCTION

The clinical syndrome of fibromyalgia [FMS] is characterized by diffuse
musculoskeletal pain, multiple muscular tender points, and often fatigue,
morning stiffness, sleep disturbances, and symptoms from the central and
the autonomous nervous system, and the immune system. The
pathophysiological mechanisms of the disorder are still unknown, but it
has been suggested that its pathophysiology is likely to be
multifactorial (1). Different viral and bacterial infections have been
mentioned as possible triggers of FMS (2), including parvovirus B19 (3),
human immunodeficiency virus (4,5), borrhelic infections (6-8), and
others. However, the findings stated in the literature have been
difficult to reproduce or have been refuted.

Recently an infection with hepatitis C virus [HCV] was connected to FMS
patients from Israel and Spain (9-12). Hepatitis C virus has shown a
tendency to cause chronic infection with active viral replication in as
much as 80% of the patients (11). It has been postulated that chronic
affection of the liver with both hepatitis B virus [HBV] (13-16) and HCV
(17-20) can give prominent symptoms from the locomotor system, that an
inverse relationship in the replicative activity exists between these
viruses, and that super-infection with HCV can exacerbate existing liver
disease for instance infection with HBV (21,22). Likewise several
autoimmune and immunologic conditions may be altered by a viral infection
of the liver (18,23).

The objective of this study was to determine whether there might be a
connection between infection with HBV and HCV and FMS in two well-defined
groups of Danish patients, and to make a comparison between the patients
with acute onset of symptoms and those with a slow onset.


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